Efficacy and safety of tocilizumab in hospitalized COVID-19 patients: A systematic review

ABSTRACT

INTRODUCTION: In this systematic review, we assessed the clinical outcomes, benefits, and adverse effects associated with tocilizumab use in hospitalized COVID-19 patients. We aimed to seek insight on the role of tocilizumab in COVID-19 associated hospitalization. METHODS: A literature search was conducted using the electronic database engines WHO, PubMed, and Google Scholar from December 1st 2019 to June 22nd 2020. The inclusion criteria of the primary studies for our review included 1) RT-PCR SARS-CoV-2 positive patients/ Confirmed COVID-19 patients, 2) Age>/= 18, 3) Need for hospitalization-, 4) Use of tocilizumab for the treatment of COVID-19. The search strategy retrieved 383 studies in total, of which only 37 qualified for inclusion with a total of 677 patients. The primary outcomes analyzed in this study were patients' ?clinical improvement/recovery or stabilization?, ?clinical deterioration but alive at the end of the study? after tocilizumab administration and mortality rate. The secondary outcomes included length of hospital stay (LOS), radiological improvement, and mean change in C - reactive protein (CRP) levels before and after tocilizumab administration, mean change in ferritin levels before and after tocilizumab administration and adverse events. RESULTS: After the administration of 1 or more doses of tocilizumab, clinical improvement/recovery or stabilization was noted in 462 (68.2%) out of 677 patients, whereas 31 (4.6 %) out of 677 patients clinically deteriorated but remained alive at the end of the study. A total of 103 (15.2%) patients died. Radiological improvement was noted in 108 (69.7%) out of 155 patients, the average LOS reported ranged from 5 to 25 days, mean change in CRP levels before and after tocilizumab administration reported ranged from 5.9 mg/L to 2400 mg/L, and the mean decrease in ferritin levels before and after tocilizumab administration reported ranged from 62.08 ng/ml to 51156 ng/ml. Finally, 97 (14.3 %) out of 677 patients experienced one or more adverse events. CONCLUSIONS: In a literature review of 37 studies, Tocilizumab as a management of critically ill hospitalized patients with COVID-19, this drug was found to be associated with improvement in both survival and radiological findings. A minority of patients were reported to have adverse events.