Association between tocilizumab treatment and clinical outcomes of COVID-19 patients: a systematic review and meta-analysis

Abstract

To explore and summarize the association between treatment with tocilizumab and clinical outcomes in COVID-19 patients. We performed a systematic review and meta-analysis (10 RCTs including 3378 patients in thetocilizumab group and 3142 patients in the control group). We systematically searched PubMed and MedRxiv forall RCTs as of June 1, 2021, to assess the benefits and harms of tocilizumab to treat patients with COVID-19. Allanalyses were carried out using RevMan version 5.4.1. There were nine RCTs published in peer-reviewed journalsand one RCTs published as a preprint. The summary RR for all-cause mortality with tocilizumab was 0.89 (95% CI=0.82-0.96, P= 0.003). There was no significant between-trial heterogeneity (I2= 28%, P= 0.19). However, all peerreviewedRCTs showed no significant associations between treatment with tocilizumab and reductions in all-causemortality. We notably found that tocilizumab significantly reduced the rate of intubation or death in patients withCOVID-19 with 3 RCTs. Across the 8 RCTs, the summary RR for discharge with tocilizumab was 1.10 (95% CI= 1.03-1.16, P< 0.00001). There was no significant association of tocilizumab with harm on other patient-relevant clinicaloutcomes, including increasing secondary infection risk, patients of adverse events, or patients of serious adverseevents. Tocilizumab significantly increased the rate of hospital discharges in COVID-19 patients. Still, it did notdecrease all-cause mortality or increase the risk of secondary infections, patients of adverse events, or patientsfor serious adverse events. Evidence that tocilizumab affects clinical outcomes in patients with COVID-19 requiresfurther proof