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The effect of tocilizumab on mortality in hospitalized patients with COVID-19: a meta-analysis of randomized controlled trials.
Eur J Clin Pharmacol. 2021 Aug; 77(8):1089-1094.EJ

Abstract

OBJECTIVE

We aimed to perform a meta-analysis of randomized controlled trials (RCTs) to summarize the overall effect of tocilizumab on the risk of mortality among patients with coronavirus disease 2019 (COVID-19).

METHODS

We systematically searched PubMed, Cochrane Central Register of Controlled Trials, Google Scholar, and medRxiv (preprint repository) databases (up to 7 January 2021). Pooled effect sizes with 95% confidence interval (CI) were generated using random-effects and inverse variance heterogeneity models. The risk of bias of the included RCTs was appraised using version 2 of the Cochrane risk-of-bias tool for randomized trials.

RESULTS

Six RCTs were included: two trials with an overall low risk of bias and four trials had some concerns regarding the overall risk of bias. Our meta-analysis did not find significant mortality benefits with the use of tocilizumab among patients with COVID-19 relative to non-use of tocilizumab (pooled hazard ratio = 0.83; 95% CI 0.66-1.05, n = 2,057). Interestingly, the estimated effect of tocilizumab on the composite endpoint of requirement for mechanical ventilation and/or all-cause mortality indicated clinical benefits, with some evidence against our model hypothesis of no significant effect at the current sample size (pooled hazard ratio = 0.62; 95% CI 0.42-0.91, n = 749).

CONCLUSION

Despite no clear mortality benefits in hospitalized patients with COVID-19, tocilizumab appears to reduce the likelihood of progression to mechanical ventilation.

Authors+Show Affiliations

School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia. chiasiang_93@hotmail.com.School of Applied Sciences, University of Huddersfield, Huddersfield, United Kingdom. School of Biomedical Sciences & Pharmacy, University of Newcastle, Callaghan, Australia.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

33532896

Citation

Kow, Chia Siang, and Syed Shahzad Hasan. "The Effect of Tocilizumab On Mortality in Hospitalized Patients With COVID-19: a Meta-analysis of Randomized Controlled Trials." European Journal of Clinical Pharmacology, vol. 77, no. 8, 2021, pp. 1089-1094.
Kow CS, Hasan SS. The effect of tocilizumab on mortality in hospitalized patients with COVID-19: a meta-analysis of randomized controlled trials. Eur J Clin Pharmacol. 2021;77(8):1089-1094.
Kow, C. S., & Hasan, S. S. (2021). The effect of tocilizumab on mortality in hospitalized patients with COVID-19: a meta-analysis of randomized controlled trials. European Journal of Clinical Pharmacology, 77(8), 1089-1094. https://doi.org/10.1007/s00228-021-03087-z
Kow CS, Hasan SS. The Effect of Tocilizumab On Mortality in Hospitalized Patients With COVID-19: a Meta-analysis of Randomized Controlled Trials. Eur J Clin Pharmacol. 2021;77(8):1089-1094. PubMed PMID: 33532896.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of tocilizumab on mortality in hospitalized patients with COVID-19: a meta-analysis of randomized controlled trials. AU - Kow,Chia Siang, AU - Hasan,Syed Shahzad, Y1 - 2021/02/02/ PY - 2020/10/27/received PY - 2021/01/08/accepted PY - 2021/2/4/pubmed PY - 2021/7/16/medline PY - 2021/2/3/entrez KW - Bias KW - COVID-19 KW - Clinical trial KW - Mortality KW - Tocilizumab SP - 1089 EP - 1094 JF - European journal of clinical pharmacology JO - Eur J Clin Pharmacol VL - 77 IS - 8 N2 - OBJECTIVE: We aimed to perform a meta-analysis of randomized controlled trials (RCTs) to summarize the overall effect of tocilizumab on the risk of mortality among patients with coronavirus disease 2019 (COVID-19). METHODS: We systematically searched PubMed, Cochrane Central Register of Controlled Trials, Google Scholar, and medRxiv (preprint repository) databases (up to 7 January 2021). Pooled effect sizes with 95% confidence interval (CI) were generated using random-effects and inverse variance heterogeneity models. The risk of bias of the included RCTs was appraised using version 2 of the Cochrane risk-of-bias tool for randomized trials. RESULTS: Six RCTs were included: two trials with an overall low risk of bias and four trials had some concerns regarding the overall risk of bias. Our meta-analysis did not find significant mortality benefits with the use of tocilizumab among patients with COVID-19 relative to non-use of tocilizumab (pooled hazard ratio = 0.83; 95% CI 0.66-1.05, n = 2,057). Interestingly, the estimated effect of tocilizumab on the composite endpoint of requirement for mechanical ventilation and/or all-cause mortality indicated clinical benefits, with some evidence against our model hypothesis of no significant effect at the current sample size (pooled hazard ratio = 0.62; 95% CI 0.42-0.91, n = 749). CONCLUSION: Despite no clear mortality benefits in hospitalized patients with COVID-19, tocilizumab appears to reduce the likelihood of progression to mechanical ventilation. SN - 1432-1041 UR - https://www.unboundmedicine.com/medline/citation/33532896/The_effect_of_tocilizumab_on_mortality_in_hospitalized_patients_with_COVID_19:_a_meta_analysis_of_randomized_controlled_trials_ L2 - https://dx.doi.org/10.1007/s00228-021-03087-z DB - PRIME DP - Unbound Medicine ER -