Tocilizumab in patients hospitalized with COVID-19 pneumonia: systematic review and meta-analysis of randomized controlled trials

• Published in: Journal of investigative medicine Vol. 70; no. 1; pp. 55 - 60
• Main Authors: Gupta, Samiksha, Padappayil, Rana Prathap, Bansal, Agam, Daouk, Salim, Brown, Brent
• Format: Journal Article
• Language: English
• Published: Los Angeles, CA BMJ Publishing Group Ltd 01-01-2022; SAGE Publications; Sage Publications Ltd; BMJ Publishing Group
• Subjects: adult; anti-inflammatory agents; Antibiotics; Antibodies, Monoclonal, Humanized - therapeutic use; Arthritis; Bias; Clinical trials; Coronaviruses; COVID-19; COVID-19 - diagnosis; COVID-19 - drug therapy; Cytokines; FDA approval; Female; Hispanic people; Hospitalization; Humans; Male; Meta-analysis; Monoclonal antibodies; Mortality; non-steroidal; Original Research; Pneumonia; Randomized Controlled Trials as Topic; respiratory distress syndrome; SARS-CoV-2; Steroids; Systematic review; Treatment Outcome; Ventilators; United States > US; COVID-19; respiratory distress syndrome; anti-inflammatory agents; pneumonia; adult; non-steroidal
• ISSN: 1081-5589; 1708-8267
• DOI: 10.1136/jim-2021-002001

Tocilizumab is an interleukin receptor inhibitor that has been used in patients with COVID-19 pneumonia. There are recent randomized controlled trials (RCTs) that evaluated the efficacy and safety of tocilizumab in hospitalized patients with COVID-19 pneumonia. We performed a systematic review and meta-analysis of RCTs that evaluated the effectiveness of tocilizumab in hospitalized patients with COVID-19 not requiring mechanical ventilation. RCTs comparing tocilizumab with the standard of care treatment in hospitalized patients with COVID-19 pneumonia not requiring mechanical ventilation at the time of administration were included for analysis. The primary outcome was a composite of mechanical ventilation or 28-day mortality and the secondary outcomes were 28-day mortality and major adverse events. A total of 6 RCTs were included for the analysis. Tocilizumab was associated with a statistically significant reduction in the primary composite outcome of mechanical ventilation or 28-day mortality (risk ratio (RR): 0.83 (95% CI: 0.74 to 0.92, I2=0, tau2=0). Treatment with tocilizumab did not show a statistically significant reduction in 28-day mortality (RR: 0.90 (95% CI: 0.76 to 1.07), I2=0, tau2=0) and rate of serious adverse events (RR: 0.82 (95% CI: 0.62 to 1.10), I2=0, tau2=0). Tocilizumab was associated with a decrease in the incidence of primary outcome, that is, mechanical ventilation or death at 28 days in hospitalized patients with COVID-19 pneumonia.