Following a review of the literature and hearings with specialists in infectious diseases and intensive care who manage patients with severe Covid-19, the French High Council for Public Health (HCSP) has updated its recommendations for the prescription of IL1 and IL6 receptor antagonists for the treatment of Covid-19.

The HCSP recommends that, concerning the use of tocilizumab:

in all situations:

• to continue the evaluation process by strongly favouring the inclusion of patients in existing randomised clinical trials with extended follow-up to at least day 60;
• to carry out new trials or adapt existing trials to identify the target populations for tocilizumab treatment and the conditions in which its use could be beneficial;
• not to use tocilizumab routinely
• not to use tocilizumab in cases of proven or suspected bacterial or fungal co-infection and/or in highly immunocompromised patients
• not to prescribe tocilizumab on an outpatient basis
• not to prescribe a second dose.

In medical units:

• to condition the use of tocilizumab to a collegial decision including the evaluation of the benefit/risk ratio of its use only in patients requiring high flow oxygen therapy and having a marked inflammatory state (CRP > 75 mg/L) and in the absence of improvement after 48 h of SOC (Standard of care) including dexamethasone (or equivalent corticoid).

In critical care units (intensive care unit: ICU):

• not to use tocilizumab in patients on invasive mechanical ventilation;
• to condition the use of tocilizumab to a collegial decision including the evaluation of the benefit/risk ratio of its use in patients requiring high flow oxygen therapy or non-invasive ventilation, in the absence of improvement after 48 hours of SOC including dexamethasone (or equivalent corticosteroid), within a maximum of 72 hours after admission to the ICU.

For sarilumab and anakinra: not to use sarilumab or anakinra in any situation.