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Tocilizumab in addition to standard of care in the management of COVID-19: a meta-analysis of RCTs

OBJECTIVE: We performed a systematic review and meta-analysis for exploring clinical benefits and safety of tocilizumab in addition to standard of care (SOC) in treating patients with coronavirus disease 2019 (COVID-19). METHODS: An electronic search was carried out in PubMed, EMBASE, Cochrane Libra...

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Autores principales: Mutua, Victor, Henry, Brandon Michael, von Csefalvay, Chris, Cheruiyot, Isaac, Vikse, Jens, Lippi, Giuseppe, Bundi, Brian, Mong’are, Newnex
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Mattioli 1885 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8972884/
https://www.ncbi.nlm.nih.gov/pubmed/35315395
http://dx.doi.org/10.23750/abm.v93i1.12208
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author Mutua, Victor
Henry, Brandon Michael
von Csefalvay, Chris
Cheruiyot, Isaac
Vikse, Jens
Lippi, Giuseppe
Bundi, Brian
Mong’are, Newnex
author_facet Mutua, Victor
Henry, Brandon Michael
von Csefalvay, Chris
Cheruiyot, Isaac
Vikse, Jens
Lippi, Giuseppe
Bundi, Brian
Mong’are, Newnex
author_sort Mutua, Victor
collection PubMed
description OBJECTIVE: We performed a systematic review and meta-analysis for exploring clinical benefits and safety of tocilizumab in addition to standard of care (SOC) in treating patients with coronavirus disease 2019 (COVID-19). METHODS: An electronic search was carried out in PubMed, EMBASE, Cochrane Library, and Science Direct, as well as in medRxiv preprint server, to identify eligible studies. Only randomized Controlled Trials (RCTs) that compared mortality events and/or adverse events between a tocilizumab + SOC group and a SOC-only control group were included. The primary outcome was 28-day mortality. Secondary outcomes include progression to severe disease, defined as need for mechanical ventilation (MV) or intensive care unit (ICU) admission, and adverse events (AE). RESULTS: A total of nine studies (6,490 participants) could be included in this meta-analysis, with 3,358 participants in the tocilizumab + SOC group and 3,132 participants in the SOC-only group. The overall mortality rate was lower in the tocilizumab group compared to the SOC-only group, though the difference was not statistically significant (odds ratio [OR], 0.87; 95% CI, 0.73-1.04; I(2), 15%). This finding was unaffected by subgroup analyses based on initial use of steroids or mechanical ventilation at baseline. Patients receiving tocilizumab were 26% less likely to progress to MV, and this difference was statistically significant (OR, 0.74; 95% CI, 0.64-0.86; I(2), 0%). Among patients who were not in ICU at randomization, the tocilizumab group had 34 % lower rate of ICU admission compared to the SOC-only group (OR, 0.66; 95% CI, 0.40-2.14; I(2), 29%). The occurrence of serious infections was lower in the tocilizumab group (OR, 0.57; 95% CI, 0.36-0.89; I(2), 21%). CONCLUSION: Tocilizumab is generally well-tolerated in COVID-19. Although this drug does not appear to have a significant benefits on survival, it may have a role in preventing progression to intensive care and MV. (www.actabiomedica.it)
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spelling pubmed-89728842022-04-15 Tocilizumab in addition to standard of care in the management of COVID-19: a meta-analysis of RCTs Mutua, Victor Henry, Brandon Michael von Csefalvay, Chris Cheruiyot, Isaac Vikse, Jens Lippi, Giuseppe Bundi, Brian Mong’are, Newnex Acta Biomed Reviews/Focus on OBJECTIVE: We performed a systematic review and meta-analysis for exploring clinical benefits and safety of tocilizumab in addition to standard of care (SOC) in treating patients with coronavirus disease 2019 (COVID-19). METHODS: An electronic search was carried out in PubMed, EMBASE, Cochrane Library, and Science Direct, as well as in medRxiv preprint server, to identify eligible studies. Only randomized Controlled Trials (RCTs) that compared mortality events and/or adverse events between a tocilizumab + SOC group and a SOC-only control group were included. The primary outcome was 28-day mortality. Secondary outcomes include progression to severe disease, defined as need for mechanical ventilation (MV) or intensive care unit (ICU) admission, and adverse events (AE). RESULTS: A total of nine studies (6,490 participants) could be included in this meta-analysis, with 3,358 participants in the tocilizumab + SOC group and 3,132 participants in the SOC-only group. The overall mortality rate was lower in the tocilizumab group compared to the SOC-only group, though the difference was not statistically significant (odds ratio [OR], 0.87; 95% CI, 0.73-1.04; I(2), 15%). This finding was unaffected by subgroup analyses based on initial use of steroids or mechanical ventilation at baseline. Patients receiving tocilizumab were 26% less likely to progress to MV, and this difference was statistically significant (OR, 0.74; 95% CI, 0.64-0.86; I(2), 0%). Among patients who were not in ICU at randomization, the tocilizumab group had 34 % lower rate of ICU admission compared to the SOC-only group (OR, 0.66; 95% CI, 0.40-2.14; I(2), 29%). The occurrence of serious infections was lower in the tocilizumab group (OR, 0.57; 95% CI, 0.36-0.89; I(2), 21%). CONCLUSION: Tocilizumab is generally well-tolerated in COVID-19. Although this drug does not appear to have a significant benefits on survival, it may have a role in preventing progression to intensive care and MV. (www.actabiomedica.it) Mattioli 1885 2022 2022-03-14 /pmc/articles/PMC8972884/ /pubmed/35315395 http://dx.doi.org/10.23750/abm.v93i1.12208 Text en Copyright: © 2021 ACTA BIO MEDICA SOCIETY OF MEDICINE AND NATURAL SCIENCES OF PARMA https://creativecommons.org/licenses/by-nc/4.0/This work is licensed under a Creative Commons Attribution 4.0 International License
spellingShingle Reviews/Focus on
Mutua, Victor
Henry, Brandon Michael
von Csefalvay, Chris
Cheruiyot, Isaac
Vikse, Jens
Lippi, Giuseppe
Bundi, Brian
Mong’are, Newnex
Tocilizumab in addition to standard of care in the management of COVID-19: a meta-analysis of RCTs
title Tocilizumab in addition to standard of care in the management of COVID-19: a meta-analysis of RCTs
title_full Tocilizumab in addition to standard of care in the management of COVID-19: a meta-analysis of RCTs
title_fullStr Tocilizumab in addition to standard of care in the management of COVID-19: a meta-analysis of RCTs
title_full_unstemmed Tocilizumab in addition to standard of care in the management of COVID-19: a meta-analysis of RCTs
title_short Tocilizumab in addition to standard of care in the management of COVID-19: a meta-analysis of RCTs
title_sort tocilizumab in addition to standard of care in the management of covid-19: a meta-analysis of rcts
topic Reviews/Focus on
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8972884/
https://www.ncbi.nlm.nih.gov/pubmed/35315395
http://dx.doi.org/10.23750/abm.v93i1.12208
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