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Tocilizumab for severe COVID-19: a systematic review and meta-analysis
- Source :
- International Journal of Antimicrobial Agents
- Publication Year :
- 2020
- Publisher :
- Elsevier B.V. and International Society of Chemotherapy., 2020.
-
Abstract
- Highlights • Systemic review and meta-analysis assessing the efficacy of tocilizumab for treatment of severe COVID-19. • All-cause mortality was similar between tocilizumab and control groups (16.3% vs. 24.1%; RR = 0.62). • Risk of ICU admission was similar between tocilizumab and control groups (35.0% vs. 15.8%; RR = 1.51). • Requirement for mechanical ventilation was similar between tocilizumab and control groups (32.4% vs. 28.6%; RR = 0.82). • There is no conclusive evidence that tocilizumab provides any additional benefit to patients with severe COVID-19.<br />This systemic review and meta-analysis aimed to assess the efficacy of tocilizumab for the treatment of severe coronavirus disease 2019 (COVID-19). Candidate studies up to 24 May 2020 were identified from PubMed, Cochrane Library, Embase, medRxiv and bioRxiv. Treatment outcomes included mortality, risk of intensive care unit (ICU) admission and the requirement for mechanical ventilation (MV). Seven retrospective studies involving 592 adult patients with severe COVID-19, including 240 in the tocilizumab group and 352 in the control group, were enrolled. All-cause mortality of severe COVID-19 patients among the tocilizumab group was 16.3% (39/240), which was lower than that in the control group (24.1%; 85/352). However, the difference did not reach statistical significance [risk ratio (RR) = 0.62, 95% confidence interval (CI) 0.31–1.22; I2 = 68%]. Additionally, risk of ICU admission was similar between the tocilizumab and control groups (35.1% vs. 15.8%; RR = 1.51, 95% CI 0.33–6.78; I2 = 86%). The requirement for MV was similar between the tocilizumab and control groups (32.4% vs. 28.6%; RR = 0.82, 95% CI 0.14–4.94; I2 = 91%). However, these non-significant differences between the tocilizumab and control groups may have been the result of baseline characteristics of the tocilizumab group, which were more severe than those of the control group. Based on low-quality evidence, there is no conclusive evidence that tocilizumab would provide any additional benefit to patients with severe COVID-19. Therefore, further recommendation of tocilizumab for COVID-19 cases should be halted until high-quality evidence from randomised controlled trials is available.
- Subjects :
- 0301 basic medicine
Anti-Inflammatory Agents
Cochrane Library
Severity of Illness Index
law.invention
chemistry.chemical_compound
0302 clinical medicine
Mechanical ventilation
law
Medicine
Pharmacology (medical)
030212 general & internal medicine
skin and connective tissue diseases
General Medicine
Bacterial Infections
Tocilizumab
Intensive care unit
Intensive Care Units
Infectious Diseases
Treatment Outcome
Meta-analysis
Cytokines
Coronavirus Infections
Cytokine Release Syndrome
Microbiology (medical)
musculoskeletal diseases
medicine.medical_specialty
030106 microbiology
Pneumonia, Viral
Opportunistic Infections
Antibodies, Monoclonal, Humanized
Antiviral Agents
Article
Drug Administration Schedule
03 medical and health sciences
Betacoronavirus
Internal medicine
Severity of illness
Humans
Immunologic Factors
Mortality
Pandemics
Retrospective Studies
business.industry
SARS-CoV-2
COVID-19
Retrospective cohort study
Respiration, Artificial
Survival Analysis
Confidence interval
chemistry
Relative risk
business
Subjects
Details
- Language :
- English
- ISSN :
- 18727913 and 09248579
- Database :
- OpenAIRE
- Journal :
- International Journal of Antimicrobial Agents
- Accession number :
- edsair.doi.dedup.....146a8edd05cf0e19f5dd3ba8d963e582