tetano
Editor, Senior Moderator
Leukemia
. 2021 May 17.
doi: 10.1038/s41375-021-01264-8. Online ahead of print.
Systematic review and meta-analysis of tocilizumab in persons with coronavirus disease-2019 (COVID-19)
Chong-Xiang Chen[SUP] #[/SUP][SUP] 1 2 3 [/SUP], Fang Hu[SUP] #[/SUP][SUP] 1 [/SUP], Jin Wei[SUP] #[/SUP][SUP] 4 [/SUP], Le-Tao Yuan[SUP] 5 [/SUP], Tian-Meng Wen[SUP] 5 [/SUP], Robert Peter Gale[SUP] 6 [/SUP], Yang Liang[SUP] 7 [/SUP]
Affiliations
Abstract
We performed a meta-analysis to determine safety and efficacy of tocilizumab in persons with coronavirus disease-2019 (COVID-19). We searched PubMed, Web of Science and Medline using Boolean operators for studies with the terms coronavirus OR COVID-19 OR 2019-nCoV OR SARS-CoV-2 AND tocilizumab. Review Manager 5.4 was used to analyze data and the modified Newcastle-Ottawa and Jadad scales for quality assessment. We identified 32 studies in 11,487 subjects including three randomized trials and 29 cohort studies with a comparator cohort, including historical controls (N = 5), a matched cohort (N = 12), or concurrent controls (N = 12). Overall, tocilizumab decreased risk of death (Relative Risk [RR] = 0.74; 95% confidence interval [CI], 0.59, 0.93; P = 0.008; I[SUP]2[/SUP] = 80%) but not of surrogate endpoints including ICU admission (RR = 1.40 [0.64,3.06]; P = 0.4; I[SUP]2[/SUP] = 88%), invasive mechanical ventilation (RR = 0.83 [0.57,1.22]; P = 0.34; I[SUP]2[/SUP] = 65%) or secondary infections (RR = 1.30 [0.97,1.74]; P = 0.08; I[SUP]2[/SUP] = 65%) and increased interval of hospitalization of subjects discharged alive(mean difference [MD] = 2 days [<1, 4 days]; P = 0.006; I[SUP]2[/SUP] = 0). RRs of death in studies with historical controls (RR = 0.28 [0.16,0.49; P < 0.001]; I[SUP]2[/SUP] = 62%) or a matched cohort (RR = 0.68 [0.53, 0.87]; P = 0.002; I[SUP]2[/SUP] = 42%) were decreased. In contrast, RRs of death in studies with a concurrent control (RR = 1.10 [0.77, 1.56]; P = 0.60; I[SUP]2[/SUP] = 85%) or randomized (RR = 1.18 [0.57,2.44]; P = 0.66; I[SUP]2[/SUP] = 0) were not decreased. A reduced risk of death was not confirmed in our analyses which questions safety and efficacy of tocilizumab in persons with COVID-19.
. 2021 May 17.
doi: 10.1038/s41375-021-01264-8. Online ahead of print.
Systematic review and meta-analysis of tocilizumab in persons with coronavirus disease-2019 (COVID-19)
Chong-Xiang Chen[SUP] #[/SUP][SUP] 1 2 3 [/SUP], Fang Hu[SUP] #[/SUP][SUP] 1 [/SUP], Jin Wei[SUP] #[/SUP][SUP] 4 [/SUP], Le-Tao Yuan[SUP] 5 [/SUP], Tian-Meng Wen[SUP] 5 [/SUP], Robert Peter Gale[SUP] 6 [/SUP], Yang Liang[SUP] 7 [/SUP]
Affiliations
- PMID: 34002026
- DOI: 10.1038/s41375-021-01264-8
Abstract
We performed a meta-analysis to determine safety and efficacy of tocilizumab in persons with coronavirus disease-2019 (COVID-19). We searched PubMed, Web of Science and Medline using Boolean operators for studies with the terms coronavirus OR COVID-19 OR 2019-nCoV OR SARS-CoV-2 AND tocilizumab. Review Manager 5.4 was used to analyze data and the modified Newcastle-Ottawa and Jadad scales for quality assessment. We identified 32 studies in 11,487 subjects including three randomized trials and 29 cohort studies with a comparator cohort, including historical controls (N = 5), a matched cohort (N = 12), or concurrent controls (N = 12). Overall, tocilizumab decreased risk of death (Relative Risk [RR] = 0.74; 95% confidence interval [CI], 0.59, 0.93; P = 0.008; I[SUP]2[/SUP] = 80%) but not of surrogate endpoints including ICU admission (RR = 1.40 [0.64,3.06]; P = 0.4; I[SUP]2[/SUP] = 88%), invasive mechanical ventilation (RR = 0.83 [0.57,1.22]; P = 0.34; I[SUP]2[/SUP] = 65%) or secondary infections (RR = 1.30 [0.97,1.74]; P = 0.08; I[SUP]2[/SUP] = 65%) and increased interval of hospitalization of subjects discharged alive(mean difference [MD] = 2 days [<1, 4 days]; P = 0.006; I[SUP]2[/SUP] = 0). RRs of death in studies with historical controls (RR = 0.28 [0.16,0.49; P < 0.001]; I[SUP]2[/SUP] = 62%) or a matched cohort (RR = 0.68 [0.53, 0.87]; P = 0.002; I[SUP]2[/SUP] = 42%) were decreased. In contrast, RRs of death in studies with a concurrent control (RR = 1.10 [0.77, 1.56]; P = 0.60; I[SUP]2[/SUP] = 85%) or randomized (RR = 1.18 [0.57,2.44]; P = 0.66; I[SUP]2[/SUP] = 0) were not decreased. A reduced risk of death was not confirmed in our analyses which questions safety and efficacy of tocilizumab in persons with COVID-19.