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. 2021 Mar;77(3):311-319.
doi: 10.1007/s00228-020-03017-5. Epub 2020 Oct 13.

Tocilizumab for treating COVID-19: a systemic review and meta-analysis of retrospective studies

Meng Zhao  1 , Jieyu Lu  2 , Yihu Tang  1 , Yawei Dai  1 , Jingxin Zhou  3 , Yanhu Wu  4
Affiliations

Tocilizumab for treating COVID-19: a systemic review and meta-analysis of retrospective studies

Meng Zhao et al. Eur J Clin Pharmacol. 2021 Mar.

Abstract

Objectives: COVID-19 has become a global epidemic, and effective therapies have not been discovered up to now. We conducted this study to explore the effectiveness and safety of tocilizumab recently used for treating COVID-19.

Method: A comprehensive search was conducted (up to September 27, 2020), and 19 eligible records were identified according to the inclusion and exclusion criteria. The data of the studies were extracted by 2 independent reviewers and were analyzed to evaluate the safety and availability of tocilizumab for treating COVID-19.

Results: Thirteen retrospective case-control studies (n = 2285 patients) and 6 retrospective single-armed studies (n = 208) were retrieved in this study. In the comparison of tocilizumab treatment group (TCZ) and standard treatment group (ST), significant associations with a lower risk of admission to ICU, use of ventilation, and mortality (OR, 95% CI: 0.53, 0.26~1.09; 0.66, 0.46~0.94; 0.44, 0.36~0.55) were found in the tocilizumab treatment group. What is more, patients treated with tocilizumab had better clinical improvement compared with the patients treated with ST (OR, 1.24; 95% CI, 0.96~1.62). After taking tocilizumab, the patients had lower C-reactive protein (CRP), white blood cell count (WBC), aspartate aminotransferase (AST) (WMD, 95% CI: - 99.66, - 156.24~- 43.09; - 0.95, - 1.8~- 0.11; - 12.58, - 18.88~-6.29) but higher troponin (WMD, 7.61; 95% CI, 3.06~12.15) than before. In addition, tocilizumab did not have significant influence on patients' neutrophil count (Neut), lymphocyte count (Lymp), platelet count (Plt), alanine aminotransferase (ALT), and creatine (WMD, 95% CI: - 0.29, - 2.91~2.33; 0.42, - 0.23~1.07; 5.2, - 2.85~13.25; 22.49, - 2.73~47.7; - 44.78, - 93.37~3.81).

Conclusion: Tocilizumab may have potential effectiveness to treat COVID-19 according to the results of this study. However, more large-scale studies are needed for more accurate conclusions.

Keywords: COVID-19; IL-6 blockade; Meta-analysis; Tocilizumab.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of procedures used to screen eligible studies
Fig. 2
Fig. 2
Forest plot of ORs for admission to ICU, use of ventilation, and mortality between TCZ and ST. ICU, intensive care unit; OR, odds ratio; CI, confidence interval
Fig. 3
Fig. 3
Forest plot of ORs for clinical improvement between TCZ and ST. OR, odds ratio; CI, confidence interval
Fig. 4
Fig. 4
Forest plot of WMDs for CRP between pre-TCZ and post-TCZ. CRP, C-reactive protein; WMD, weighted mean differences; CI, confidence interval
Fig. 5
Fig. 5
Forest plot of WMDs for WBC count, Neut count, Lymp count, and Plt count between pre-TCZ and post-TCZ. WBC, white blood cell; Neut, neutrophil; Lymp, lymphocyte; Plt, platelet; WMD, weighted mean differences; CI, confidence interval
Fig. 6
Fig. 6
Forest plot of WMDs for ALT, AST, troponin, and creatine between pre-TCZ and post-TCZ. ALT, alanine aminotransferase; AST, aspartate aminotransferase; WMD, weighted mean differences; CI, confidence interval
Fig. 7
Fig. 7
Sensitivity analysis of studies on mortality between TCZ and ST
See this image and copyright information in PMC

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