Trial reportAnnals of the rheumatic diseases2020
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.
Trial report in Annals of the rheumatic diseases, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 121 papers, 11 of them syntheses that pooled it.
What it found
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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
121 citing papers in PubMed, 11 syntheses or guidelines pooled it, 231 citations in OpenAlex.
- Pooled it
- Effect of corticosteroid therapy on mortality in COVID-19 patients-A systematic review and meta-analysis.Reviews in medical virology · 2022Pooled it
- Comparing the efficacy of tocilizumab with corticosteroid therapy in treating COVID-19 patients: a systematic review and meta-analysis.Daru : journal of Faculty of Pharmacy, Tehran University of Medical Sciences · 2022Pooled it
- Use of steroids in COVID-19 patients: A meta-analysis.European journal of pharmacology · 2022Pooled it
- Development of Evidence-Based COVID-19 Management Guidelines for Local Context: The Methodological Challenges.Global health, epidemiology and genomics · 2022Pooled it
- Tocilizumab and Systemic Corticosteroids in the Management of Patients with COVID-19: A Systematic Review and Meta-Analysis.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2021Pooled it
- Immunomodulatory therapies for SARS-CoV-2 infection: a systematic literature review to inform EULAR points to consider.Annals of the rheumatic diseases · 2021Pooled it
- Management of hospitalised adults with coronavirus disease 2019 (COVID-19): a European Respiratory Society living guideline.The European respiratory journal · 2021Guideline
- Global REnal Involvement of CORonavirus Disease 2019 (RECORD): A Systematic Review and Meta-Analysis of Incidence, Risk Factors, and Clinical Outcomes.Frontiers in medicine · 2021Pooled it
- Optimal use of tocilizumab for severe and critical COVID-19: a systematic review and meta-analysis.F1000Research · 2021Pooled it
- Ferritin in the coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis.Journal of clinical laboratory analysis · 2020Pooled it
- Therapeutic plasma exchange in patients with life-threatening COVID-19: a randomised controlled clinical trial.International journal of antimicrobial agents · 2021Trial
- Short term survival of critically ill COVID-19 Egyptian patients on assisted ventilation treated by either Dexamethasone or Tocilizumab.Scientific reports · 2021Trial
- Tocilizumab combined with favipiravir in the treatment of COVID-19: A multicenter trial in a small sample size.Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie · 2021Trial
- Decreased serum levels of the inflammaging marker miR-146a are associated with clinical non-response to tocilizumab in COVID-19 patients.Mechanisms of ageing and development · 2021Trial
- Potential Predictors of the Outcome of Tocilizumab Treatment in Patients with COVID-19-Associated Hyperinflammation.Infectious diseases & clinical microbiology · 2025Article
- A meta-analysis of the efficacy and safety of immunomodulators in the treatment of severe COVID-19.The Journal of international medical research · 2025Article
- Osteonecrosis following Steroid Therapy in COVID-19 Patients: An Outlook on the Emerging Problem.Hip & pelvis · 2025Review
- Elevated IL-6, IL-10, and IFN-γ levels in fatal elephant endotheliotropic herpesvirus - hemorrhagic disease cases suggest an excessive proinflammatory cytokine response contributes to pathogenesis.Frontiers in immunology · 2025Article
- Risk factors for intensive care unit admission among COVID-19 patients in the West Bank, Palestine: a retrospective cohort study.Frontiers in medicine · 2025Article
61 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
14 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo prospectively investigate in patients with severe COVID-19-associated cytokine storm syndrome (CSS) whether an intensive course of glucocorticoids with or without tocilizumab accelerates clinical improvement, reduces mortality and prevents invasive mechanical ventilation, in comparison with a historic control group of patients who received supportive care only.
methodsFrom 1 April 2020, patients with COVID-19-associated CSS, defined as rapid respiratory deterioration plus at least two out of three biomarkers with important elevations (C-reactive protein >100 mg/L; ferritin >900 µg/L; D-dimer >1500 µg/L), received high-dose intravenous methylprednisolone for 5 consecutive days (250 mg on day 1 followed by 80 mg on days 2-5). If the respiratory condition had not improved sufficiently (in 43%), the interleukin-6 receptor blocker tocilizumab (8 mg/kg body weight, single infusion) was added on or after day 2. Control patients with COVID-19-associated CSS (same definition) were retrospectively sampled from the pool of patients (n=350) admitted between 7 March and 31 March, and matched one to one to treated patients on sex and age. The primary outcome was ≥2 stages of improvement on a 7-item WHO-endorsed scale for trials in patients with severe influenza pneumonia, or discharge from the hospital. Secondary outcomes were hospital mortality and mechanical ventilation.
resultsAt baseline all patients with COVID-19 in the treatment group (n=86) and control group (n=86) had symptoms of CSS and faced acute respiratory failure. Treated patients had 79% higher likelihood on reaching the primary outcome (HR: 1.8; 95% CI 1.2 to 2.7) (7 days earlier), 65% less mortality (HR: 0.35; 95% CI 0.19 to 0.65) and 71% less invasive mechanical ventilation (HR: 0.29; 95% CI 0.14 to 0.65). Treatment effects remained constant in confounding and sensitivity analyses.
conclusionsA strategy involving a course of high-dose methylprednisolone, followed by tocilizumab if needed, may accelerate respiratory recovery, lower hospital mortality and reduce the likelihood of invasive mechanical ventilation in COVID-19-associated CSS.
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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.