Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Methodol. May 20, 2021; 11(3): 95-109
Published online May 20, 2021. doi: 10.5662/wjm.v11.i3.95
Tocilizumab as treatment for COVID-19: A systematic review and meta-analysis
Fausto Petrelli, Sara Cherri, Michele Ghidini, Gianluca Perego, Antonio Ghidini, Alberto Zaniboni
Fausto Petrelli, Oncology Unit, Asst Bergamo Ovest, Milano 20124, Italy
Sara Cherri, Department of Clinical Oncology, Fondazione Poliambulanza, Brescia 25124, Italy
Michele Ghidini, Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Gianluca Perego, Pharmacy Unit, San Raffaele Hospital, Milano 20100, Italy
Antonio Ghidini, Department of Medicine, Casa di Cura Igea, Milano 20100, Italy
Alberto Zaniboni, Department of Oncology, Fondazione Poliambulanza, Brescia 25124, Italy
Author contributions: All authors made equal contribution to this manuscript.
Conflict-of-interest statement: The authors declare no conflict of interest.
PRISMA 2009 Checklist statement: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed for evaluating records identified during the literature search.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fausto Petrelli, MD, Oncology Unit, Asst Bergamo Ovest, Piazzale Ospedale 1, Milano 20124, Italy. faustopetrelli@gmail.com
Received: November 1, 2020
Peer-review started: November 1, 2020
First decision: November 30, 2020
Revised: December 2, 2020
Accepted: March 28, 2021
Article in press: March 28, 2021
Published online: May 20, 2021
Abstract
BACKGROUND

The majority of patients with coronavirus disease 2019 (COVID-19) have good prognoses, but some develop a critical illness that can lead to death. Evidence shows severe acute respiratory syndrome is closely related to the induced cytokine storm. Interleukin-6 is a key player; its role in systemic inflammation is well known.

AIM

To evaluate the effect of tocilizumab (TCZ), an interleukin-6 receptor antagonist, on the outcomes for patients with COVID-19 pneumonia.

METHODS

PubMed, EMBASE, SCOPUS, Web of Science, MedRxiv, Science Direct, and the Cochrane Library were searched from inception to 9th June 2020 for observational or prospective studies reporting results of hospitalized adult patients with COVID-19 infection treated with TCZ. Effect sizes were reported as odds ratios (ORs) with 95% confidence intervals (CIs), and an OR less than 1 was associated with a better outcome in those treated with TCZ.

RESULTS

Overall 13476 patients (33 studies; n = 3264 received TCZ) with COVID-19 pneumonia and various degree of severity were included. Outcome was improved with TCZ. In the primary analysis (n = 19 studies reporting data), mortality was reduced in patients treated with TCZ (OR = 0.64, 95%CI: 0.47-0.87; P < 0.01). In 9 studies where risk of death with TCZ use was controlled for other variables mortality was reduced by 57% (OR = 0.43, 95%CI: 0.27-0.7; P < 0.01). Intensive care need (mechanical ventilation) was also reduced (OR = 0.36, 95%CI: 0.14-0.89; P = 0.02).

CONCLUSION

In COVID-19-infected patients treated with TCZ, outcome may be improved compared to those not treated with TCZ.

Keywords: Tocilizumab, COVID-19, Pandemic, Treatment, Meta-analysis, Review

Core Tip: Coronavirus disease 2019 (COVID-19) infection is associated with a citokine storm during acute phase. Interleukin-6 is a key player in this systemic inflammation. We evaluated the effect of tocilizumab (TCZ) on the outcomes of COVID-19 pneumonia. Mortality was reduced in patients treated with TCZ (Odds ratio =0.64, 95% confidence intervals: 0.47-0.87; P < 0.01). We conclude that TCZ may improve outcome of COVID-19 infected patients.