COVID-19 Evidence Alerts
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Treatment Lin WT, Hung SH, Lai CC, et al. The effect of tocilizumab on COVID-19 patient mortality: A systematic review and meta-analysis of randomized controlled trials. Int Immunopharmacol. 2021 Mar 24;96:107602. doi: 10.1016/j.intimp.2021.107602.
Abstract

OBJECTIVES: This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to investigate the clinical efficacy and safety of tocilizumab for treating patients with COVID-19.

METHODS: The PubMed, Embase, Cochrane Library, Clinicaltrials.gov, WHO International Clinical Trials Registry Platform and the preprint server of medRxiv.org were searched from their inception to February 20, 2021. Only RCTs that compared the treatment efficacy and safety of tocilizumab with the placebo or the standard of care for adult patients with COVID-19 were included in this meta-analysis. The primary outcome was 28-day mortality.

RESULTS: This meta-analysis included eight RCTs which enrolled a total of 6314 patients for randomization, in which 3267 and 3047 patients were assigned to the tocilizumab and control groups, respectively. The mortality at day 28 was 24.4% and 29.9% in patients in the tocilizumab and control groups, respectively, meaning there was no significant difference observed between these two groups (OR, 0.92; 95% CI, 0.66-1.28; I2 = 62). This finding did not change in the subgroup analysis according to the initial use of MV or steroid while enrollment. The patients receiving tocilizumab had a lower rate of mechanical ventilation (MV) and intensive care unit (ICU) admission at day 28 compared with the control group (MV use: OR, 0.75; 95% CI, 0.62-0.90; I2 = 11; ICU admission: OR, 0.51; 95% CI, 0.28-0.92; I2 = 30). There were no significant differences between these two treatment groups in terms of the risk of treatment-emergent adverse events (AEs) (OR, 1.03; 95% CI, 0.71-1.49; I2 = 43), serious AEs (OR, 0.86; 95% CI, 0.67-1.12; I2 = 0) or infection (OR, 0.87; 95% CI, 0.63-1.20; I2 = 0).

CONCLUSIONS: Tocilizumab does not provide a survival benefit for patients with COVID-19, but it may help reduce the risk of MV and ICU admission. In addition, tocilizumab is a safe agent to use for the treatment of COVID-19.

Ratings
Discipline / Specialty Area Score
Infectious Disease
Intensivist/Critical Care
Respirology/Pulmonology
Hospital Doctor/Hospitalists
Internal Medicine
Comments from MORE raters

Hospital Doctor/Hospitalists rater

As a practicing hospitalist, I have noticed an increased use of this new treatment. This review is very helpful and it sheds light on what one should expect when administering this drug.

Infectious Disease rater

So, we are slowly inching back to square one.

Respirology/Pulmonology rater

This meta-analysis suggests decreased need for ICU admission and mechanical ventilation with tocilizumab, however, there is no 28-day mortality benefit. A variety of additional medications such as steroids and ant-viral medications were not excluded. Tocilizumab is a recommended therapy for more severe Covid-19 infection, but this study raises more questions about its efficacy.

Respirology/Pulmonology rater

Very useful paper to put tocilizumab in perspective.

Respirology/Pulmonology rater

Just confirmative.