Tocilizumab for severe COVID-19: a systematic review and meta-analysis
Journal
International Journal of Antimicrobial Agents
Journal Volume
56
Journal Issue
3
Date Issued
2020
Author(s)
Abstract
This systemic review and meta-analysis aimed to assess the efficacy of tocilizumab for the treatment of severe coronavirus disease 2019 (COVID-19). Candidate studies up to 24 May 2020 were identified from PubMed, Cochrane Library, Embase, medRxiv and bioRxiv. Treatment outcomes included mortality, risk of intensive care unit (ICU) admission and the requirement for mechanical ventilation (MV). Seven retrospective studies involving 592 adult patients with severe COVID-19, including 240 in the tocilizumab group and 352 in the control group, were enrolled. All-cause mortality of severe COVID-19 patients among the tocilizumab group was 16.3% (39/240), which was lower than that in the control group (24.1%; 85/352). However, the difference did not reach statistical significance [risk ratio (RR) = 0.62, 95% confidence interval (CI) 0.31–1.22; I2 = 68%]. Additionally, risk of ICU admission was similar between the tocilizumab and control groups (35.1% vs. 15.8%; RR = 1.51, 95% CI 0.33–6.78; I2 = 86%). The requirement for MV was similar between the tocilizumab and control groups (32.4% vs. 28.6%; RR = 0.82, 95% CI 0.14–4.94; I2 = 91%). However, these non-significant differences between the tocilizumab and control groups may have been the result of baseline characteristics of the tocilizumab group, which were more severe than those of the control group. Based on low-quality evidence, there is no conclusive evidence that tocilizumab would provide any additional benefit to patients with severe COVID-19. Therefore, further recommendation of tocilizumab for COVID-19 cases should be halted until high-quality evidence from randomised controlled trials is available. ? 2020 Elsevier Ltd
Subjects
COVID-19; Intensive care unit; Mechanical ventilation; Mortality; SARS-CoV-2; Tocilizumab
SDGs
Other Subjects
tocilizumab; antiinflammatory agent; antivirus agent; cytokine; immunologic factor; monoclonal antibody; tocilizumab; all cause mortality; Article; artificial ventilation; coronavirus disease 2019; disease severity; drug efficacy; human; intensive care unit; meta analysis; priority journal; systematic review; treatment outcome; bacterial infection; Betacoronavirus; Coronavirus infection; cytokine release syndrome; drug administration; drug effect; genetics; growth, development and aging; immunology; mortality; opportunistic infection; pandemic; retrospective study; severity of illness index; survival analysis; virology; virus pneumonia; Anti-Inflammatory Agents; Antibodies, Monoclonal, Humanized; Antiviral Agents; Bacterial Infections; Betacoronavirus; Coronavirus Infections; Cytokine Release Syndrome; Cytokines; Drug Administration Schedule; Humans; Immunologic Factors; Intensive Care Units; Opportunistic Infections; Pandemics; Pneumonia, Viral; Respiration, Artificial; Retrospective Studies; Severity of Illness Index; Survival Analysis; Treatment Outcome
Type
journal article