Tocilizumab as a Treatment for Cytokine Storm in COVID-19 Patients: A systematic review

Abstract

Tocilizumab is a competitive interleukin-6 inhibitor agent that has been proposed to combat the COVID-19-related hyperinflammatory state, known as a cytokine storm. This systematic review was conducted to study the treatment of cytokine storm by Tocilizumab in COVID-19 patients. The search strategy (“COVID-19” OR “COVID19” OR SARS-CoV-2”) AND “tocilizumab” AND “cytokine storm” AND “inflammatory markers” AND (“ICU stay duration” OR “intensive care unit stay duration”) AND “mechanical ventilation requirement” AND (mortality OR death) were manually searched through Web of Science, Scopus, and PubMed databases spanned from March 2020 to November 2021. The inclusion criteria were: research articles, human study, clinical trial, and articles in English. The exclusion criteria were: review articles, case reports, early access, editorial materials, letters, short survey, in vivo or in vitro studies. Five articles were included in the analysis. There were four countries had conducted the studies (Italy, China, USA and Netherland) with different study designs (observational (80%) and randomized controlled trials (20%)) involving 649 patients (48% received TCZ) among moderate to severe COVID-19 patients. There were variabilities in the TCZ dosage given with some combination with other medication (methylprednisolone, azithromycin, hydroxychloroquine, lopinavir and ritonavir). TCZ reduce death cases significantly. It improves respiratory function, reduces the incidence of respiratory syndrome and less-invasive mechanical ventilation usage. The level of inflammatory markers such as C-reactive protein, ferritin and lactate dehydrogenase were significantly higher in the TCZ group. Tocilizumab may increase survival and favourable clinical course, improved hypoxia, accelerate respiratory recovery, lower hospital mortality, reduce the likelihood of invasive mechanical ventilation, improve clinical symptoms, represses the deterioration of patients (prolonging survival) and improve inflammation and immune cell function.