Tocilizumab in Patients with COVID-19 Pneumonia: A Systematic Review A
Abstract
Background: The use of IL-6 blocking agents has been proposed as a therapeutic option for COVID-19 pneumonia in view of the involvement of this cytokine in inflammation. Tocilizumab is the most widely evaluated IL-6 blocker within this context. In this review we looked at the evidence for safety, efficacy and outcomes of tocilizumab treatment for COVID-19 pneumonia.
Methods: A systematic search in PubMed, covering 2020 and part of 2021, yielded a sample of 19 randomized clinical trials. The present review was conducted and reported following PRISMA-IPD guidelines.
Results: The selected trials were conducted in Europe (n=6; 31.5%), Asia (n=6; 31.5%), multiple continents (n=3; 15.7%), North America (n=2; 10.5%), South America (n=1; 5.2%), and Africa (n=1; 5.2%), evaluating 7,961 adult patients, of whom 4,061 received tocilizumab and 3,630 received standard care or placebo. Tocilizumab reduced mortality in most patients (n=2985; 87.9%). Benefits were also observed with regard to hospital discharge (2 trials; one of them had a cohort of 2022 tocilizumab users, of whom 56% were benefited; the other had a cohort of 350 tocilizumab users, whom were benefited in a hazards ratio of 1.44), clinical outcomes (2 trials, with a total of 392 patients, perceived tocilizumab in a positive manner [n=350/HR=1.44 and n=42/83,3%]; 4 trials saw no benefit [n=73/39% and n=294/OR=1.26]), and the composite outcome of mechanical ventilation and death (n=2003; 32%). Patients undergoing treatment with…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 7,961 participants or records.
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