Covid-19 living Data

Pharmacologic treatments for covid-19 patients

Tocilizumab vs Dexamethasone

This comparison will not be updated. Last search date 14 Dec, 2022

Hospitalized patients

Forest plots
(last update: 2022-02-17)

Summary of findings
(last update: 2022-09-27)

Patient or population: COVID-19 patients
Setting: Worldwide
Intervention: Tocilizumab
Comparison: Dexamethasone

Outcome	Relative effect (95% CI)	Absolute effect (95% CI)¹		Certainty of the Evidence (GRADE)
Clinical improvement D28	Outcome not yet measured or reported
Clinical improvement D60	Outcome not yet measured or reported
WHO progression score (level 7 or above) D28	Outcome not yet measured or reported
WHO progression score (level 7 or above) D60	Outcome not yet measured or reported
All-cause mortality D28	RR: 0.51 (0.06 - 4.23)	296 fewer per 1000 (from 568 fewer to 1000 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding adequate randomization, deviation from intended intervention, and selection of the reported results Inconsistency: Serious Inconsistency downgraded by 1 level: I²=:89.5% Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
2 trials Naik NB, 2021; Rashad A, 2021 191 participants		Tocilizumab 308 per 1,000 (36 - 1000)	Dexamethasone 604 per 1,000
All-cause mortality D60	Outcome not yet measured or reported
Viral negative conversion D7	Outcome not yet measured or reported
Adverse events	Outcome not yet measured or reported
Serious adverse events	Outcome not yet measured or reported

¹The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

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Permanent URL for this comparison: https://covid-nma.com/living_data/index.php?comparison=364

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Trial	Funding	Comparisons		Design	Participants	Sample size	Overall risk of bias Highest assessment	Full description
		Treatment 1	Treatment 2
CTRI/2021/04/033263 Naik NB, Cureus, 2021 Full text Commentary Commentary	Public/non profit	Tocilizumab	Dexamethasone High Dose	RCT	Patients with confirmed COVID-19 (moderate-severe) admitted to a single center in India	N=42	Some concerns Details	Full description
NCT04519385 Rashad A, Scientific Reports, 2021 Full text Commentary Commentary	Not reported/unclear	Tocilizumab	Dexamethasone	RCT	Patients with confirmed COVID-19 (severe-critical) admitted to a single center in Egypt	N=149	High Details	Full description