1/n Much will be made about this case report. I am very pleased that the patient did well and survived #COVID19 after a difficult course. On the heels of tweeting about anti IL-6 therapy (tocilizumab) I'm taking a stab at this case report. ashpublications.org/bloodadvances/…
2/n It is a purely correlative, observational study. The title is misleading though. An alternate, equally valid title would be: First case of COVID-19 in a patient with multiple myeloma successfully treated with methylprednisolone. The patient received corticosteroid (MP)
3/n therapy on five consecutive days (day +2 to day +6). On day +9 the patient received tocilizumab. He continued to improve and was released from the hospital 10 days later. Did tocilizumab cause this improvement? It is impossible to tell. However, I conclude that it is safe to
4/n administer tocilizumab to a critically ill #COVID19 patient. The authors go further in their interpretation and state that "this case is the first to prove that tocilizumab is effective in the treatment of COVID-19 in MM with obvious clinical recovery". I disagree. No proof.
5/n In the highlight section, they write: Although tocilizumab was effective in the treatment of COVID-19 in this case, randomized controlled trials are needed. I think a more accurate (and lengthy) highlight would be: Although tocilizumab was safe to administer in the treatment
6/n of COVID-19 in this case (and temporally preceded clinical improvement), the use of multiple immune modulatory therapies (methylprednisolone) make it impossible to determine whether tocilizumab impacted the clinical outcome. The authors and I agree, though, on the following
7/7 point: randomized clinical trials needed. This case report highlights the uncertainty of equating a correlation with causation. Buyer beware.
PS - The critical point here is that I think we ought to try tocilizumab and many other strategies to fight #COVID19. I object to claims not supported by clinical data.
