We performed a meta-analysis to determine safety and efficacy of tocilizumab in persons with coronavirus disease-2019 (COVID-19). We searched PubMed, Web of Science and Medline using Boolean operators for studies with the terms coronavirus OR COVID-19 OR 2019-nCoV OR SARS-CoV-2 AND tocilizumab. Review Manager 5.4 was used to analyze data and the modified Newcastle–Ottawa and Jadad scales for quality assessment. We identified 32 studies in 11,487 subjects including three randomized trials and 29 cohort studies with a comparator cohort, including historical controls ( N = 5), a matched cohort ( N = 12), or concurrent controls ( N = 12). Overall, tocilizumab decreased risk of death (Relative Risk [RR] = 0.74; 95% confidence interval [CI], 0.59, 0.93; P = 0.008; I 2 = 80%) but not of surrogate endpoints including ICU admission (RR = 1.40 [0.64,3.06]; P = 0.4; I 2 = 88%), invasive mechanical ventilation (RR = 0.83 [0.57,1.22]; P = 0.34; I 2 = 65%) or secondary infections (RR = 1.30 [0.97,1.74]; P = 0.08; I 2 = 65%) and increased interval of hospitalization of subjects discharged alive(mean difference [MD] = 2 days [<1, 4 days]; P = 0.006; I 2 = 0). RRs of death in studies with historical controls (RR = 0.28 [0.16,0.49; P < 0.001]; I 2 = 62%) or a matched cohort (RR = 0.68 [0.53, 0.87]; P = 0.002; I 2 = 42%) were decreased. In contrast, RRs of death in studies with a concurrent control (RR = 1.10 [0.77, 1.56]; P = 0.60; I 2 = 85%) or randomized (RR = 1.18 [0.57,2.44]; P = 0.66; I 2 = 0) were not decreased. A reduced risk of death was not confirmed in our analyses which questions safety and efficacy of tocilizumab in persons with COVID-19.
【저자키워드】 Infectious diseases, Immunotherapy, 【초록키워드】 COVID-19, coronavirus disease, Meta-analysis, SARS-CoV-2, review, Efficacy, coronavirus, Hospitalization, Tocilizumab, randomized trial, 2019-nCoV, Cohort studies, Relative risk, cohort study, coronavirus disease-2019, Randomized, Cohort, Secondary infection, ICU admission, Control, death, secondary infections, Invasive mechanical ventilation, Analysis, risk of death, Web of Science, Endpoint, not decreased, 95% confidence interval, reduced risk, subject, relative, Boolean operators, performed, was used, searched, determine, question, discharged, Boolean operator, Jadad scale, with COVID-19, 【제목키워드】 COVID-19, coronavirus,