Combination therapy of tocilizumab and steroid for COVID-19 patients: A meta-analysis.

ABSTRACT

The coagulation markers, pro-inflammatory cytokines (such as IL-2R, IL-6, IL-10, and TNF-a) and lymphopenia are associated with the severity of coronavirus disease 2019 (COVID-19) disease. The use of anti-inflammatory agents, such as corticosteroids (CS) or tosilizumab (TCZ), has been suggested for the treatment of advanced stage of COVID-19 and the reduction of mechanical ventilators and mortality. The aim of this meta-analysis is to determine the role of combination therapy with tocilizumab and steroids in COVID-19 patients. Relevant studies were found using online international databases, and suitable studies were selected and assessed by two independent researchers. The quality of all papers was determined by a checklist. Heterogeneity assay among the primary studies was evaluated by Cochran's Q-test and I2 index. The statistical analyses were done using the Stata ver. 14 package (StataCorp) software. Publication bias was estimated through Egger's test, and the impact of each study on the overall estimate was assessed by sensitivity analysis. Five studies were entered into this meta-analysis. The results of these studies showed that the risk of death for COVID-19 patients treated with the combination of corticosteroids and tocilizumab compared to tocilizumab and the control group was 0.74 (95% confidence interval [CI] 0.36-1.50) and 0.48 (95% CI 0.31-0.74), respectively. This meta-analysis showed that the risk of death in COVID-19 patients who were treated with corticosteroids and tocilizumab was lower than the tocilizumab alone and control groups (26% and 52%, respectively).