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Tocilizumab for severe COVID-19: a systematic review and meta-analysis.
Int J Antimicrob Agents. 2020 Sep; 56(3):106103.IJ

Abstract

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.

Authors+Show Affiliations

School of Pharmaceutical Sciences and Medical Technology, Putian University, Putian 351100, China.Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan.Department of Pharmacy, Chi Mei Medical Center, Liouying, Taiwan.Yijia Pharmacy, Tainan 70846, Taiwan.School of Management, Putian University, Putian 351100, China.Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: hsporen@ntu.edu.tw.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

32712333

Citation

Lan, Shao-Huan, et al. "Tocilizumab for Severe COVID-19: a Systematic Review and Meta-analysis." International Journal of Antimicrobial Agents, vol. 56, no. 3, 2020, p. 106103.
Lan SH, Lai CC, Huang HT, et al. Tocilizumab for severe COVID-19: a systematic review and meta-analysis. Int J Antimicrob Agents. 2020;56(3):106103.
Lan, S. H., Lai, C. C., Huang, H. T., Chang, S. P., Lu, L. C., & Hsueh, P. R. (2020). Tocilizumab for severe COVID-19: a systematic review and meta-analysis. International Journal of Antimicrobial Agents, 56(3), 106103. https://doi.org/10.1016/j.ijantimicag.2020.106103
Lan SH, et al. Tocilizumab for Severe COVID-19: a Systematic Review and Meta-analysis. Int J Antimicrob Agents. 2020;56(3):106103. PubMed PMID: 32712333.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tocilizumab for severe COVID-19: a systematic review and meta-analysis. AU - Lan,Shao-Huan, AU - Lai,Chih-Cheng, AU - Huang,Hui-Ting, AU - Chang,Shen-Peng, AU - Lu,Li-Chin, AU - Hsueh,Po-Ren, Y1 - 2020/07/23/ PY - 2020/06/04/received PY - 2020/07/15/revised PY - 2020/07/19/accepted PY - 2020/7/28/pubmed PY - 2020/9/12/medline PY - 2020/7/27/entrez KW - COVID-19 KW - Intensive care unit KW - Mechanical ventilation KW - Mortality KW - SARS-CoV-2 KW - Tocilizumab SP - 106103 EP - 106103 JF - International journal of antimicrobial agents JO - Int. J. Antimicrob. Agents VL - 56 IS - 3 N2 - 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. SN - 1872-7913 UR - https://www.unboundmedicine.com/medline/citation/32712333/Tocilizumab_for_severe_COVID_19:_a_systematic_review_and_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0924-8579(20)30286-7 DB - PRIME DP - Unbound Medicine ER -