To the Editor:
We would like to share our thoughts on the article “The role of tocilizumab therapy in critically ill patients with severe acute respiratory syndrome coronavirus 2” by Saffo et al.  in which the authors concluded that “In this cohort study, no difference in survival was observed in critically ill patients treated with TCZ.” The benefit of tocilizumab depends on many factors. An important factor is timing of administration is an important factor . In a recent publication, Richier et al.  noted that “tocilizumab could be less effective when oxygen requirement is >11 L/min” . The pharmacological action of tociluzubmab is via interleukin blockage [3, 4] so it can help control of interleukin-related pathology in COVID-19. Therefore, it has to be used before there is any irreversible clinical problem due to pathological interleukin process. This can confirm the concept that drug will be effective if it’s used at the right time according to its pharmacological action.
Research funding: None reported.
Author contributions: Both authors provided substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; both authors drafted the article or revised it critically for important intellectual content; both authors gave final approval of the version of the article to be published; and both authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Competing interests: None reported.
1. Saffo, Z, Guo, W, Springer, K, Maksimowicz-McKinnon, K, Kak, V, McKinnon, JE, et al.. The role of tocilizumab therapy in critically ill patients with severe acute respiratory syndrome coronavirus 2. J Osteopath Med 2021;121:705–14. https://doi.org/10.1515/jom-2020-0292.Search in Google Scholar
2. Richier, Q, Jachiet, V, Bonnemains, V, Plaçais, L, Abisror, N, Garnier, M, et al.. Tocilizumab and COVID-19: timing of administration assessment. Infect Dis Now 2021;S2666–9919:420–6. https://doi.org/10.1016/j.idnow.2021.06.304.Search in Google Scholar
4. Rugberg, W, Mishra, S, Rajput, R. Tociliumab for patients admitted with COVID-19 pneumonia. Adv Trop Med Public Health Int 2021;11:17–8.Search in Google Scholar
© 2021 Rujittika Mungmunpuntipantip and Viroj Wiwanitkit, published by De Gruyter, Berlin/Boston
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