No Increased Risk for Respiratory Symptoms With IL-6 Inhibitors During COVID-19

Treatment with interleukin (IL)-6 receptor inhibitors, including tocilizumab and sarilumab, is not associated with increased respiratory symptoms in patients with rheumatologic conditions during the COVID-19 pandemic, according to a letter to the editor published in Rheumatology.

Many patients receiving immunosuppressive treatments, such as steroids, biologic or conventional disease-modifying antirheumatic drugs (DMARDs), have reported concerns about the potential risk for SARS-CoV-2 infection; however, the data on the risk associated with the use of IL-6 receptor inhibitors are limited.

To address the effect of DMARD treatment on respiratory symptoms in rheumatologic conditions, a prospective survey was conducted that included 146 Italian patients with rheumatologic conditions receiving tocilizumab or sarilumab (treatment duration, 32.9±2.9 months). Most patients were being treated for rheumatoid arthritis (n=133; 91.1%), and the remaining for giant cell arteritis (n=10; 6.8%) or systemic sclerosis (n=3; 2.1%) in Rome, Italy. All participants provided information on potential COVID-19 symptoms, including cough, sore throat, and dyspnea in the previous 12 weeks; however, they denied previous contact with individuals with confirmed SARS-CoV-2.

Because antimalarial drugs were suggested to have a protective effect against SARS-CoV-2, the survey participants were stratified based on the concomitant use of antimalarials plus IL-6 receptor inhibitors. Data suggest no significant difference between treated and untreated patients, in terms of incidence of fever and respiratory symptoms. Similarly, no difference was recorded between IL-6 receptor inhibitor monotherapy and combined treatment with conventional DMARDs. However, rates of fever and sore throat were higher in patients receiving IL-6 receptor inhibitors and conventional DMARDs plus steroid therapy compared with patients receiving IL-6 receptor inhibitor monotherapy (17.9% vs 0% and 20.5% vs 3.5%; P =.017 and P =.041 respectively).

“[O]ur data support the current policy of the rheumatological community to suggest not to stop conventional or biologic-DMARDs therapies where otherwise indicated, despite the fact that low-dose steroid seems to be avoided if possible,” the authors of the letter concluded.


Alivernini S, Petricca L, Perniola S, et al. No higher risk of respiratory symptoms in Italian rheumatological patients under IL-6R-inhibitor therapy in SARS-CoV-2 pandemic. Letter. Rheumatology (Oxford). Published July 29, 2020. doi:10.1093/rheumatology/keaa388