tetano
Editor, Senior Moderator
Emerg Microbes Infect
. 2022 Mar 28;1-41.
doi: 10.1080/22221751.2022.2059405. Online ahead of print.
Clinical efficacy and safety of interleukin-6 receptor antagonists (tocilizumab and sarilumab) in patients with COVID-19: A systematic review and meta-analysis
Su-Yeon Yu[SUP] 1 [/SUP], Dae-Hyup Koh[SUP] 1 [/SUP], Miyoung Choi[SUP] 1 [/SUP], Seungeun Ryoo[SUP] 1 [/SUP], Kyungmin Huh[SUP] 2 [/SUP], Joon Sup Yeom[SUP] 3 [/SUP], Young Kyung Yoon[SUP] 4 [/SUP]
Affiliations
Abstract
Background: This study investigated the efficacy and safety of interleukin-6 (IL-6) receptor antagonists with standard care treatment in patients with coronavirus disease 2019 (COVID-19).
Methods: The randomized controlled trials comparing the efficacy and safety of tocilizumab or sarilumab treatment in patients with COVID-19 were identified through systematic searches of electronic databases through February 10, 2022, and risk of bias assessments and meta-analysis was followed for the systemic review.
Results: In total, 17 trials comprising 8,614 patients were included. Compared with exclusive standard care or placebo, IL-6 receptor antagonists with standard of care treatment were associated with a significantly reduced all-cause mortality at 28 days (pooled risk ratios [RR], 0.88; 95% confidence interval (CI), 0.82-0.95; 17 studies] and progression to invasive mechanical ventilation (RR, 0.79; 95% CI, 0.71-0.88; nine studies). Particularly, the subgroup of patients with moderate-to-severe COVID-19 showed a significant mortality benefit (RR, 0.89; 95% CI, 0.81-0.96; four studies) and a reduced risk for mechanical ventilation (RR, 0.80; 95% CI, 0.70-0.91; three studies) with tocilizumab treatment. The frequency of serious adverse events was lower in the tocilizumab treatment group than in the standard of care treatment group (RR, 0.83; 95% CI, 0.71-0.97; 11 studies), with no significant difference in the sarilumab treatment group (RR, 1.12; 95% CI, 0.89-1.40; four studies).
Conclusion: Our meta-analysis demonstrated that tocilizumab treatment showed promising results in reducing 28-day mortality and progression to mechanical ventilation in patients with moderate-to-severe COVID-19, without the burden of serious adverse events.Trial registration: Clinical Trials Registry India identifier: CTRI/2020/05/025369..
Keywords: COVID-19; meta-analysis; sarilumab; systematic review; tocilizumab.
. 2022 Mar 28;1-41.
doi: 10.1080/22221751.2022.2059405. Online ahead of print.
Clinical efficacy and safety of interleukin-6 receptor antagonists (tocilizumab and sarilumab) in patients with COVID-19: A systematic review and meta-analysis
Su-Yeon Yu[SUP] 1 [/SUP], Dae-Hyup Koh[SUP] 1 [/SUP], Miyoung Choi[SUP] 1 [/SUP], Seungeun Ryoo[SUP] 1 [/SUP], Kyungmin Huh[SUP] 2 [/SUP], Joon Sup Yeom[SUP] 3 [/SUP], Young Kyung Yoon[SUP] 4 [/SUP]
Affiliations
- PMID: 35343397
- DOI: 10.1080/22221751.2022.2059405
Abstract
Background: This study investigated the efficacy and safety of interleukin-6 (IL-6) receptor antagonists with standard care treatment in patients with coronavirus disease 2019 (COVID-19).
Methods: The randomized controlled trials comparing the efficacy and safety of tocilizumab or sarilumab treatment in patients with COVID-19 were identified through systematic searches of electronic databases through February 10, 2022, and risk of bias assessments and meta-analysis was followed for the systemic review.
Results: In total, 17 trials comprising 8,614 patients were included. Compared with exclusive standard care or placebo, IL-6 receptor antagonists with standard of care treatment were associated with a significantly reduced all-cause mortality at 28 days (pooled risk ratios [RR], 0.88; 95% confidence interval (CI), 0.82-0.95; 17 studies] and progression to invasive mechanical ventilation (RR, 0.79; 95% CI, 0.71-0.88; nine studies). Particularly, the subgroup of patients with moderate-to-severe COVID-19 showed a significant mortality benefit (RR, 0.89; 95% CI, 0.81-0.96; four studies) and a reduced risk for mechanical ventilation (RR, 0.80; 95% CI, 0.70-0.91; three studies) with tocilizumab treatment. The frequency of serious adverse events was lower in the tocilizumab treatment group than in the standard of care treatment group (RR, 0.83; 95% CI, 0.71-0.97; 11 studies), with no significant difference in the sarilumab treatment group (RR, 1.12; 95% CI, 0.89-1.40; four studies).
Conclusion: Our meta-analysis demonstrated that tocilizumab treatment showed promising results in reducing 28-day mortality and progression to mechanical ventilation in patients with moderate-to-severe COVID-19, without the burden of serious adverse events.Trial registration: Clinical Trials Registry India identifier: CTRI/2020/05/025369..
Keywords: COVID-19; meta-analysis; sarilumab; systematic review; tocilizumab.