Efficacy and safety of Tocilizumab in severe and critical COVID-19: A Systematic Review and Meta-Analysis.
Soheila Rezaei,Behzad Fatemi,Zahra Karimi Majd,Hossein Minaei,Mohammad Peikanpour,Nassim Anjidani,Ali Taheri,Farzaneh Dastan,Reza Mosaed +8 more
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TLDR
In this article, a meta-analysis was performed to investigate the efficacy and safety of tocilizumab in severely-to-critically ill COVID-19 patients.Abstract:
OBJECTIVES: Currently published papers and clinical guidelines regarding the effects of tocilizumab in severe and critical COVID-19 are contradictory. The aim of this meta-analysis was to combine the results of clinical studies of different designs to investigate the efficacy and safety of tocilizumab in severely-to-critically ill COVID-19 patients. METHODS: A systematic search was performed in PubMed, Embase, CENTRAL, ClinicalTrials.gov, Scopus, and preprint servers up to 26 December 2020. Since a substantial heterogeneity was expected, a random-effects model was applied to calculate the pooled effect size (ES) and 95% confidence interval (CI) for each study outcome. RESULTS: Forty-five comparative studies involving 13,189 patients and 28 single-arm studies involving 1,770 patients were analyzed. The risk of mortality (RR of 0.76 [95%CI 0.65 to 0.89], P < 0.01) and intubation (RR of 0.48 [95%CI 0.24 to 0.97], P = 0.04) were lower in tocilizumab patients compared with controls. We did not find any significant difference in secondary infections, length of hospital stay, hospital discharge before day 14, and ICU admission between groups. CONCLUSION: Tocilizumab can improve clinical outcomes and reduce mortality rates in severe to critical COVID-19 patients. Large-scale randomized controlled trials are still required to improve the statistical power of meta-analysis.read more
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TL;DR: TCZ appears to be an effective treatment option in COVID‐19 patients with a risk of cytokine storms and for these critically ill patients with elevated IL‐6, the repeated dose of the TCZ is recommended.
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Tocilizumab in patients with severe COVID-19: a retrospective cohort study
Giovanni Guaraldi,Marianna Meschiari,Alessandro Cozzi-Lepri,Jovana Milic,Roberto Tonelli,Marianna Menozzi,Erica Franceschini,Gianluca Cuomo,Gabriella Orlando,Vanni Borghi,Antonella Santoro,Margherita Di Gaetano,Cinzia Puzzolante,Federica Carli,Andrea Bedini,Luca Corradi,Riccardo Fantini,Ivana Castaniere,Luca Tabbì,Massimo Girardis,Sara K. Tedeschi,Maddalena Giannella,Michele Bartoletti,Renato Pascale,Giovanni Dolci,Lucio Brugioni,Antonello Pietrangelo,Andrea Cossarizza,Federico Pea,Enrico Clini,Carlo Salvarani,Marco Massari,Pierluigi Viale,Cristina Mussini +33 more
TL;DR: Assessment of the role of tocilizumab in reducing the risk of invasive mechanical ventilation and death in patients with severe COVID-19 pneumonia who received standard of care treatment found it to be associated with a reduced risk.