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46 tocilizumab COVID-19 controlled studies, 13 RCTs
8% improvement, RR
0.92
[0.78-1.08]
Supplementary Data — Tocilizumab for COVID-19: real-time meta analysis of 46 studies
0
0.25
0.5
0.75
1
1.25
1.5
1.75
2+
SMACORE
Colaneri (PSM)
18%
0.82 [0.07-3.41]
death
5/21
19/91
Improvement, RR [CI]
Treatment
Control
SMACORE
Colaneri (PSM)
88%
0.12 [0.00-2.57]
ICU
3/21
12/91
Ip
24%
0.76 [0.57-1.00]
death
134 (n)
413 (n)
Rojas-Marte
21%
0.79 [0.60-1.05]
death
43/96
55/97
Campochiaro
53%
0.47 [0.18-1.20]
death
5/32
11/33
Campochiaro
-106%
2.06 [0.41-10.5]
ventilation
4/32
2/33
Campochiaro
27%
0.73 [0.42-1.27]
no disch.
12/32
17/33
Campochiaro
21%
0.79 [0.41-1.54]
no improv.
10/32
13/33
Somers (PSW)
45%
0.55 [0.33-0.90]
death
78 (n)
76 (n)
Carvalho
-166%
2.66 [0.32-5.52]
death
5/29
4/24
Maeda
0%
1.00 [0.27-3.72]
death
23 (n)
201 (n)
Gokhale
38%
0.62 [0.38-0.99]
death
70 (n)
91 (n)
Kewan
-23%
1.23 [0.22-6.76]
death
3/28
2/23
Kewan
-40%
1.40 [0.80-2.43]
no disch.
17/28
10/23
Kewan
30%
0.70 [0.43-1.15]
ventilation time
28 (n)
23 (n)
Kewan
-57%
1.57 [0.84-2.93]
hosp. time
28 (n)
23 (n)
Pettit
-71%
1.71 [1.00-2.91]
death
29/74
17/74
Guaraldi
62%
0.38 [0.17-0.83]
death
13/125
73/179
Guaraldi
39%
0.61 [0.40-0.92]
death/int.
125 (n)
179 (n)
Menzella
45%
0.55 [0.22-1.35]
death
41 (n)
38 (n)
Menzella
56%
0.44 [0.22-0.89]
death/int.
41 (n)
38 (n)
Okoh
-167%
2.67 [0.66-10.8]
death
4/20
3/40
Okoh
-344%
4.44 [1.34-14.8]
ICU
10/30
3/40
Guisado-Vasco
-140%
2.40 [1.13-5.11]
death
132 (n)
475 (n)
Rossi (PSM)
64%
0.36 [0.18-0.70]
death
84 (n)
84 (n)
Rossi (PSM)
60%
0.40 [0.23-0.70]
death/int.
84 (n)
84 (n)
Patel
9%
0.91 [0.45-1.83]
death
21 (n)
21 (n)
Patel
33%
0.67 [0.22-2.03]
death
4/21
6/21
Patel
-11%
1.11 [0.45-2.74]
death
7/21
6/20
Chilimuri
60%
0.40 [0.20-0.77]
death/int.
83 (n)
685 (n)
Kimmig
-82%
1.82 [0.96-3.47]
death
19/54
11/57
Masiá
80%
0.20 [0.04-0.93]
death
2/76
8/62
Masiá
8%
0.92 [0.38-2.24]
ICU
9/76
8/62
Masiá
-44%
1.44 [1.18-1.77]
hosp. time
76 (n)
62 (n)
Masiá (PSM)
-68%
1.68 [0.36-7.81]
viral+
29 (n)
29 (n)
Langer-Gould
-117%
2.17 [0.05-5.56]
death
24/52
9/41
OT1
Biran (PSM)
29%
0.71 [0.56-0.89]
death
205 (n)
416 (n)
Tsai (PSM)
0%
1.00 [0.57-1.75]
death
18/66
18/66
Roumier
32%
0.68 [0.31-1.48]
death
49 (n)
47 (n)
Roumier
42%
0.58 [0.36-0.94]
ventilation
49 (n)
47 (n)
Roumier
45%
0.55 [0.36-0.82]
no disch.
49 (n)
47 (n)
Hill
43%
0.57 [0.21-1.52]
death
43 (n)
45 (n)
Hill
8%
0.92 [0.38-2.22]
no improv.
43 (n)
45 (n)
Canziani
18%
0.82 [0.42-1.58]
death
64 (n)
64 (n)
TOCICOV
Ruiz-Antorán (PSW)
26%
0.74 [0.62-0.89]
death
268 (n)
238 (n)
BACC Bay
Stone (DB RCT)
-52%
1.52 [0.41-5.61]
death
9/161
3/82
BACC Bay
Stone (DB RCT)
35%
0.65 [0.26-1.62]
ventilation
11/161
8/82
BACC Bay
Stone (DB RCT)
17%
0.83 [0.38-1.81]
death/int.
17/161
10/82
BACC Bay
Stone (DB RCT)
-11%
1.11 [0.59-2.10]
progression
31/161
14/82
Wang (RCT)
27%
0.73 [0.32-1.66]
progression
7/24
8/20
Wang (RCT)
54%
0.46 [0.09-2.32]
no recov.
2/34
4/31
Wang (RCT)
79%
0.21 [0.05-0.87]
no recov.
2/24
8/20
Wang (RCT)
-8%
1.08 [0.92-1.28]
hosp. time
34 (n)
31 (n)
Wang (RCT)
-6%
1.06 [0.88-1.28]
viral time
34 (n)
31 (n)
Gupta
29%
0.71 [0.56-0.92]
death
433 (n)
3,491 (n)
RCT-TCZ-COVID-19
Salvarani (RCT)
-110%
2.10 [0.20-22.6]
death
2/60
1/63
RCT-TCZ-COVID-19
Salvarani (RCT)
-26%
1.26 [0.41-3.91]
ICU
6/60
5/63
RCT-TCZ-COVID-19
Salvarani (RCT)
-26%
1.26 [0.41-3.91]
no disch.
6/60
5/63
RCT-TCZ-COVID-19
Salvarani (RCT)
-5%
1.05 [0.59-1.86]
no disch.
17/60
17/63
CORIMUNO-TOCI-1
Hermine (RCT)
7%
0.93 [0.36-2.42]
death
7/63
8/67
CORIMUNO-TOCI-1
Hermine (RCT)
-24%
1.24 [0.44-3.49]
death
7/63
6/67
CORIMUNO-TOCI-1
Hermine (RCT)
62%
0.38 [0.15-0.99]
ventilation
5/63
14/67
CORIMUNO-TOCI-1
Hermine (RCT)
34%
0.66 [0.39-1.15]
progression
15/63
24/67
EMPACTA
Salama (DB RCT)
-22%
1.22 [0.62-2.38]
death
26/249
11/128
EMPACTA
Salama (DB RCT)
44%
0.56 [0.33-0.97]
death/int.
249 (n)
128 (n)
TOCIBRAS
Veiga (RCT)
-130%
2.30 [0.94-5.61]
death
14/65
6/64
TOCIBRAS
Veiga (RCT)
1%
0.99 [0.65-1.49]
no recov.
65 (n)
64 (n)
Fisher
-4%
1.04 [0.27-3.75]
death
45 (n)
70 (n)
Martínez-Sanz
35%
0.65 [0.19-2.25]
death
n/a
n/a
Martínez-Sanz
66%
0.34 [0.17-0.71]
death
n/a
n/a
Martínez-Sanz
-21%
1.21 [0.65-2.23]
death
n/a
n/a
SAMI-COVID
Rodríguez-.. (PSM)
78%
0.22 [0.05-0.96]
death
88 (n)
176 (n)
SAMI-COVID
Rodríguez-.. (PSM)
58%
0.42 [0.19-0.92]
death/int.
88 (n)
176 (n)
COVACTA
Rosas (DB RCT)
-1%
1.01 [0.68-1.52]
death
58/294
28/144
COVACTA
Rosas (DB RCT)
24%
0.76 [0.53-1.09]
ventilation
51/183
33/90
COVACTA
Rosas (DB RCT)
41%
0.59 [0.37-0.94]
ICU
27/127
23/64
COVACTA
Rosas (DB RCT)
22%
0.78 [0.54-1.12]
recov. time
294 (n)
144 (n)
REMAP-CAP
Gordon (RCT)
22%
0.78 [0.63-0.97]
death
98/350
127/355
De Rosa
-41%
1.41 [0.66-2.99]
death
97 (n)
1,239 (n)
COVINTOC
Soin (RCT)
29%
0.71 [0.34-1.46]
death
11/91
15/88
COVINTOC
Soin (RCT)
-4%
1.04 [0.52-2.09]
ventilation
14/91
13/88
COVINTOC
Soin (RCT)
30%
0.70 [0.30-1.67]
progression
8/91
11/88
COVINTOC
Soin (RCT)
-7%
1.07 [0.91-1.27]
ICU
71/91
64/88
RECOVERY
Horby (RCT)
12%
0.88 [0.81-0.96]
death
621/2,022
729/2,094
RECOVERY
Horby (RCT)
21%
0.79 [0.69-0.92]
ventilation
265/1,754
343/1,800
RECOVERY
Horby (RCT)
14%
0.86 [0.81-0.92]
no disch.
872/2,022
1,050/2,094
CORIMUNO-SARI-2
Hermine (RCT)
33%
0.67 [0.30-1.49]
death
49 (n)
43 (n)
Ho
-290%
3.90 [2.96-5.13]
death
Talaschian (DB RCT)
-40%
1.40 [0.45-4.37]
death
5/17
4/19
Talaschian (DB RCT)
47%
0.53 [0.17-1.59]
no disch.
17 (n)
19 (n)
Talaschian (DB RCT)
-40%
1.40 [0.45-4.37]
no recov.
5/17
4/19
Talaschian (DB RCT)
-11%
1.11 [0.66-1.87]
recov. time
17 (n)
19 (n)
Yen
-58%
1.58 [0.98-2.57]
death
67 (n)
2,129 (n)
COVIDOSE-2
Reid (RCT)
-56%
1.56 [0.17-14.3]
death
3/50
1/26
COVIDOSE-2
Reid (RCT)
66%
0.34 [0.01-7.92]
death
0/25
1/26
COVIDOSE-2
Reid (RCT)
-212%
3.12 [0.35-28.0]
death
3/25
1/26
COVIDOSE-2
Reid (RCT)
-2%
1.02 [0.59-1.77]
recov. time
25 (n)
26 (n)
COVIDOSE-2
Reid (RCT)
20%
0.80 [0.62-1.04]
recov. time
25 (n)
26 (n)
COVIDOSE-2
Reid (RCT)
-40%
1.40 [0.89-2.20]
recov. time
25 (n)
26 (n)
Tocilizumab COVID-19 outcomes
c19 early .org
June 2025
1 OT: comparison with other treatment
Favors tocilizumab
Favors control
Figure S2. Comparison of results for RCTs versus observational studies.
For COVID-19 treatments, there is no significant difference between the results of RCTs and observational studies. Observational studies do not systematically over or underestimate efficacy. For high-cost treatments, there is a non-significant trend towards RCTs showing greater efficacy.
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