Systematic Reviews and Meta-Analyses of the Use of Tocilizumab in Treating Central Nervous Diseases

To perform systematic reviews and meta-analyses on the use of the tocilizumab in the central nervous system (CNS) diseases.

A systematic search was carried out in the PubMed, Embase and Cochrane databases for all years until August 2025.

The review revealed 618 CNS diseases patients treated with tocilizumab. The proportion of neuromyelitis optica spectrum disorder (NMOSD) relapse-free patients after tocilizumab was 79.00% (95% confidence interval (CI): 0.67, 0.89). There was a significant correlation between remission and positive anti-AQP4 antibody status (p = 0.001). Tocilizumab significantly reduced the standardized mean Annualized Relapse Ratio (-1.3 (95% CI: -1.94, -0.66; p = 0.00191), Extended Disability Status Scale score (-0.48; 95% CI: -0.92, -0.04; p = 0.0329), and fatigue score (-1.08; 95% CI: -1.53, -0.63; p < 0.0001). The proportion of new-onset refractory status epilepticus (NORSE), febrile infection-related epilepsy syndrome (FIRES), and refractory status epilepticus patients who improved after tocilizumab was 95.00% (95% CI: 0.78, 1.00). The proportion of the anti-NMDAR encephalitis patients with a favorable outcome after tocilizumab was 73.00% (95% CI: 0.64, 0.81). Although other CNS diseases showed improvement following tocilizumab, they did not meet the criteria for meta-analyses. Tocilizumab altered several pro- and anti-inflammatory markers in humans, animals, and cell models. The pooled proportion of tocilizumab adverse effects was 45.00% (95% CI: 0.26, 0.65).

This study may guide clinicians in managing patients with CNS diseases and in conducting prospective studies and clinical trials.

Some of the CNS diseases may be treated with tocilizumab.