Tocilizumab and Systemic Corticosteroids in the Management of Patients with COVID-19: A Systematic Review and Meta-Analysis

Abstract

Background : To date, there is no effective treatment for the new coronavirus (COVID-19). We aimed to systematically review the literature on the association between the combination of tocilizumab (TCZ) and systemic corticosteroid therapy (SCT) on outcomes of COVID-19 patients. Methods : We searched MEDLINE, Cochrane Central, and preprints, for studies in which health outcomes were compared between adults with severe COVID-19 who received TCZ and SCT and those who received standard of care without TCZ. Record screening, data extraction, and risk of bias assessment were performed in duplicate. Random effect models were used when pooling crude numbers and adjusted effect estimates of study outcomes. Results : Our search identified seventeen studies. The pooled crude mortality rate was lower in the combination arm (relative risk, RR=0.62, 95% confidence interval [CI]=0.42 – 0.91; I 2 =60%). The adjusted mortality rates were also lower in the combination arm (RR=0.58, 95% CI=0.42 – 0.81; I 2 =75%). The rate of superinfections did not differ between the two interventions. Conclusions : The findings of this study show that combination of TCZ and SCT compared to SOC has lower mortality rates. There is an urgent need for well-designed randomized trials to assess the safety and efficacy of this combination in subjects with severe COVID-19.

Corticosteroids for treatment of COVID-19: effect, evidence, expectation and extent

“…The patients suffer CSS elevated levels of cytokines thus raising interleukin-6 (IL-6), interleukin-10 (IL-10) and interferon-gamma (IFN-γ). The scientific reports indicate that the SARS-CoV-2 infection is associated with a significant increase in IL-6 [ 51 , 52 ]. Tocilizumab is a monoclonal antibody that inhibits IL-6, and the FDA has already granted emergency use authorization for the management of COVID-19 related CSS and organ failure.…”

Tocilizumab treatment in COVID-19: A prognostic study using propensity score matching

“…23 It was reported that in subjects with severe COVID-19, the use of both TCZ and systemic corticosteroid therapy compared to no TCZ treatment reduced the risk of mortality. 24 For severe COVID-19 patients, the addition of TCZ to the standard of care may reduce mortality and the need for mechanical ventilation. 25 A meta-analysis that included 25 peerreviewed publications determined that TCZ treatment is related to a decreased risk of mortality and the need for mechanical ventilation, as well as a better prognosis in COVID-19 patients, particularly those who are critically ill. 26 In the unmatched population, patients who received TCZ had greater NIMV, HFNO, mechanical ventilation requirements, and mortality.…”

Tocilizumab in critically ill COVID-19 patients: An observational study

“…Several randomized controlled trials (RCTs) and cohort studies have been conducted in search of effective therapies for COVID-19 with conflicting results [1] , [6] , [7] , [8] , [9] , [10] , [11] , [12] . Systemic corticosteroids were the first of these treatments which showed mortality benefits in patients who received oxygen and ventilatory support in the RECOVERY trial [10] .…”