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Meta-Analysis
. 2021 Jun;199(3):239-248.
doi: 10.1007/s00408-021-00451-9. Epub 2021 May 29.

Tocilizumab in Hospitalized Patients with COVID-19: A Meta Analysis of Randomized Controlled Trials

Vijairam Selvaraj  1   2 , Mohammad Saud Khan  3   4 , Chirag Bavishi  4   5 , Kwame Dapaah-Afriyie  3   4 , Arkadiy Finn  3   4 , Amos Lal  6 , Eleftherios Mylonakis  4   7
Affiliations
Meta-Analysis

Tocilizumab in Hospitalized Patients with COVID-19: A Meta Analysis of Randomized Controlled Trials

Vijairam Selvaraj et al. Lung. 2021 Jun.

Abstract

Background: To date, only dexamethasone has been shown to reduce mortality in coronavirus disease-19 (COVID-19) patients. Tocilizumab has been recently added to the treatment guidelines for hospitalized COVID-19 patients, but data remain conflicting.

Study design and methods: Electronic databases such as MEDLINE, EMBASE, and Cochrane central were searched from March 1, 2020, until March 10, 2021, for randomized controlled trials evaluating the efficacy of tocilizumab in hospitalized COVID-19 patients. The outcomes assessed were all-cause mortality, mechanical ventilation, and time to discharge.

Results: Nine studies (with 6490 patients) were included in the analysis. In total, 3358 patients received tocilizumab, and 3132 received standard care/placebo. Pooled analysis showed a significantly decreased risk of all-cause mortality (RR 0.89, 95% CI 0.80-0.98, p = 0.02) and progression to mechanical ventilation (RR 0.80, 95% CI 0.71-0.89, p < 0.0001) in the tocilizumab arm compared to standard therapy or placebo. In addition, there was a trend towards improved median time to hospital discharge (RR 1.28, 95% CI 1.12-1.45, p = 0.0002).

Conclusions: Tocilizumab therapy improves outcomes of mortality and need for mechanical ventilation, in hospitalized patients with COVID-19 infection compared with standard therapy or placebo. Our findings suggest the efficacy of tocilizumab therapy in hospitalized COVID-19 patients and strengthen the concept that tocilizumab is a promising therapeutic intervention to improve mortality and morbidity in COVID-19 patients.

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

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Conflict of interest statement

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow chart outlining literature search
Fig. 2
Fig. 2
Risk of bias assessment of trials included in the study
Fig. 3
Fig. 3
Forest plots for primary and secondary outcomes. A Mortality outcome. B Progression to mechanical ventilation. C Progression to mechanical ventilation or death. D Time to discharge
See this image and copyright information in PMC

References

    1. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239–1242. doi: 10.1001/jama.2020.2648. - DOI - PubMed
    1. Siddiqi HK, Mehra MR. COVID-19 illness in native and immunosuppressed states: A clinical-therapeutic staging proposal. J Heart Lung Transplant. 2020 doi: 10.1016/j.healun.2020.03.012. - DOI - PMC - PubMed
    1. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan China. JAMA. 2020 doi: 10.1001/jama.2020.1585. - DOI - PMC - PubMed
    1. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020;395(10229):1054–1062. doi: 10.1016/S0140-6736(20)30566-3. - DOI - PMC - PubMed
    1. Kermali M, et al. The role of biomarkers in diagnosis of COVID-19—a systematic review. Life Sci. 2020 doi: 10.1016/j.lfs.2020.117788. - DOI - PMC - PubMed

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