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Efficacy of tocilizumab in COVID-19: A systematic review and meta-analysis.
J Med Virol. 2021 03; 93(3):1620-1630.JM

Abstract

The efficacy of tocilizumab (TOC), monoclonal antibody against interleukin-6 (IL-6) receptor, in patients with coronavirus disease-2019 (COVID-19) patients has led to conflicting results. We performed a systematic review and meta-analysis to compare the efficacy of addition of TOC to standard of care (SOC) versus SOC in patients with COVID-19. We performed a comprehensive literature search of PubMed, Embase, Web of Science, WHO COVID, LitCOVID, and Cochrane databases. Pooled outcomes (overall mortality, need for mechanical ventilation, intensive care unit admission, and secondary infections) were compared using DerSimonian-Laird/Random-effects approach. Risk difference (RD), confidence interval (CI), and p values were generated. A total of 23 studies with 6279 patients (1897 in TOC and 4382 in SOC group, respectively) were included. The overall mortality was lower in TOC group compared to SOC group (RD: -0.06; CI: -0.12 to -0.01; p = .03). Subgroup analysis including studies with only severe cases revealed lower mortality (RD: -0.12; CI: -0.18 to -0.06; p < .01) and need for mechanical ventilation (RD: -0.11; CI: -0.19 to -0.02; p = .01) in TOC group compared to SOC group. The addition of TOC to SOC has the potential to reduce mortality and need for mechanical ventilation in patients with severe COVID-19. Randomized controlled trials are needed to validate this.

Authors+Show Affiliations

Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, USA.Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA.Division of Infectious Disease, University of Toledo Medical Center, Toledo, Ohio, USA.Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA.Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA.Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA.University of Toledo Libraries, University of Toledo Medical Center, Toledo, Ohio, USA.Division of Infectious Disease, University of Toledo Medical Center, Toledo, Ohio, USA.Division of Infectious Disease, University of Toledo Medical Center, Toledo, Ohio, USA.Division of Infectious Disease, University of Toledo Medical Center, Toledo, Ohio, USA.Division of Pulmonary, Critical Care, and Sleep Medicine, University of Toledo Medical Center, Toledo, Ohio, USA.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

32918755

Citation

Aziz, Muhammad, et al. "Efficacy of Tocilizumab in COVID-19: a Systematic Review and Meta-analysis." Journal of Medical Virology, vol. 93, no. 3, 2021, pp. 1620-1630.
Aziz M, Haghbin H, Abu Sitta E, et al. Efficacy of tocilizumab in COVID-19: A systematic review and meta-analysis. J Med Virol. 2021;93(3):1620-1630.
Aziz, M., Haghbin, H., Abu Sitta, E., Nawras, Y., Fatima, R., Sharma, S., Lee-Smith, W., Duggan, J., Kammeyer, J. A., Hanrahan, J., & Assaly, R. (2021). Efficacy of tocilizumab in COVID-19: A systematic review and meta-analysis. Journal of Medical Virology, 93(3), 1620-1630. https://doi.org/10.1002/jmv.26509
Aziz M, et al. Efficacy of Tocilizumab in COVID-19: a Systematic Review and Meta-analysis. J Med Virol. 2021;93(3):1620-1630. PubMed PMID: 32918755.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy of tocilizumab in COVID-19: A systematic review and meta-analysis. AU - Aziz,Muhammad, AU - Haghbin,Hossein, AU - Abu Sitta,Emad, AU - Nawras,Yusuf, AU - Fatima,Rawish, AU - Sharma,Sachit, AU - Lee-Smith,Wade, AU - Duggan,Joan, AU - Kammeyer,Joel A, AU - Hanrahan,Jennifer, AU - Assaly,Ragheb, Y1 - 2020/09/28/ PY - 2020/08/02/received PY - 2020/09/04/revised PY - 2020/09/08/accepted PY - 2020/9/13/pubmed PY - 2021/3/3/medline PY - 2020/9/12/entrez KW - antibody-containing preparations KW - coronavirus KW - disease control KW - epidemiology KW - immune responses KW - infection KW - interleukin KW - virus classification SP - 1620 EP - 1630 JF - Journal of medical virology JO - J Med Virol VL - 93 IS - 3 N2 - The efficacy of tocilizumab (TOC), monoclonal antibody against interleukin-6 (IL-6) receptor, in patients with coronavirus disease-2019 (COVID-19) patients has led to conflicting results. We performed a systematic review and meta-analysis to compare the efficacy of addition of TOC to standard of care (SOC) versus SOC in patients with COVID-19. We performed a comprehensive literature search of PubMed, Embase, Web of Science, WHO COVID, LitCOVID, and Cochrane databases. Pooled outcomes (overall mortality, need for mechanical ventilation, intensive care unit admission, and secondary infections) were compared using DerSimonian-Laird/Random-effects approach. Risk difference (RD), confidence interval (CI), and p values were generated. A total of 23 studies with 6279 patients (1897 in TOC and 4382 in SOC group, respectively) were included. The overall mortality was lower in TOC group compared to SOC group (RD: -0.06; CI: -0.12 to -0.01; p = .03). Subgroup analysis including studies with only severe cases revealed lower mortality (RD: -0.12; CI: -0.18 to -0.06; p < .01) and need for mechanical ventilation (RD: -0.11; CI: -0.19 to -0.02; p = .01) in TOC group compared to SOC group. The addition of TOC to SOC has the potential to reduce mortality and need for mechanical ventilation in patients with severe COVID-19. Randomized controlled trials are needed to validate this. SN - 1096-9071 UR - https://www.unboundmedicine.com/medline/citation/32918755/Efficacy_of_tocilizumab_in_COVID_19:_A_systematic_review_and_meta_analysis_ L2 - https://doi.org/10.1002/jmv.26509 DB - PRIME DP - Unbound Medicine ER -