الفهرس 
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Abstract
Tocilizumab is an inhibitor of the IL-6 pathway and controlled clinical trials have now supported its effects on patients with moderate and severe COVID-19. Treatment with the IL-6 receptor (IL-6R) antagonists (tocilizumab) improved patient outcomes and survival.
Corticosteroids also are among the most commonly used drugs for immunomodulatory therapy of infectious diseases. A recent retrospective Chinese paper showed impressive positive effect of methylprednisolone (MP) on survival of SARS-CoV-2 critically ill patients.
The inflammatory cytokine storm increases the severity of COVID-19 and can lead to severe complications and death. IL-6 is the primary trigger for cytokine storms.
CRP &PCT are among biomarkers that are used to diagnosis covid -19 patient with severe infections ,also the Ordinal Scale which was adopted by WHO committee as a predictor of the outcome by measuring illness severity over time
This study aimed to compare the efficacy of current immune- modulatory therapy (TCZ+MP vs MP only) as a treatment of critically ill cases of covid-19 on 28 days mortality, need for mechanical ventilation and side effects of both regimens.
This retrospective observational cohort study included 60 adult patients aged 18-70 years of both sexes, diagnosed as having covid 19 infection with cytokine storm & severe acute respiratory syndrome who needed high oxygen support or ventilatory support and needed ICU admission.
Patients were divided into 2 equal groups:
• group (TCZ+MP): received 2 doses tocilizumab within 24 hrs (5 mg/kg in each dose) in addition to a dose of methylprednisolone (2 mg/kg/day) for 7days.
• group (MP): received only a dose of methylprednisolone (2 mg\kg\day) for 7days.
Summary of our results:
• Age, sex, obesity, chronic lung disease, chronic heart disease, end-stage renal disease, chronic liver disease, DM, previous systemic corticosteroid therapy and smoking were insignificantly different between both groups.
• Pretreatment symptoms (cough, fever, dyspnea, diarrhea, myalgia and impaired consciousness) were insignificantly different between both groups.
• Regarding vital signs after (24h), axillary temperature and SpO2/FiO2 ratio were significantly lower in patients on TCZ+MP than those on MP only (P value =0.028 and 0.043 respectively) while respiratory rate and heart rate were insignificantly different between both groups.
• Regarding the baseline laboratory investigations before treatment, leucocytes, lymphocytes, neutrophils, NLR, CRP, LDH, ferritin, D-dimer, IL-6 and procalcitonin were insignificantly different between both groups. After treatment, 3 measurements of all laboratory investigations were taken at days 3, 7 and 10 then their mean was compared between both groups. Leucocytes were significantly higher in patients on TCZ+MP than those on MP only. Lymphocytes and neutrophils were significantly lower in patients on TCZ+MP than those on MP only (P value <0.001 and 0.002 respectively). NLR, CRP, LDH, ferritin, D-dimer, IL-6 and procalcitonin were insignificantly different between both groups.
• Chest CT manifested by (CO-RADS) after 10 days of treatment was insignificantly different between both groups.
• Adverse effects of intervention drugs after 28 days (superinfection, GIT bleeding, elevation in liver function, hypertriglyceridemia, anemia and thrombocytopenia) were insignificantly different between both groups.
• Mortality incidence was significantly lower in patients on TCZ+MP than those on MP only (P value =0.018). Causes of mortality (MOF, ARDS, septic shock and cardiovascular collapse) were insignificantly different between both groups.
• Number of patients who required mechanical ventilation was significantly lower in patients on TCZ+MP than those on MP only (P value =0.009).Duration of mechanical ventilation was insignificantly different between both groups.
• Hazards ratio of mortality was significantly lower in patients on TCZ+MP (HR= 0.389, 95%CI= 0.115 – 0.977) than those on MP only (P value =0.044).