Beneficial and harmful outcomes of tocilizumab in severe COVID-19: a systematic review and meta-analysis
Abstract
Objectives
Pending for randomized control trials, the use of tocilizumab (TCZ) in COVID-19 remains controversial. We performed a systematic review and meta-analysis to investigate the effect on clinical outcomes of TCZ to treat severe COVID-19.
Methods
From 1 January to 21 August 2020, we searched PubMed (via MEDLINE), Scopus, and medRxiv repository databases for observational studies in any language reporting efficacy and safety of TCZ use in hospitalized adults with COVID-19. Independent and dually data extraction and quality assessment were performed.
Results
Of 57 eligible studies, 27 controlled and 30 not. The overall included patients were 8,128: 4,021 treated with TCZ, in addition to standard of care (SOC), and 4,107 only receiving SOC. The pooled mortality was lower in the TCZ-group, with a relative risk (RR) of 0.73 (95%CI 0.57-0.93; p=0.010). TCZ-treated patients were transferred to the intensive care unit (ICU) in a higher proportion, but ICU mortality was lower than in the control group. Conversely, a higher proportion of TCZ-treated patients developed secondary infections after TCZ use.
Conclusions
TCZ seems beneficial in preventing in-hospital mortality in severe, non-critically ill COVID-19 patients. However, patients receiving TCZ appear to be at higher risk for secondary infections, especially those admitted to ICU.
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