Efficacy and Safety of Tocilizumab in Severe and Critical Covid-19: A Systematic Review and Meta-Analysis Publisher Pubmed



Rezaei S¹ ; Fatemi B² ; Karimi Majd Z¹ ; Minaei H¹ ; Peikanpour M¹ ; Anjidani N³ ; Taheri A³ ; Dastan F⁴ ; Mosaed R⁵ Show Affiliations
Source: Expert Review of Clinical Immunology Published:2021

Abstract

Objectives: Currently published papers and clinical guidelines regarding the effects of tocilizumab in severe and critical COVID-19 are contradictory. The aim of this meta-analysis was to combine the results of clinical studies of different designs to investigate the efficacy and safety of tocilizumab in severely-to-critically ill COVID-19 patients. Methods: A systematic search was performed in PubMed, Embase, CENTRAL, ClinicalTrials.gov, Scopus, and preprint servers up to 26 December 2020. Since a substantial heterogeneity was expected, a random-effects model was applied to calculate the pooled effect size (ES) and 95% confidence interval (CI) for each study outcome. Results: Forty-five comparative studies involving 13,189 patients and 28 single-arm studies involving 1,770 patients were analyzed. The risk of mortality (RR of 0.76 [95%CI 0.65 to 0.89], P < 0.01) and intubation (RR of 0.48 [95%CI 0.24 to 0.97], P = 0.04) were lower in tocilizumab patients compared with controls. We did not find any significant difference in secondary infections, length of hospital stay, hospital discharge before day 14, and ICU admission between groups. Conclusion: Tocilizumab can improve clinical outcomes and reduce mortality rates in severe to critical COVID-19 patients. Large-scale randomized controlled trials are still required to improve the statistical power of meta-analysis. © 2021 Informa UK Limited, trading as Taylor & Francis Group.