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
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.
