As cases of coronavirus 2019 (COVID-19) keep rising, reported deaths are increasing. Public health measures have been implemented with mixed efficacy. As vaccines are becoming more widely available and accessible globally, treating critically ill COVID-19 patients remains an issue with only dexamethasone found to be therapeutically effective to date. However, trials studying the efficacy of IL-6 inhibitors, namely tocilizumab have been underway with promising results. This paper is a narrative review that aims to review the current evidence provided by randomized clinical trials (RCT) for the use of tocilizumab in COVID-19. Electronic database searches were carried out in Medline, PubMed, Embase, Google Scholar, and ongoing clinical trial registries with the period set from January 1, 2020 to February 20, 2021. Prepublication manuscripts were found using the pre-print repository medRxiv. Keywords included “COVID-19,”“coronavirus,”“SARS-CoV-2,”“sepsis,”“pneumonia,”“cytokine storm,”“cytokine release syndrome,”“IL-6 inhibitors,” and “tocilizumab,” as exact phrases, and a combination of subject headings according to databases syntax. Only trials with a clear and well-defined methodology, at least 100 patients recruited, and which have had results published either after peer review or in pre-print were included. In hospitalized patients with severe COVID-19, who are hypoxic and have a CRP ≥ 75 mg/L, the current evidence favors the use of a combination of tocilizumab and corticosteroids to reduce mortality, among other clinical benefits. There is also overwhelming evidence of the good safety profile of tocilizumab with only few cases of neutropenia reported with a decrease in infection rates. Tocilizumab is currently thought to work through the inhibition of IL-6 receptors (IL-6R), preventing downstream activation of pro-inflammatory reactions and cytokine release syndrome.

随着 2019 年冠状病毒 (COVID-19) 病例不断增加，报告的死亡人数也在增加。公共卫生措施的实施效果参差不齐。随着疫苗在全球范围内变得越来越广泛和容易获得，治疗重症 COVID-19 患者仍然是一个问题，迄今为止只有地塞米松被发现具有治疗效果。然而，研究 IL-6 抑制剂（即托珠单抗）功效的试验正在进行中，并取得了有希望的结果。本文是一篇叙述性综述，旨在回顾随机临床试验 (RCT) 提供的关于使用托珠单抗治疗 COVID-19 的当前证据。在 Medline、PubMed、Embase、Google Scholar 和正在进行的临床试验注册中心进行了电子数据库检索，检索期间为 2020 年 1 月 1 日至 2021 年 2 月 20 日。使用预印本存储库 medRxiv 找到了预发表手稿。关键词包括“COVID-19”、“冠状病毒”、“SARS-CoV-2”、“败血症”、“肺炎”、“细胞因子风暴”、“细胞因子释放综合征”、“IL-6抑制剂”和“托珠单抗” ” 作为精确短语，以及根据数据库语法的主题标题组合。仅纳入采用明确且明确的方法学、至少招募了 100 名患者、并且在同行评审后或预印本中发表结果的试验。对于缺氧且 CRP ≥ 75 mg/L 的重症 COVID-19 住院患者，目前的证据支持联合使用托珠单抗和皮质类固醇以降低死亡率以及其他临床益处。还有压倒性的证据表明托珠单抗具有良好的安全性，只有少数中性粒细胞减少病例报告感染率下降。目前认为托珠单抗通过抑制 IL-6 受体 (IL-6R) 发挥作用，防止下游促炎反应和细胞因子释放综合征的激活。