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The effect of tocilizumab on COVID-19 patient mortality: A systematic review and meta-analysis of randomized controlled trials.
Int Immunopharmacol. 2021 Jul; 96:107602.II

Abstract

OBJECTIVES

This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to investigate the clinical efficacy and safety of tocilizumab for treating patients with COVID-19.

METHODS

The PubMed, Embase, Cochrane Library, Clinicaltrials.gov, WHO International Clinical Trials Registry Platform and the preprint server of medRxiv.org were searched from their inception to February 20, 2021. Only RCTs that compared the treatment efficacy and safety of tocilizumab with the placebo or the standard of care for adult patients with COVID-19 were included in this meta-analysis. The primary outcome was 28-day mortality.

RESULTS

This meta-analysis included eight RCTs which enrolled a total of 6314 patients for randomization, in which 3267 and 3047 patients were assigned to the tocilizumab and control groups, respectively. The mortality at day 28 was 24.4% and 29.9% in patients in the tocilizumab and control groups, respectively, meaning there was no significant difference observed between these two groups (OR, 0.92; 95% CI, 0.66-1.28; I2 = 62). This finding did not change in the subgroup analysis according to the initial use of MV or steroid while enrollment. The patients receiving tocilizumab had a lower rate of mechanical ventilation (MV) and intensive care unit (ICU) admission at day 28 compared with the control group (MV use: OR, 0.75; 95% CI, 0.62-0.90; I2 = 11; ICU admission: OR, 0.51; 95% CI, 0.28-0.92; I2 = 30). There were no significant differences between these two treatment groups in terms of the risk of treatment-emergent adverse events (AEs) (OR, 1.03; 95% CI, 0.71-1.49; I2 = 43), serious AEs (OR, 0.86; 95% CI, 0.67-1.12; I2 = 0) or infection (OR, 0.87; 95% CI, 0.63-1.20; I2 = 0).

CONCLUSIONS

Tocilizumab does not provide a survival benefit for patients with COVID-19, but it may help reduce the risk of MV and ICU admission. In addition, tocilizumab is a safe agent to use for the treatment of COVID-19.

Authors+Show Affiliations

Department of Orthopedic, Chi Mei Medical Center, Tainan 71004, Taiwan.Division of Urology, Department of Surgery, Chi-Mei Hospital, Chia Li, Tainan, Taiwan.Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan, Taiwan.Department of Internal Medicine, Cardinal Tien Hospital, New Taipei City, Taiwan.Division of Pulmonary, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan. Electronic address: stardust.macaque@gmail.com.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

33812260

Citation

Lin, Wei-Ting, et al. "The Effect of Tocilizumab On COVID-19 Patient Mortality: a Systematic Review and Meta-analysis of Randomized Controlled Trials." International Immunopharmacology, vol. 96, 2021, p. 107602.
Lin WT, Hung SH, Lai CC, et al. The effect of tocilizumab on COVID-19 patient mortality: A systematic review and meta-analysis of randomized controlled trials. Int Immunopharmacol. 2021;96:107602.
Lin, W. T., Hung, S. H., Lai, C. C., Wang, C. Y., & Chen, C. H. (2021). The effect of tocilizumab on COVID-19 patient mortality: A systematic review and meta-analysis of randomized controlled trials. International Immunopharmacology, 96, 107602. https://doi.org/10.1016/j.intimp.2021.107602
Lin WT, et al. The Effect of Tocilizumab On COVID-19 Patient Mortality: a Systematic Review and Meta-analysis of Randomized Controlled Trials. Int Immunopharmacol. 2021;96:107602. PubMed PMID: 33812260.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of tocilizumab on COVID-19 patient mortality: A systematic review and meta-analysis of randomized controlled trials. AU - Lin,Wei-Ting, AU - Hung,Shun-Hsing, AU - Lai,Chih-Cheng, AU - Wang,Cheng-Yi, AU - Chen,Chao-Hsien, Y1 - 2021/03/24/ PY - 2021/03/02/received PY - 2021/03/18/accepted PY - 2021/4/4/pubmed PY - 2021/6/25/medline PY - 2021/4/3/entrez KW - COVID-19 KW - Mortality KW - SARS-CoV-2 KW - Tocilizumab SP - 107602 EP - 107602 JF - International immunopharmacology JO - Int Immunopharmacol VL - 96 N2 - OBJECTIVES: This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to investigate the clinical efficacy and safety of tocilizumab for treating patients with COVID-19. METHODS: The PubMed, Embase, Cochrane Library, Clinicaltrials.gov, WHO International Clinical Trials Registry Platform and the preprint server of medRxiv.org were searched from their inception to February 20, 2021. Only RCTs that compared the treatment efficacy and safety of tocilizumab with the placebo or the standard of care for adult patients with COVID-19 were included in this meta-analysis. The primary outcome was 28-day mortality. RESULTS: This meta-analysis included eight RCTs which enrolled a total of 6314 patients for randomization, in which 3267 and 3047 patients were assigned to the tocilizumab and control groups, respectively. The mortality at day 28 was 24.4% and 29.9% in patients in the tocilizumab and control groups, respectively, meaning there was no significant difference observed between these two groups (OR, 0.92; 95% CI, 0.66-1.28; I2 = 62). This finding did not change in the subgroup analysis according to the initial use of MV or steroid while enrollment. The patients receiving tocilizumab had a lower rate of mechanical ventilation (MV) and intensive care unit (ICU) admission at day 28 compared with the control group (MV use: OR, 0.75; 95% CI, 0.62-0.90; I2 = 11; ICU admission: OR, 0.51; 95% CI, 0.28-0.92; I2 = 30). There were no significant differences between these two treatment groups in terms of the risk of treatment-emergent adverse events (AEs) (OR, 1.03; 95% CI, 0.71-1.49; I2 = 43), serious AEs (OR, 0.86; 95% CI, 0.67-1.12; I2 = 0) or infection (OR, 0.87; 95% CI, 0.63-1.20; I2 = 0). CONCLUSIONS: Tocilizumab does not provide a survival benefit for patients with COVID-19, but it may help reduce the risk of MV and ICU admission. In addition, tocilizumab is a safe agent to use for the treatment of COVID-19. SN - 1878-1705 UR - https://www.unboundmedicine.com/medline/citation/33812260/The_effect_of_tocilizumab_on_COVID_19_patient_mortality:_A_systematic_review_and_meta_analysis_of_randomized_controlled_trials_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1567-5769(21)00238-1 DB - PRIME DP - Unbound Medicine ER -