The administration of tocilizumab in patients with COVID-19 pneumonia and a Pao2/Fio2 ratio between 200 and 300 mm Hg did not reduce the risk of clinical worsening.

Further blinded, placebo-controlled randomized clinical trials are needed to confirm the results and to explore possible applications of tocilizumab in different stages of the disease, such as in patients with a Pao2/Fio2 ratio less than 200 mm Hg.

Our trial has several limitations, but also some strengths. Among the limitations is that the trial was open label.

The possibility of conducting a double-blind placebo-controlled trial was considered, but it was excluded for 2 main reasons: the logistic obstacles in organizing it in a period of emergency and the intrinsic anti–IL-6 effect of tocilizumab. It has been consistently reported and clinically observed that this monoclonal antibody rapidly lowers fever and serum CRP level in patients with COVID-19, thus making allocation concealment unlikely.

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