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Decreased Mortality in Coronavirus Disease 2019 Patients Treated With Tocilizumab: A Rapid Systematic Review and Meta-analysis of Observational Studies.
Clin Infect Dis. 2021 06 01; 72(11):e742-e749.CI

Abstract

BACKGROUND

We systematically reviewed the literature to answer the following research questions: (1) Does interleukin 6 (IL-6) (receptor) antagonist therapy reduce mortality in coronavirus disease 2019 (COVID-19) patients compared to patients not treated with IL-6 (receptor) antagonists; and (2) is there an increased risk of side effects in COVID-19 patients treated with IL-6 (receptor) antagonists compared to patients not treated with IL-6 (receptor) antagonists?

METHODS

We systematically searched PubMed, PMC PubMed Central, Medline, World Health Organization COVID-19 Database, Embase, Web of Science, Cochrane Library, Emcare, and Academic Search Premier (through 30 June 2020). Random effects meta-analysis was used to pool the risk ratios and risk differences of individual studies. Risk of bias was appraised using the Methodological Index for Non-randomized Studies (MINORS) checklist.

RESULTS

The search strategy retrieved 743 unique titles, of which 10 studies (all on tocilizumab [TCZ]) comprising 1358 patients were included. Nine of 10 studies were considered to be of high quality. Meta-analysis showed that the TCZ group had lower mortality than the control group. The risk ratio was 0.27 (95% confidence interval [CI], .12-.59) and the risk difference was 12% (95% CI, 4.6%-20%) in favor of the TCZ group. With only a few studies available, there were no differences observed regarding side effects.

CONCLUSIONS

Our results showed that mortality was 12% lower for COVID-19 patients treated with TCZ compared with those not treated with TCZ. The number needed to treat was 11, suggesting that for every 11 (severe) COVID-19 patients treated with TCZ, 1 death is prevented. These results require confirmation by randomized controlled trials.

Authors+Show Affiliations

Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.Walaeus Library, Leiden University Medical Centre, Leiden, The Netherlands.Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

32964913

Citation

Malgie, Jishnu, et al. "Decreased Mortality in Coronavirus Disease 2019 Patients Treated With Tocilizumab: a Rapid Systematic Review and Meta-analysis of Observational Studies." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 72, no. 11, 2021, pp. e742-e749.
Malgie J, Schoones JW, Pijls BG. Decreased Mortality in Coronavirus Disease 2019 Patients Treated With Tocilizumab: A Rapid Systematic Review and Meta-analysis of Observational Studies. Clin Infect Dis. 2021;72(11):e742-e749.
Malgie, J., Schoones, J. W., & Pijls, B. G. (2021). Decreased Mortality in Coronavirus Disease 2019 Patients Treated With Tocilizumab: A Rapid Systematic Review and Meta-analysis of Observational Studies. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 72(11), e742-e749. https://doi.org/10.1093/cid/ciaa1445
Malgie J, Schoones JW, Pijls BG. Decreased Mortality in Coronavirus Disease 2019 Patients Treated With Tocilizumab: a Rapid Systematic Review and Meta-analysis of Observational Studies. Clin Infect Dis. 2021 06 1;72(11):e742-e749. PubMed PMID: 32964913.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Decreased Mortality in Coronavirus Disease 2019 Patients Treated With Tocilizumab: A Rapid Systematic Review and Meta-analysis of Observational Studies. AU - Malgie,Jishnu, AU - Schoones,Jan W, AU - Pijls,Bart G, PY - 2020/07/19/received PY - 2020/09/21/accepted PY - 2020/9/24/pubmed PY - 2021/6/5/medline PY - 2020/9/23/entrez KW - COVID-19 KW - IL-6 receptor antagonists KW - mortality KW - tocilizumab SP - e742 EP - e749 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 72 IS - 11 N2 - BACKGROUND: We systematically reviewed the literature to answer the following research questions: (1) Does interleukin 6 (IL-6) (receptor) antagonist therapy reduce mortality in coronavirus disease 2019 (COVID-19) patients compared to patients not treated with IL-6 (receptor) antagonists; and (2) is there an increased risk of side effects in COVID-19 patients treated with IL-6 (receptor) antagonists compared to patients not treated with IL-6 (receptor) antagonists? METHODS: We systematically searched PubMed, PMC PubMed Central, Medline, World Health Organization COVID-19 Database, Embase, Web of Science, Cochrane Library, Emcare, and Academic Search Premier (through 30 June 2020). Random effects meta-analysis was used to pool the risk ratios and risk differences of individual studies. Risk of bias was appraised using the Methodological Index for Non-randomized Studies (MINORS) checklist. RESULTS: The search strategy retrieved 743 unique titles, of which 10 studies (all on tocilizumab [TCZ]) comprising 1358 patients were included. Nine of 10 studies were considered to be of high quality. Meta-analysis showed that the TCZ group had lower mortality than the control group. The risk ratio was 0.27 (95% confidence interval [CI], .12-.59) and the risk difference was 12% (95% CI, 4.6%-20%) in favor of the TCZ group. With only a few studies available, there were no differences observed regarding side effects. CONCLUSIONS: Our results showed that mortality was 12% lower for COVID-19 patients treated with TCZ compared with those not treated with TCZ. The number needed to treat was 11, suggesting that for every 11 (severe) COVID-19 patients treated with TCZ, 1 death is prevented. These results require confirmation by randomized controlled trials. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/32964913/Decreased_Mortality_in_Coronavirus_Disease_2019_Patients_Treated_With_Tocilizumab:_A_Rapid_Systematic_Review_and_Meta_analysis_of_Observational_Studies_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/ciaa1445 DB - PRIME DP - Unbound Medicine ER -