Efficacy and Safety of Tocilizumab for Coronavirus Disease 2019 (Covid-19) Patients: A Systematic Review and Meta-analysis

Background Currently, the data regarding the effectiveness and safety of tocilizumab as treatment for COVID-19 infection is still conflicting. This study aims to give clear evidence regarding the potential benefit and safety of tocilizumab in improving the outcome of COVID-19 patients. Methods We systematically searched the PubMed and Europe PMC database using specific keywords related to our aims until November 1st, 2020. All articles published on COVID-19 and tocilizumab were retrieved. Statistical analysis was done using Review Manager 5.4 software. Results A total of 38 studies with a total of 13 412 COVID-19 patients were included in our analysis. Our meta-analysis showed that tocilizumab treatment is associated with reduction of mortality rate from COVID-19 [OR 0.54 (95 % CI 0.42-0.71), p < 0.00001, I-2 = 79 %, random-effect modelling], but did not alter the severity of COVID-19 [OR 1.05 (95 % CI 0.92-1.20), p = 0.47, I-2 = 84 %, random-effect modelling] and length of hospital stay [Mean Difference 1.77 days (95 % CI - 0.61-4.14 days), p = 0.15, I-2 = 97 %, random-effect modelling]. Tocilizumab also does not associated with serious adverse events compared with standard of care treatment [OR 0.91 (95 % CI 0.71-1.15), p =0.42, I-2 = 46 %, random-effect modelling]. Conclusion Our study does not support the routine use of tocilizumab for COVID-19 patients. Future studies should focus more on other potential therapies for COVID-19 patients.