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Meta-Analysis
. 2022 Jun;30(1):211-228.
doi: 10.1007/s40199-021-00430-8. Epub 2022 Jan 27.

Comparing the efficacy of tocilizumab with corticosteroid therapy in treating COVID-19 patients: a systematic review and meta-analysis

Phei Ching Lim  1 , Kar Loon Wong  1 , Retha Rajah  2 , Meng Fei Chong  1 , Ting Soo Chow  3 , Sivasangari Subramaniam  4 , Chong Yew Lee  5
Affiliations
Meta-Analysis

Comparing the efficacy of tocilizumab with corticosteroid therapy in treating COVID-19 patients: a systematic review and meta-analysis

Phei Ching Lim et al. Daru. 2022 Jun.

Abstract

Purpose: Tocilizumab has shown equivocal outcomes in reducing mortality in COVID-19. The corticosteroids appear to be an affordable alternative to tocilizumab. This study aims to estimate the efficacy of tocilizumab and the corticosteroids particularly dexamethasone and methylprednisolone and to identify possible determinants of their efficacy.

Methods: Five electronic databases were searched for studies involving tocilizumab, dexamethasone, and methylprednisolone in treating COVID-19. We included case-control and randomized or partially randomized trials. Meta-regression for patient baseline characteristics, co-medications, and tocilizumab dose regimens was performed to identify contributing factors to drug efficacy.

Results: Thirteen randomized controlled trials (RCTs) and twenty-four case-control studies were included in our meta-analysis involving 18,702 patients. Meta-analysis among the RCTs showed that a summary estimate favoring mortality reduction (OR 0.71, 95%CI 0.55 - 0.92) contributed mainly by tocilizumab and dexamethasone. Among case-control studies, meta-analysis showed mortality reduction (OR 0.52, 95%CI 0.36 - 0.75) contributed by tocilizumab and tocilizumab-methylprednisolone combination. Methylprednisolone alone did not reduce mortality except for one study involving high dose pulse therapy. Meta-analysis also found that all three drugs did not significantly reduce mechanical ventilation (OR 0.72, 95%CI 0.32 - 1.60).

Conclusion: Tocilizumab and dexamethasone emerge as viable options in reducing mortality in severe COVID-19 patients. A tocilizumab-corticosteroid combination strategy may improve therapeutic outcome in cases where single therapy fails.

Keywords: COVID-19; Dexamethasone; Meta-analysis; Methylprednisolone; Tocilizumab.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow chart for study screening and selection according to PRISMA guidelines
Fig. 2
Fig. 2
Forest plot for the effect for all treatments (tocilizumab, methylprednisolone, and dexamethasone) on mortality in randomised controlled trials
Fig. 3
Fig. 3
Forest plot for the effect of all treatments (tocilizumab, methylprednisolone, and dexamethasone) on mortality in case–control studies
Fig. 4
Fig. 4
Forest plot for the effect of tocilizumab alone on mortality
Fig. 5
Fig. 5
Forest plot for effect of all treatments (tocilizumab, methylprednisolone, and dexamethasone) on the event of invasive mechanical ventilation
Fig. 6
Fig. 6
Funnel plot for (a) randomised clinical trials, and (b) case–control studies included in the meta-analysis
See this image and copyright information in PMC

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