The results of studies of tocilizumab (TCZ) in COVID-19 are contradictory. Our study aims to update the medical evidence from controlled observational studies and randomized clinical trials (RCTs) on the use of TCZ in hospitalized patients with COVID-19.
We searched the following databases from January 1, 2020 to April 13, 2021 (date of last search): MEDLINE database via the PubMed and Scopus search engine, using the terms (“COVID-19” [Supplementary Concept]) AND “tocilizumab” [Supplementary Concept]).
64 studies were included in the present study, 54 were observational controlled studies (50 retrospective and 4 prospective) and 10 were RCTs. The overall results provided data on 20,616 hospitalized patients with COVID-19: 7,668 patients received TCZ in addition to standard care (SOC) (including 1,915 patients admitted to intensive care units (ICU) with reported mortality), and 12,948 patients receiving only SOC (including 4,410 ICU patients with reported mortality). After applying the random-effects model, the pooled hospital-wide (including intensive care) death odds ratio (OR) of TCZ-treated COVID-19 patients was 0.73 ( 95% confidence interval (CI) = 0.56-0.93). The OR for hospital-wide mortality was 1.25 (95% CI = 0.74 to 2.18) in patients admitted to conventional wards versus 0.66 (95% CI = 0.59 to 0.76) in patients admitted to the ICU. The pooled OR of hospital-wide (including intensive care) mortality of COVID-19 patients treated with TCZ plus corticosteroids (CS) was 0.67 (95% CI = 0.54- 0.84). The OR of combined in-hospital mortality was 0.71 (95% CI = 0.35-1.42) when TCZ was administered early (≤ 10 days after symptom onset) versus 0.83 ( 95% CI 0.48-1.45) for late administration (> 10 days after symptom onset). start). The meta-analysis did not find a significantly higher risk of secondary infections in COVID-19 patients treated with TCZ.
The TCZ has prevented mortality in hospitalized patients for COVID-19. This benefit was seen to a greater extent in patients receiving concomitant CS and when administration of TCZ occurred within 10 days of symptom onset.