Tocilizumab and Remdesivir can be More Harmful than Beneficial to COVID-19 Patients

We eagerly read the article by Chiu et al. about a review of the safety profile of anti-COVID-19 drugs [1]. It was concluded that hydroxy-chloroquine, lopinavir/ritonavir, ivermectin, chloroquine, and favipiravir should not be used for the treatment of COVID-19 patients [1]. On the contrary, tocilizumab, remdesivir, and dexamthasone were recommended for COVID-19 patients under certain conditions [1]. The study is appealing but raises concerns which require discussion. Several adverse reactions following the use of tocilizumab were not acknowledged. One of the adverse reactions of tocilizumab is bowel ulceration [2]. Another adverse reaction not addressed is pyomyositis [3]. In a single patient lung and liver sarcoidosis-like reactions have been reported following the administration of tocilizumab [4]. There is also one report about tocilizumab-induced lupus [5]. In a 65yo male, treated with tocilizumab for rheumatoid arthritis, pericardial tamponade developed two months after initiation of the treatment [5]. According to an investigation by means of WHO’s “VigiBase”, tocilizumab increases the risk of reactivating hepatitis-B and tuberculosis [6]. According to this study the mean cumulative incidence of hepatitis-B and tuberculosis was 3.3% respectively 4.3% [6]. In a patient receiving tocilizumab for Takayasu arteritis, pyoderma gangrenosum developed following the anti-IL-6 therapy [7]. There are also indications that tocilizumab can reactivate psoriasis-like eruptions [8]. In a study of 74 patients receiving tocilizumab for COVID-19, 23% experienced late onset infections following tocilizumab use [9]. Bacteriemia and fungemia were also more frequently observed in the cohort receiving tocilizumab as comparted to the control group [9]. In a study of 2433 adverse reactions after tocilizumab reported to the worldwide FDA adverse event reporting system (WAERS), pancreatitis, and lung fibrosis were the most frequent in addition to liver injury [10].