• Arunmozhimaran Elavarasi, Ranjit Kumar Sahoo, Tulika Seth, Shalimar Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India., Karan Madan, Neeraj Nischal, Manish Soneja, Atul Sharma, Pramod Garg, and Kameshwar Prasad.
• Department of Neurology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
• Natl Med J India. 2020 May 1; 33 (3): 152-157.

Background. Coronavirus disease 2019 (Covid-19) has emerged as a pandemic by end-January 2020. Of the infected patients, 10%-15% may develop severe or critical illness. So far, no definite treatment is available for Covid-19. Cytokine release syndrome may underlie the pathogenesis of severe and critical disease. Anti-interleukin (IL)-6 therapies are being tried to improve clinical outcomes.Methods. We did a systematic review to identify the available literature on anti-IL-6 therapies in the treatment of Covid-19 and used the GRADE method to assess the quality of evidence.Results. Four case series and 10 case reports were identified. On critical assessment, we found that these studies reported some beneficial effect of anti-IL-6 therapy, but all the studies had a high risk of bias. The pooled estimate showed that 42% of patients improved but with a very wide confidence interval (CI) (95% CI 1%-91%) and substantial heterogeneity (I2 = 95%). The overall quality of evidence was graded as 'very low'.Conclusions. Although promising, anti-IL-6 therapy for Covid-19 needs to be tested in randomized controlled trials to provide robust evidence.

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