Background Tocilizumab is an IL-6 receptor-blocking agent proposed for the treatment of severe COVID-19. The aim of this systematic review was to describe the rationale for the use of tocilizumab for the treatment of COVID-19 and to summarize the available evidence regarding its efficacy and safety. Methods MEDLINE, PubMed, EMBASE, pre-print repositories (bioRxiv and medRxiv) and two trial Registries were searched for studies on the use of tocilizumab in COVID-19 or SARS-CoV-2 infection, viral pneumonia, and/or sepsis until 20th June 2020. Results We identified 3 indirect pre-clinical studies and 28 clinical studies including 5776 patients with COVID-19 (13 with a comparison group, 15 single-arm). To date, no randomized trials have been published. We retrieved no studies at low risk of bias. Forty-five ongoing studies were retrieved from trial registries. Conclusions There is insufficient evidence regarding the clinical efficacy and safety of tocilizumab in patients with COVID-19. Its use should be considered experimental, requiring ethical approval and clinical trial oversight.
【저자키워드】 COVID-19, SARS-CoV-2, coronavirus, Tocilizumab, Pneumonia, COVID-19, Coronavirus disease 2019, ARDS, acute respiratory distress syndrome, WHO, World Health Organization, TNF, Tumor Necrosis Factor, RA, Rheumatoid arthritis, CPAP, continuous positive airway pressure, IMV, invasive mechanical ventilation, AIFA, Agenzia Italiana del Farmaco, CRS, CAR-T cell-induced cytokine release syndrome, GCA, Giant cell arteritis, ICTRP, International Clinical Trials Registry Platform, IDSA, Infectious Diseases Society of America, NIH, U.S. National Institutes of Health, NIV, Noninvasive mechanical ventilation, pJIA, Pediatric juvenile idiopathic arthritis, SIMIT, Italian Society of Infectious and Tropical disease, sJIA, Juvenile idiopathic arthritis,