Tocilizumab for severe COVID-19: a systematic review and meta-analysis

Lan, Shao-Huan; Lai, Chih-Cheng; Huang, Hui-Ting; Chang, Shen-Peng; Lu, Li-Chin; Hsueh, Po-Ren

This systemic review and meta-analysis aimed to assess the efficacy of tocilizumab for the treatment of severe coronavirus disease-2019 (COVID-19). Candidate studies up to May 24, 2020 were identified from PubMed, Cochrane Library, Embase, MedRxiv, and BioRxiv. Treatment outcomes included mortality, risk of intensive care unit (ICU) admission, and the requirement of mechanical ventilation (MV). A total of 7 retrospective studies involving 593 adult patients with severe COVID-19, including 241 in the tocilizumab group and 352 in the control group were enrolled. All-cause mortality of severe COVID-19 patients among the tocilizumab group was 16.2% (39/241), which was lower than that in the control group (24.1%, 85/352). However, the difference did not reach statistical significance (risk ratio [RR], 0.61; 95% confidence interval [CI], 0.31-1.22, I(2) = 68%). In addition, the risk of ICU admission was similar between the tocilizumab and control groups (35.0% vs. 15.8%, RR, 1.51; 95% CI, 0.33-6.78, I(2) = 86%). The requirement of MV was similar between the tocilizumab and control groups (32.4% vs. 28.6%, RR, 0.72; 95% CI, 0.05-10.96, I(2) = 91%). However, these nonsignificant differences between the tocilizumab and control groups may have been the result of the baseline characteristics of the tocilizumab group, which were more severe than those of the control group. Based on low-quality evidence, there is no conclusive evidence that tocilizumab would provide any additional benefit to patients with severe COVID-19. Therefore, further recommendation of tocilizumab for COVID-19 cases should be halted until high-quality evidence from randomized controlled trials is made available.