We do not recommend Tocilizumab for non-severe COVID-19 (Strong recommendation)
Definition of non-severe:
NO features of severe or critical illness (see below). For some interventions this group may be divided into:
Mild illness
- Symptomatic (any acute COVID-19 related symptoms)
- AND respiratory rate <24/min
- WITHOUT pneumonia or hypoxia
Moderate illness
- Pneumonia (clinical or radiological) OR hypoxia (SpO2 <94% in adults with no underlying lung disease)
- AND respiratory rate ≤30/min
- AND SpO2 ≥90% on room air
Tocilizumab may be added to corticosteroids in people with severe or critical illness who have rapidly increasing oxygen requirements AND significant systemic inflammation (Conditional recommendation)
A conditional recommendation is one for which the panel is less confident about the balance between desirable and undesirable effects of the intervention.
Definition of severe:
Pneumonia with ANY ONE of the following:
- respiratory rate >30/min
- severe respiratory distress
- SpO2 <90% on room air
- NO invasive or non-invasive respiratory support needed
Definition of critical:
- Requirement for high-level respiratory support: noninvasive ventilation, high-flow oxygen (≥20 litres per minute) or invasive mechanical ventilation
- OR acute respiratory distress syndrome (PaO2/FiO2 ratio of <300)
- OR sepsis
- OR shock