Observational studyChest2020
Tocilizumab Treatment for Cytokine Release Syndrome in Hospitalized Patients With Coronavirus Disease 2019: Survival and Clinical Outcomes.
Observational study in Chest, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 146 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
146 citing papers in PubMed, 7 syntheses or guidelines pooled it, 213 citations in OpenAlex.
- Tissue factor in COVID-19-associated coagulopathy.Thrombosis research · 2022Pooled it
- Potential plants for inflammatory dysfunction in the SARS-CoV-2 infection.Inflammopharmacology · 2022Pooled it
- Beneficial and harmful outcomes of tocilizumab in severe COVID-19: A systematic review and meta-analysis.Pharmacotherapy · 2021Pooled it
- Efficacy and safety of Tocilizumab in severe and critical COVID-19: A Systematic Review and Meta-Analysis.Expert review of clinical immunology · 2021Pooled it
- Tocilizumab administration is associated with the reduction in biomarkers of coronavirus disease 2019 infection.Journal of medical virology · 2021Pooled it
- Guidelines for COVID-19 Management in Hematopoietic Cell Transplantation and Cellular Therapy Recipients.Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation · 2020Guideline
- Pooled it
- Phase IIB, Randomized, Double-Blind, Placebo-Controlled Clinical Trial of Intravenous Defibrotide for the Prevention and Treatment of Respiratory Distress and Cytokine Release Syndrome in COVID-19.European journal of haematology · 2026Trial
- Efficacy and Safety of Sarilumab in Hospitalized Patients With Coronavirus Disease 2019: A Randomized Clinical Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2022Trial
- Tocilizumab in patients with moderate or severe COVID-19: a randomized, controlled, open-label, multicenter trial.Frontiers of medicine · 2021Trial
- Effect of Tocilizumab vs Standard Care on Clinical Worsening in Patients Hospitalized With COVID-19 Pneumonia: A Randomized Clinical Trial.JAMA internal medicine · 2021Trial
- Increased interleukin-6 and macrophage chemoattractant protein-1 are associated with respiratory failure in COVID-19.Scientific reports · 2020Trial
- Efficacy of Tocilizumab in Patients Hospitalized with Covid-19.The New England journal of medicine · 2020Trial
- Efficacy of therapeutic plasma exchange in the treatment of penn class 3 and 4 cytokine release syndrome complicating COVID-19.Respiratory medicine · 2020Trial
- PANoptosis in Cytokine Release Syndrome: Bridging the Gap between Inflammation and Cell Death.Current pharmaceutical design · 2026Review
- The Clinical Value of Inflammatory Indicators at the Time of Secondary Infection After Treatment With Tocilizumab: A Cross-Sectional Study.Health science reports · 2025Article
- Perspectives on the current diagnostic and treatment paradigms in secondary hemophagocytic lymphohistiocytosis (HLH).Orphanet journal of rare diseases · 2025Review
- Serial biomarker measurements may be helpful to predict the successful application of high flow nasal cannula in COVID-19 pneumonia patients.Scientific reports · 2025Article
- Harnessing immunotherapeutic molecules and diagnostic biomarkers as human-derived adjuvants for MERS-CoV vaccine development.Frontiers in immunology · 2025Review
- Prognostic significance of serum interleukin-6 in severe/critical COVID-19 patients treated with tocilizumab: a detailed observational study analysis.Scientific reports · 2024Observational
86 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
29 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundTocilizumab, an IL-6 receptor antagonist, can be used to treat cytokine release syndrome (CRS), with observed improvements in a coronavirus disease 2019 (COVID-19) case series. RESEARCH QUESTION: The goal of this study was to determine if tocilizumab benefits patients hospitalized with COVID-19. STUDY DESIGN AND
methodsThis observational study of consecutive COVID-19 patients hospitalized between March 10, 2020, and March 31, 2020, and followed up through April 21, 2020, was conducted by chart review. Patients were treated with tocilizumab using an algorithm that targeted CRS. Survival and mechanical ventilation (MV) outcomes were reported for 14 days and stratified according to disease severity designated at admission (severe, ≥ 3 L supplemental oxygen to maintain oxygen saturation > 93%). For tocilizumab-treated patients, pre/post analyses of clinical response, biomarkers, and safety outcomes were assessed. Post hoc survival analyses were conducted for race/ethnicity.
resultsAmong the 239 patients, median age was 64 years; 36% and 19% were black and Hispanic, respectively. Hospital census increased exponentially, yet MV census did not. Severe disease was associated with lower survival (78% vs 93%; P < .001), greater proportion requiring MV (44% vs 5%; P < .001), and longer median MV days (5.5 vs 1.0; P = .003). Tocilizumab-treated patients (n = 153 [64%]) comprised 90% of those with severe disease; 44% of patients with nonsevere disease received tocilizumab for evolving CRS. Tocilizumab-treated patients with severe disease had higher admission levels of high-sensitivity C-reactive protein (120 vs 71 mg/L; P < .001) and received tocilizumab sooner (2 vs 3 days; P < .001), but their survival was similar to that of patients with nonsevere disease (83% vs 91%; P = .11). For tocilizumab-treated patients requiring MV, survival was 75% (95% CI, 64-89). Following tocilizumab treatment, few adverse events occurred, and oxygenation and inflammatory biomarkers (eg, high-sensitivity C-reactive protein, IL-6) improved; however, D-dimer and soluble IL-2 receptor (also termed CD25) levels increased significantly. Survival in black and Hispanic patients, after controlling for age, was significantly higher than in white patients (log-rank test, P = .002).
interpretationA treatment algorithm that included tocilizumab to target CRS may influence MV and survival outcomes. In tocilizumab-treated patients, oxygenation and inflammatory biomarkers improved, with higher than expected survival. Randomized trials must confirm these findings.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.