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Systematic review and meta-analysis of tocilizumab in persons with coronavirus disease-2019 (COVID-19)

Chong-Xiang Chen1,2,3, Fang Hu1, Jin Wei4

  • 1Department of Hematologic Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.

Leukemia
|May 18, 2021
PubMed

Insights

This meta-analysis found tocilizumab reduced the risk of death in COVID-19 patients, but did not improve surrogate endpoints like ICU admission. The drug

Area of Science:

  • * Medical research
  • * Pharmacology
  • * Public health

Background:

  • * Coronavirus disease-2019 (COVID-19) is a global health crisis.
  • * Tocilizumab, an interleukin-6 receptor inhibitor, has been investigated for its potential therapeutic effects in COVID-19.
  • * The safety and efficacy of tocilizumab in COVID-19 patients require robust evaluation.

Purpose of the Study:

  • * To conduct a meta-analysis assessing the safety and efficacy of tocilizumab in patients with COVID-19.
  • * To synthesize evidence from available studies to determine the overall impact of tocilizumab on mortality and surrogate endpoints.

Main Methods:

  • * A systematic literature search was performed on PubMed, Web of Science, and Medline.
  • * Studies published on coronavirus OR COVID-19 OR 2019-nCoV OR SARS-CoV-2 AND tocilizumab were included.
  • * Data were analyzed using Review Manager 5.4, with study quality assessed using modified Newcastle-Ottawa and Jadad scales.

Main Results:

  • * The meta-analysis included 32 studies with 11,487 subjects.
  • * Tocilizumab was associated with a decreased risk of death (RR=0.74, P=0.008) overall, but not for surrogate endpoints like ICU admission or mechanical ventilation.
  • * The drug increased hospitalization duration for survivors and its mortality benefit was not confirmed in studies using concurrent or randomized controls.

Conclusions:

  • * While tocilizumab showed a potential to reduce mortality in COVID-19 patients, this finding was not consistently observed across all study designs.
  • * The lack of confirmed benefit in randomized controlled trials and concurrent control studies raises questions about the drug's overall safety and efficacy.
  • * Further high-quality research is needed to definitively establish the role of tocilizumab in COVID-19 management.

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