TABLE 3

Summary of evidence and outcomes reported by guidelines discussing tocilizumab

GuidelinesRCTsOutcomes considered
REMAP-CAP (NCT02735707) [63]RECOVERY (NCT04381936) [4]TOCIBRAS (NCT04403685) [52]CORIMUNO-19 (NCT04331808) [53]COVACTA(NCT04320615) [54]EMPACTA (NCT04372186) [55]Salvarani 2021 (NCT04346355) [64]Stone 2020 (NCT04356937) [56]Wang 2020 (ChiCTR2000029765) [67]COVINTOC (CTRI/2020/05/025369) [65]PreToVid (EU-CTR-2020-001375-32) [61]Talaschian 2021 [66]CostMortalityClinical recoveryDischargeSafetyTime to ICU admissionProgression to IMVOther
Guidelines recommending for the use of tocilizumab in at least one population described
ERSa
WHOb
COVID-19 Advisory Ontarioc
AWMFd
CIDSe
SITA/SIP#f
J-SSCG
Government of Mexico
NICEg
IDSAh
NIHi
Guidelines Recommending against the use of tocilizumab in any population described+
MoH Brazil

“✓”: guideline explicitly mentions evidence or outcome. Empty cell: guideline does not explicitly mention evidence or outcome. #: composite end-point of ICU admission, death or clinical worsening led to enrolment discontinuation for futility. : composite of death, mechanical ventilation and clinical worsening. +: includes guidelines which only provided recommendations against tocilizumab or recommended against tocilizumab for at least one disease severity category and reported insufficient evidence for any other categories. Organisations: AWMF: Association of the Scientific Medical Societies in Germany; CIDS: Clinical Infectious Disease Society; ERS: European Respiratory Society; IDSA: Infectious Disease Society of America; J-SSCG: Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock; MoH: Ministry of Health; NICE: National Institute for Health and Care Excellence; NIH: National Institutes of Health; SIP: Italian Society of Pulmonology; SITA: Italian Society of Anti-Infective Therapy; SSC: Surviving Sepsis Campaign; WHO: World Health Organization. Abbreviations: ICU: intensive care unit; IMV: invasive mechanical ventilation; NCT: National Clinical Trial; NR: not reported; RCT: randomised controlled trial. Other outcomes considered: a: clinical worsening. b: duration of IMV. c: composite or mortality or invasive mechanical ventilation was considered; respiratory or cardiovascular organ support-free days was considered. d: need for new haemodialysis/haemofiltration.e: ventilator-free days. f: disease progression; scoring higher than 5 on day 4 on a 10-point ordinal clinical scale. g: ordinal scale combining in-hospital mortality and days free of organ support by Day 21, days free of organ support in survivors by Day 21. h: clinical deterioration (follow-up: range 14 days to 30 days). i: progression to high-flow oxygen or noninvasive ventilation. Sources: AWMF, October 2021 [24]; CIDS, May 2021 [25]; COVID-19 Advisory Ontario, March 2021 [72]; ERS, April 2021 [10]; Government of Mexico, August 2021 [35]; IDSA, October 2021 [36]; J-SSCG, September 2021 [37]; MoH Brazil, May 2021 [38]; NICE, January 2022 [8]; NIH, December 2021 [39]; SITA/SIP, May 2021 [40]; WHO, January 2022 [9].