Efficacy of Tocilizumab in Covid 19: A metanalysis of case series studies

Mohamed hussain, s.; Ayesha Farhana, S.; Alwutayd, O.; Alnafeesah, A.; Alshammari, M.; Alnasser, S.; Krishnadas, N.

Abstract Background : characteristic feature of COVID-19 during its progression in severity is the cytokine storm (via interleukin-6, IL-6) which is responsible for secondary acute respiratory distress syndrome (ARDS) [4]. Tocilizumab has an antagonist effect on the IL-6 receptor. With present review and metanalysis, we intend to update the current status on the clinical efficacy of tocilizumab in the treatment of Covid 19 infections in the published literature of case series. MATERIALS AND METHODS: The following inclusion criteria were used: (i) case series studies (number of reported patients in each study equal to or greater than ten (ii) use of tocilizumab alone or in combination with standard of care therapy (iii) Covid 19 adult patients (iv) the studies with endpoints on all-cause mortality, need for mechanical ventilation, clinical improvements. Data synthesis and statistical analysis Meta-analysis was performed using a random effects model and the DerSimonian and Laird method. RESULTS 18 were selected for the quantitative analysis (meta-analysis). 14 studies were retrospective and 4 were prospective Meta-analysis The mortality rate of COVID-19 patients with tocilizumab was 21% (251/1212) Asymmetric funnel plot in the cylindrical form due to publication bias In conclusion the present synthesis provide us useful insights with the other available evidence to refine our strategy and equip ourselves effectively with tocilizumab to defeat COVID 19 to save humanity. Limitations The included studies utilized varied doses of tocilizumab (single or double), and duration drug availability issues emerged in some centers, which may have influenced both sample sizes and study designs. Clinical implications: Incorporated studies without control groups into systematic reviews and quantitative synthesis especially when there are no other studies to consider can provide information for formulating effective treatment strategies for management of COVID 19 infections through the use of tocilizumab. Keywords: COVID 19; tocilizumab, interleukin-6, cytokine storm, case series