Background: The effect of Tocilizumab and high dose of corticosteroid on COVID-19 mortality and out-comes is equivocal. This study was designed to compare the effect of tocilizumab and Methylpredniso-lone pulse dose on mortality, outcomes and duration of hospitalization in severe COVID-19 patients.
Materials and Methods: The above research was a retrospective study conducted on 131 patients with severe COVID-19 admitted to the acute respiratory ward of Shohadaye Khalije Fars Hospital in Bushehr, Iran, from March to October 2021. Of these patients, 66 were assigned to the methylprednisolone pulse group and 65 to the tocilizumab group and the two groups were then compared in terms of clinical out-comes, laboratory test results, and lung imaging findings.
Results: The results of the study showed that the percentage of mortality, the mean duration of hospitali-zation, and the rate of requirement for intubation were not signiciantly different between the methylpred-nisolone pulse and the tocilizumab groups (P>0.05). The improvement in CRP and arterial oxygen satura-tion was significantly different between the two groups after treatment (P<0.01). 
Conclusion: High dose of methylprednisolone in severely ill patients was associated with faster recovery of the patients in terms of arterial oxygenation and the inflammatory marker CRP. Nevertheless, there was no difference between the two drugs in terms of mortality rate and prognosis. Therefore methylprednisolone pulse dose can be a good alternative to tocilizumab in severe COVID-19.