Response to: ‘Correspondence on ‘Historically controlled comparison of glucocorticoids with or without tocilizumab versus supportive care only in patients with COVID-19-associated cytokine storm syndrome: results of the CHIC study’’ by Charles

Abstract

In his correspondence, Charles challenged the appropriateness of publishing the COVID Highintensity Immunosuppressionin Cytokine storm syndrome (CHIC) study in ARD. 2 I am always grateful for our readers’ critical assessments of papers published in ARD, since this allows the authors to address further questions of interest and thus provide additional clarification. Ramiro et al have done so in their response to Charles’ critique. Regarding the decision to publish the paper, I can assure Charles that all research papers in ARD undergo a full peerreview process. In this case, the paper was reviewed by three top experts in the field who all regarded it as an important contribution and recommended publication after revision. The results of this study have been submitted on 1 July, at a time when very little was known about optimal therapy of severe COVID-19 and prospective randomised controlled trials were of extreme rarity, if available at all. In the early COVID-19 era, knowledge accrued stepwise and reviewers and journal editors had to make decisions based on the little information available in the literature and by critical assessment of the incremental information that was provided with every submitted manuscript. Charles based his critique on findings that tocilizumab is not generally efficacious in COVID-19 patients. However, as Ramiro et al pointed out in their own and with reference to newer papers, the drug does appear to convey significant benefit in patients with severe disease. This is further exemplified by a recent report not yet covered by Ramiro et al. The results of all these trials were published long after the CHIC study. Whether to embark on publication of research related to COVID-19 in general rather than just focusing on rheumatic diseases is a question that was raised within the ARD editorial board last year. Since antiinflammatory therapies used in rheumatology are often the focus of studies on COVID-19, the decision was to also consider such papers for publication in ARD. I am very grateful to the members of the editorial board who assessed these manuscripts before we made the decision to review or reject them without review, and also to the many referees who evaluated these papers so carefully over the last year, like the one on the CHIC trial. While I am aware that occasionally data of publications may not be confirmed by subsequent studies, the data from the CHIC trial presented in ARD were apparently fully confirmed. 5 Thus, ARD spearheaded the field by providing new, thoroughly peerreviewed findings at an early stage of our understanding of COVID-19 treatment so that others could perform confirmatory trials and patients could benefit timely from this advance.