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  • Correspondence on ‘Historically controlled comparison of glucocorticoids with or without tocilizumab versus supportive care only in patients with COVID-19-associated cytokine storm syndrome: results of the CHIC study’

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Correspondence
Correspondence on ‘Historically controlled comparison of glucocorticoids with or without tocilizumab versus supportive care only in patients with COVID-19-associated cytokine storm syndrome: results of the CHIC study’
  1. Maria De Santis1,
  2. Antonio Voza2,
  3. Victor Savevski3,
  4. Salvatore Badalamenti4,
  5. Maurizio Cecconi5,6,
  6. Alberto Mantovani6,7,8,
  7. Carlo Selmi1,6
  1. 1 Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Rozzano, Lombardia, Italy
  2. 2 Emergency Department, IRCCS Humanitas Research Hospital, Rozzano, Lombardia, Italy
  3. 3 Artificial Intelligence Research, IRCCS Humanitas Research Hospital, Rozzano, Lombardia, Italy
  4. 4 Nephrology, IRCCS Humanitas Research Hospital, Rozzano, Lombardia, Italy
  5. 5 Anesthesiology and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
  6. 6 Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
  7. 7 Department of Immunology and Inflammation, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
  8. 8 The William Harvey Research Institute, Queen Mary University of London, London, UK
  1. Correspondence to Professor Carlo Selmi, Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele, Milan, Italy; carlo.selmi{at}hunimed.eu

https://doi.org/10.1136/annrheumdis-2021-220044

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    As pointed out by Ramiro et al in the September issue of the Annals,1 trials and observational studies investigated numerous drugs against SARS-Cov2 and glucocorticoids proved effective in reducing the mortality among hospitalised patients with COVID-19 requiring respiratory support.2 3 At first, based on the negative data in SARS and other viral infections,4 the WHO advised against glucocorticoids in COVID-19.5 However, up to 20% of patients with COVID-19 develop a hyperinflammatory status resembling a cytokine release syndrome with a severe respiratory deterioration and a higher mortality,6 thus possibly benefiting from glucocorticoids and anti-interleukin biologics.7 The CHIC trial showed that a course of high-dose methylprednisolone, followed by Interleukins (IL)-6 receptor antagonist, accelerated respiratory recovery, lowered hospital mortality and reduced the likelihood of invasive mechanical ventilation in COVID-19-associated cytokine storm syndrome defined by C reactive protein >100 mg/L, serum ferritin >900 µg/L on one occasion or a twofold increase within 48 hours, and D-dimer level >1500 µg/L.1 The RECOVERY trial, whose results were released in June 2020, showed that glucocorticoids were effective in reducing the …

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    Footnotes

    • MDS and AV contributed equally.

    • Contributors MDS and AV analysed and interpreted data and wrote the manuscript. VS analysed and interpreted data. AM CS SB and MC conceived the project and edited the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; internally peer reviewed.

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