Published online May 20, 2021. doi: 10.5662/wjm.v11.i3.95
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
Processing time: 192 Days and 0.7 Hours
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.
To evaluate the effect of tocilizumab (TCZ), an interleukin-6 receptor antagonist, on the outcomes for patients with COVID-19 pneumonia.
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.
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).
In COVID-19-infected patients treated with TCZ, outcome may be improved compared to those not treated with TCZ.
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.