Supportive Treatment with Tocilizumab for COVID-19: A Systematic Review

Abstract

In December of 2019, an outbreak of inexplicable pneumonia cases in several patients appeared in Wuhan, China. What is now known as coronavirus disease 2019 (COVID-19) has spread widely since then and, as of this writing, has infected over 1.8 million people worldwide and has claimed the lives of over 100,000 patients [1]. The disease, COVID-19, is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 has many similarities to SARS-CoV-1 and Middle East respiratory syndrome coronavirus (MERS-CoV), both of which have also been fatal [2]. The number of cases of COVID-19 continues to increase but there is not an approved vaccine or medication that can be used for treatment. Thus, there is an immense need for treatment strategies to help combat this contagious disease. In previous studies, severe patients that have been hospitalized for COVID-19 have had laboratory results that show an increased level of cytokines, specifically interleukin 6 (IL-6) [3]. This increase may be attributed to the cytokine release syndrome (CRS) that is triggered by a variety of factors such as infections [4]. Since IL-6 plays an important role in CRS, it serves as a possible mechanism of treatment in severe patients. Tocilizumab (TCZ) is a recombinant humanized monoclonal antibody that has an antagonist effect on the IL-6 receptor. It is currently used in the treatment of rheumatoid arthritis, but could also play a key role in treatment for severely ill patients with COVID-19. We performed a systematic review to evaluate outcomes associated with TCZ treatment in patients with COVID-19.