Rationale and evidence on the use of tocilizumab in COVID-19: a systematic review

A. Cortegiani; M. Ippolito; M. Greco; V. Granone; A. Protti; C. Gregoretti; A. Giarratano; S. Einav; M. Cecconi

Pulmonology (Jan 2021)

Rationale and evidence on the use of tocilizumab in COVID-19: a systematic review

A. Cortegiani,
M. Ippolito,
M. Greco,
V. Granone,
A. Protti,
C. Gregoretti,
A. Giarratano,
S. Einav,
M. Cecconi

Affiliations

A. Cortegiani: Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo. Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy; Corresponding author.
M. Ippolito: Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo. Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
M. Greco: Department of Anesthesiology and Intensive Care, Humanitas Clinical and Research Center – IRCCS, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
V. Granone: Department of Anesthesiology and Intensive Care, Humanitas Clinical and Research Center – IRCCS, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
A. Protti: Department of Anesthesiology and Intensive Care, Humanitas Clinical and Research Center – IRCCS, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy
C. Gregoretti: Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo. Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy; Fondazione “Giglio”, Cefalù, Italy
A. Giarratano: Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo. Department of Anesthesia Intensive Care and Emergency, Policlinico Paolo Giaccone, Palermo, Italy
S. Einav: IntensiveCare Unit of the Shaare Zedek Medical Medical Centre and Hebrew University Faculty of Medicine, Jerusalem, Israel
M. Cecconi: Department of Anesthesiology and Intensive Care, Humanitas Clinical and Research Center – IRCCS, Milan, Italy; Department of Biomedical Science, Humanitas University, Milan, Italy

Journal volume & issue: Vol. 27, no. 1
pp. 52 – 66

Abstract

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Background: Tocilizumab is an IL-6 receptor-blocking agent proposed for the treatment of severe COVID-19. The aim of this systematic review was to describe the rationale for the use of tocilizumab for the treatment of COVID-19 and to summarize the available evidence regarding its efficacy and safety. Methods: MEDLINE, PubMed, EMBASE, pre-print repositories (bioRxiv and medRxiv) and two trial Registries were searched for studies on the use of tocilizumab in COVID-19 or SARS-CoV-2 infection, viral pneumonia, and/or sepsis until 20th June 2020. Results: We identified 3 indirect pre-clinical studies and 28 clinical studies including 5776 patients with COVID-19 (13 with a comparison group, 15 single-arm). To date, no randomized trials have been published. We retrieved no studies at low risk of bias. Forty-five ongoing studies were retrieved from trial registries. Conclusions: There is insufficient evidence regarding the clinical efficacy and safety of tocilizumab in patients with COVID-19. Its use should be considered experimental, requiring ethical approval and clinical trial oversight.

Published in Pulmonology

ISSN: 2531-0429 (Print); 2531-0437 (Online)
Publisher: Elsevier España
Country of publisher: Spain
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the respiratory system
Website: https://www.journals.elsevier.com/pulmonology

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