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

Background: To date, there is no effective treatment for the new coronavirus disease (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 per -formed 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 com-bination 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 = 71%). 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. (c) 2021 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )