Efficacy of tocilizumab in COVID-19: A systematic review and meta-analysis.
Muhammad AzizHossein HaghbinEmad Abu SittaYusuf NawrasRawish FatimaSachit SharmaWade Lee-SmithJoan DugganJoel A KammeyerJennifer HanrahanRagheb AssalyPublished in: Journal of medical virology (2020)
The efficacy of tocilizumab (TOC), monoclonal antibody against interleukin-6 (IL-6) receptor, in patients with coronavirus disease-2019 (COVID-19) patients has led to conflicting results. We performed a systematic review and meta-analysis to compare the efficacy of addition of TOC to standard of care (SOC) versus SOC in patients with COVID-19. We performed a comprehensive literature search of PubMed, Embase, Web of Science, WHO COVID, LitCOVID, and Cochrane databases. Pooled outcomes (overall mortality, need for mechanical ventilation, intensive care unit admission, and secondary infections) were compared using DerSimonian-Laird/Random-effects approach. Risk difference (RD), confidence interval (CI), and p values were generated. A total of 23 studies with 6279 patients (1897 in TOC and 4382 in SOC group, respectively) were included. The overall mortality was lower in TOC group compared to SOC group (RD: -0.06; CI: -0.12 to -0.01; p = .03). Subgroup analysis including studies with only severe cases revealed lower mortality (RD: -0.12; CI: -0.18 to -0.06; p < .01) and need for mechanical ventilation (RD: -0.11; CI: -0.19 to -0.02; p = .01) in TOC group compared to SOC group. The addition of TOC to SOC has the potential to reduce mortality and need for mechanical ventilation in patients with severe COVID-19. Randomized controlled trials are needed to validate this.
Keyphrases
- mechanical ventilation
- coronavirus disease
- intensive care unit
- acute respiratory distress syndrome
- sars cov
- cardiovascular events
- respiratory failure
- monoclonal antibody
- rheumatoid arthritis
- risk factors
- randomized controlled trial
- respiratory syndrome coronavirus
- emergency department
- healthcare
- early onset
- palliative care
- ejection fraction
- systematic review
- clinical trial
- juvenile idiopathic arthritis
- coronary artery disease
- patient reported outcomes
- adipose tissue
- machine learning
- prognostic factors
- climate change
- meta analyses
- chronic pain