Document Type : Letter to Editor


Emergency Medicine Department, Sultan Qaboos University Hospital, Muscat, Oman


Interleukin-6 is pro-inflammatory cytokine which plays a role in cytokine storm and brought into notice with corona virus disease of 2019. Lymphopenia and dysregulated immune response were seen in the critically ill patients of corona virus disease of 2019. IL-6 inhibitors were proposed as a treatment option in this pandemic with a concept that it will reduce inflammation, infection and organ failure. Tocilizumab, a monoclonal antibody against soluble and membrane IL‐6 receptors was considered as forefront treatment option as it was used previously in rheumatologic disorder as a licensed agent. Tocilizumab is an immunosuppressive agent and serious or fatal infections could occur. Presence of superimposed bacterial infections in critically ill patients with corona virus disease of 2019 should be aggressively treated. However clinical experiences showed higher rates of superimposed bacterial infections which renders for extreme caution while prescribing such therapies. Perspective is needed when using the rheumatologic literature of IL-6 into corona virus disease of 2019 and their range observed in these conditions.


Main Subjects

1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395(10223): 497-506. doi:10.1016/s0140-6736(20)30183-5.
2. Zhang C, Wu Z, Li JW, Zhao H, Wang GQ. Cytokine release syndrome in severe COVID-19: interleukin-6 receptor antagonist tocilizumab may be the key to reduce mortality.Int J Antimicrob Agents 2020; 55(5): 105954. doi: 10.1016/j.ijantimicag.2020.105954.
3. Zumla A, Hui DS, Azhar EI, Memish ZA, Maeurer M. Reducing mortality from 2019-nCoV: host-directed
therapies should be an option. Lancet 2020; 395(10224):e35-e6. doi: 10.1016/s0140-6736(20)30305-6.
4. Zhou Y, Fu B, Zheng X, Wang D, Zhao C, Qi Y, et al. Pathogenic T cells and inflammatory monocytes incite inflammatory storm in severe COVID-19 patients. Natl Sci Rev 2020; 7(6): 998-1002. doi:10.1093/nsr/nwaa041
5. Gong J, Dong H, Xia Q, Huang Z, Wang D, Zhao Y, et al. Correlation analysis between disease severity
and inflammation-related parameters in patients with COVID-19 pneumonia. medRxiv 2020. doi:
6. Rahmati M, Moosavi MA. Cytokine-targeted therapy in severely ill COVID-19 patients: options and cautions. Eurasian J Med Oncol 2020; 4(2): 179-81. doi: 10.14744/ejmo.2020.72142.