Rationale and evidence on the use of tocilizumab in COVID-19: a systematic review

A Cortegiani, M Ippolito, M Greco, V Granone, A Protti, C Gregoretti, A Giarratano, S Einav, M Cecconi

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Tocilizumab is an IL-6 receptor-blocking agent proposed for the treatment of severe COVID-19. The aim of this systematic review was to describe the rationale for the use of tocilizumab for the treatment of COVID-19 and to summarize the available evidence regarding its efficacy and safety.

METHODS: MEDLINE, PubMed, EMBASE, pre-print repositories (bioRxiv and medRxiv) and two trial Registries were searched for studies on the use of tocilizumab in COVID-19 or SARS-CoV-2 infection, viral pneumonia, and/or sepsis until 20th June 2020.

RESULTS: We identified 3 indirect pre-clinical studies and 28 clinical studies including 5776 patients with COVID-19 (13 with a comparison group, 15 single-arm). To date, no randomized trials have been published. We retrieved no studies at low risk of bias. Forty-five ongoing studies were retrieved from trial registries.

CONCLUSIONS: There is insufficient evidence regarding the clinical efficacy and safety of tocilizumab in patients with COVID-19. Its use should be considered experimental, requiring ethical approval and clinical trial oversight.

Original languageEnglish
Pages (from-to)52-66
Number of pages15
Issue number1
Publication statusPublished - Jul 28 2020


  • Animals
  • Antibodies, Monoclonal, Humanized/pharmacology
  • COVID-19/drug therapy
  • Humans
  • Interleukin-6/antagonists & inhibitors
  • SARS-CoV-2


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