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Meta-Analysis
. 2022 May;88(5):1955-1963.
doi: 10.1111/bcp.15124. Epub 2021 Nov 30.

Efficacy and safety of tocilizumab versus standard care/placebo in patients with COVID-19; a systematic review and meta-analysis of randomized clinical trials

Driton Vela  1 , Zana Vela-Gaxha  1   2 , Mjellma Rexhepi  1   3 , Rozafa Olloni  2 , Violeta Hyseni  4 , Rajmonda Nallbani  1   5
Affiliations
Meta-Analysis

Efficacy and safety of tocilizumab versus standard care/placebo in patients with COVID-19; a systematic review and meta-analysis of randomized clinical trials

Driton Vela et al. Br J Clin Pharmacol. 2022 May.

Abstract

Aims: Tocilizumab has emerged as an important therapy in treating patients with coronavirus disease (COVID-19). Our purpose was to evaluate the efficacy and safety of tocilizumab versus standard care/placebo in patients with COVID-19.

Methods: We searched a variety of sources from 1 January 2020 to 5 May 2021. All randomized controlled trials that reported tocilizumab efficacy as a primary agent in COVID-19 patients were considered. RCTs had to include mortality events, incidence of mechanical ventilation and serious adverse events. Two reviewers were independently responsible for data extraction. Assessment of bias and certainty of evidence was carried out using the Cochrane Risk of Bias Tool and GRADE methodology. RR for mortality events was evaluated using a fixed-effects model.

Results: A total of 6837 patients were included from 10 RCTs, of which nine were peer-reviewed. Pooled risk ratio (RR) for all-cause mortality in patients with tocilizumab administration was RR = 0.88 (95% CI: 0.81-0.95, P = .0009). RR for incidence of mechanical ventilation at 28-30 days was 0.79 (95% CI: 0.71-0.88). Serious adverse events (SAE) with tocilizumab use were associated with lower RR (RR = 0.91, 95% CI: 0.76-1.09) but the certainty of evidence was downgraded to moderate due to serious risk of bias.

Conclusion: In COVID-19 patients with moderate to critical COVID-19, use of tocilizumab reduces all-cause mortality and progression to mechanical ventilation. This efficacy was not associated with higher number of serious adverse events.

Keywords: COVID-19; meta-analysis; randomized clinical trial; tocilizumab.

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Conflict of interest statement

The authors declare there are no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
All‐cause mortality (follow‐up 28 days) in all patients with COVID‐19, tocilizumab vs standard care/placebo. A. Mortality events for all patients with COVID‐19. B. Mortality events in patients with COVID‐19 without inclusion of results from RECOVERY trial
FIGURE 2
FIGURE 2
All‐cause mortality in patients with COVID‐19 without mechanical ventilation at baseline, tocilizumab vs standard care/placebo. A. Mortality events in patients with COVID‐19 without mechanical ventilation at baseline. B. Mortality events in patients with COVID‐19 without mechanical ventilation at baseline (without results from RECOVERY trial). C. Mortality events in patients with COVID‐19 with mechanical ventilation at baseline
FIGURE 3
FIGURE 3
Incidence of mechanical ventilation in patients with COVID‐19, tocilizumab vs standard care/placebo. A. Incidence of mechanical ventilation in all patients with COVID‐19. B. Incidence of mechanical ventilation in patients with COVID‐19 without results from RECOVERY trial
FIGURE 4
FIGURE 4
Incidence of serious adverse events in patients with COVID‐19, tocilizumab vs standard care/placebo
See this image and copyright information in PMC

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