Abstract
Tocilizumab has been repurposed against the ‘cytokine storm’ in the setting of coronavirus disease 2019 (COVID-19). Our aim was to evaluate the efficacy of tocilizumab in the management of hospitalized COVID-19 patients. We searched MEDLINE, CENTRAL and medRxiv for studies of tocilizumab in hospitalized COVID-19 patients. Primary objective was the effectiveness of tocilizumab on mortality. Secondary objectives included the need for invasive mechanical ventilation (IMV), composite endpoints of mortality or IMV and intensive care unit (ICU) admission or IMV, length of hospitalization and differences in mortality in subgroups (ICU and non-ICU patients and patients receiving or not receiving concomitant corticosteroids). We included 52 studies (nine randomized controlled trials [RCTs] and 43 observational) with a total of 27,004 patients. In both RCTs and observational studies, the use of tocilizumab was associated with a reduction in mortality; 11% in RCTs (risk ratio [RR] 0.89, 95% CI 0.82 to 0.96) and 31% in observational studies (RR 0.69, 95% CI 0.58 to 0.83). The need for IMV was reduced by 19% in RCTs (RR 0.81, 95% CI 0.71 to 0.93), while no significant reduction was observed in observational studies. Both RCTs and observational studies showed a benefit from tocilizumab on the composite endpoint of mortality or IMV. Tocilizumab improved mortality both in ICU and non-ICU patients. Reduction in mortality was evident in observational studies regardless of the use of systemic corticosteroids, while that was not the case in the RCTs. Tocilizumab was associated with lower mortality and other clinically relevant outcomes in hospitalized patients with moderate-to-critical COVID-19.
Keywords: COVID-19; SARS-CoV-2; coronavirus disease; meta-analysis; mortality; tocilizumab.
【저자키워드】 COVID-19, coronavirus disease, Meta-analysis, SARS-CoV-2, Mortality, Tocilizumab, 【초록키워드】 Randomized controlled trial, Efficacy, Cytokine storm, coronavirus, Corticosteroids, intensive care, Hospitalization, Tocilizumab, risk, outcome, observational studies, RCT, observational study, ICU, management, Patient, Effectiveness, Admission, patients, RCTs, Invasive mechanical ventilation, composite endpoint, reduction, subgroup, hospitalized COVID-19 patients, 95% CI, systemic corticosteroids, lower mortality, non-ICU patients, IMV, benefit, improved mortality, evaluate, clinically, nine, receiving, searched, hospitalized patient, reduction in, was reduced, non-ICU patient, Secondary objective, 【제목키워드】 Treatment, systematic review, administration, hospitalized patient,