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Optimal use of tocilizumab for severe and critical COVID-19: a systematic review and meta-analysis.
F1000Res. 2021; 10:73.F

Abstract

Background:

Several studies have revealed the potential use of tocilizumab in treating COVID-19 since no therapy has yet been approved for COVID-19 pneumonia. Tocilizumab may provide clinical benefits for cytokine release syndrome in COVID-19 patients.

Methods:

We searched for relevant studies in PubMed, Embase, Medline, and Cochrane published from March to October 2020 to evaluate optimal use and baseline criteria for administration of tocilizumab in severe and critically ill COVID-19 patients. Research involving patients with confirmed SARS-CoV-2 infection, treated with tocilizumab and compared with the standard of care (SOC) was included in this study. We conducted a systematic review to find data about the risks and benefits of tocilizumab and outcomes from different baseline criteria for administration of tocilizumab as a treatment for severe and critically ill COVID-19 patients.

Results:

A total of 26 studies, consisting of 23 retrospective studies, one prospective study, and two randomised controlled trials with 2112 patients enrolled in the tocilizumab group and 6160 patients in the SOC group, were included in this meta-analysis. Compared to the SOC, tocilizumab showed benefits for all-cause mortality events and a shorter time until death after first intervention but showed no difference in hospital length of stay. Upon subgroup analysis, tocilizumab showed fewer all-cause mortality events when CRP level ≥100 mg/L, P/F ratio 200-300 mmHg, and P/F ratio <200 mmHg. However, tocilizumab showed a longer length of stay when CRP <100 mg/L than the SOC.

Conclusion:

This meta-analysis demonstrated that tocilizumab has a positive effect on all-cause mortality. It should be cautiously administrated for optimal results and tailored to the patient's eligibility criteria.

Authors+Show Affiliations

Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia. Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia.Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia. Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia.Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia.Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia. Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia.Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia. Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia.Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia. Department of Anesthesiology and Reanimation, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia.Universitas Airlangga Hospital, Surabaya, East Java, 60115, Indonesia. Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia.Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia.Department of Internal Medicine, Faculty of Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia.Faculty of Medicine, Airlangga University, Surabaya, East Java, 60132, Indonesia.Department of Internal Medicine, Faculty of Medicine, Brawijaya University, Malang, East Java, 65145, Indonesia.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

33763201

Citation

Nugroho, Cahyo Wibisono, et al. "Optimal Use of Tocilizumab for Severe and Critical COVID-19: a Systematic Review and Meta-analysis." F1000Research, vol. 10, 2021, p. 73.
Nugroho CW, Suryantoro SD, Yuliasih Y, et al. Optimal use of tocilizumab for severe and critical COVID-19: a systematic review and meta-analysis. F1000Res. 2021;10:73.
Nugroho, C. W., Suryantoro, S. D., Yuliasih, Y., Rosyid, A. N., Asmarawati, T. P., Andrianto, L., Setiawan, H. W., Mahdi, B. A., Windradi, C., Agustin, E. D., & Fajar, J. K. (2021). Optimal use of tocilizumab for severe and critical COVID-19: a systematic review and meta-analysis. F1000Research, 10, 73. https://doi.org/10.12688/f1000research.45046.1
Nugroho CW, et al. Optimal Use of Tocilizumab for Severe and Critical COVID-19: a Systematic Review and Meta-analysis. F1000Res. 2021;10:73. PubMed PMID: 33763201.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Optimal use of tocilizumab for severe and critical COVID-19: a systematic review and meta-analysis. AU - Nugroho,Cahyo Wibisono, AU - Suryantoro,Satriyo Dwi, AU - Yuliasih,Yuliasih, AU - Rosyid,Alfian Nur, AU - Asmarawati,Tri Pudy, AU - Andrianto,Lucky, AU - Setiawan,Herley Windo, AU - Mahdi,Bagus Aulia, AU - Windradi,Choirina, AU - Agustin,Esthiningrum Dewi, AU - Fajar,Jonny Karunia, Y1 - 2021/02/04/ PY - 2021/01/28/accepted PY - 2021/3/25/entrez PY - 2021/3/26/pubmed PY - 2021/3/30/medline KW - COVID-19 KW - Severe KW - critically ill KW - tocilizumab SP - 73 EP - 73 JF - F1000Research JO - F1000Res VL - 10 N2 - Background: Several studies have revealed the potential use of tocilizumab in treating COVID-19 since no therapy has yet been approved for COVID-19 pneumonia. Tocilizumab may provide clinical benefits for cytokine release syndrome in COVID-19 patients. Methods: We searched for relevant studies in PubMed, Embase, Medline, and Cochrane published from March to October 2020 to evaluate optimal use and baseline criteria for administration of tocilizumab in severe and critically ill COVID-19 patients. Research involving patients with confirmed SARS-CoV-2 infection, treated with tocilizumab and compared with the standard of care (SOC) was included in this study. We conducted a systematic review to find data about the risks and benefits of tocilizumab and outcomes from different baseline criteria for administration of tocilizumab as a treatment for severe and critically ill COVID-19 patients. Results: A total of 26 studies, consisting of 23 retrospective studies, one prospective study, and two randomised controlled trials with 2112 patients enrolled in the tocilizumab group and 6160 patients in the SOC group, were included in this meta-analysis. Compared to the SOC, tocilizumab showed benefits for all-cause mortality events and a shorter time until death after first intervention but showed no difference in hospital length of stay. Upon subgroup analysis, tocilizumab showed fewer all-cause mortality events when CRP level ≥100 mg/L, P/F ratio 200-300 mmHg, and P/F ratio <200 mmHg. However, tocilizumab showed a longer length of stay when CRP <100 mg/L than the SOC. Conclusion: This meta-analysis demonstrated that tocilizumab has a positive effect on all-cause mortality. It should be cautiously administrated for optimal results and tailored to the patient's eligibility criteria. SN - 2046-1402 UR - https://www.unboundmedicine.com/medline/citation/33763201/Optimal_use_of_tocilizumab_for_severe_and_critical_COVID_19:_a_systematic_review_and_meta_analysis_ L2 - https://f1000research.com/articles/10.12688/f1000research.45046.1/doi DB - PRIME DP - Unbound Medicine ER -