Tocilizumab and dexamethasone as treatments for severe COVID-19: a systematic review and meta-analysis

Abstract

Abstract Background: The global pandemic caused by the coronavirus SARS-CoV-2 triggered an urgent need for effective therapeutics to treat severe COVID-19. Various treatments have been studied, including synthetic glucocorticoids and monoclonal antibodies against IL-6. Methods: A systematic search was conducted to identify relevant randomized controlled trials (RCTs) assessing the efficacy of these drugs against the standard of care. Data were pooled from a total of 5849 patients, with 4607 patients in the dexamethasone group and 1242 patients in the tocilizumab group. Meta-analyses compared the effectiveness of two widely used treatments, tocilizumab and dexamethasone, in managing COVID-19 while considering the concomitant use of corticosteroids in tocilizumab patients. Results: Our findings demonstrated a reduction in the odds of unfavourable clinical outcomes with dexamethasone compared to the standard of care, with an odds ratio (OR) of 0.83 [95% confidence interval (CI) 0.74, 0.93] for death at 28 days. In contrast, tocilizumab was not related to a decrease in mortality compared to the standard of care, with an OR of 1.04 [95% CI 0.73, 1.47]. Notably, most patients in the tocilizumab group also received simultaneous corticosteroid treatment. Conclusions: This meta-analysis provides evidence that dexamethasone is more effective than tocilizumab for treating COVID-19, with lower odds ratios for unfavourable clinical outcomes. The concomitant use of corticosteroids in the tocilizumab group may have influenced these findings. These results are essential for optimizing treatment strategies and informing clinical decision-making for patients with severe COVID-19. Further research is warranted to elucidate the specific mechanisms underlying these therapeutic agents' differential efficacy and explore potential synergistic effects in combination therapy.