Title: Efficacy and safety of Tocilizumab in severe and critical COVID-19: A systematic review and meta-analysis

Abstract

Objectives: Currently published papers and clinical guidelines regarding the effects of tocilizumab in severe and critical COVID-19 are contradictory. The aim of this meta-analysis was to combine the results of clinical studies of different designs to investigate the efficacy and safety of tocilizumab in severely-to-critically ill COVID-19 patients. Methods: A systematic search was performed in PubMed, Embase, CENTRAL, ClinicalTrials.gov, Scopus, and preprint servers up to 26 December 2020. Since a substantial heterogeneity was expected, a random-effects model was applied to calculate the pooled effect size (ES) and 95% confidence interval (CI) for each study outcome. Results: Forty-five comparative studies involving 13,189 patients and 28 single-arm studies involving 1,770 patients were analyzed. The risk of mortality (RR of 0.76 [95%CI 0.65 to 0.89], P < 0.01) and intubation (RR of 0.48 [95%CI 0.24 to 0.97], P = 0.04) were lower in tocilizumab patients compared with controls. We did not find any significant difference in secondary infections, length of hospital stay, hospital discharge before day 14, and ICU admission between groups. Conclusion: Tocilizumab can improve clinical outcomes and reduce mortality rates in severe to critical COVID-19 patients. Large-scale randomized controlled trials are still required to improve the statistical power of meta-analysis.

Biography

Soheila Rezaei is Pharm.D and Ph.D. candidate of Pharmacoeconomics and pharma management, Pharmacy Faculty of Shahid Beheshti Medical University, Tehran, Iran. She interested in some topics of public health that related to Health Economics and Outcome Research, Medication adherence, and Pharmacoeconomics evaluation study. She has been in charge of execution of several scientific studies and cost-effectiveness analysis projects for multinational company offices in Iran like Sanofi Aventis, Roche, and Novo Nordisk. Also, she is finalizing her Ph.D. thesis entitled “Development and empirical analysis of a conceptual model of cost-related medication nonadherence inIranian elderly patients”.Her ambition and desire to everyday learning and quickly growing ishighly appreciated by her colleagues and academic professors. She is an exemplary wife and mother, too.