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Efficacy and safety of Tocilizumab in severe and critical COVID-19: A Systematic Review and Meta-Analysis.
Expert Rev Clin Immunol. 2021 05; 17(5):499-511.ER

Abstract

OBJECTIVES

Currently published papers and clinical guidelines regarding the effects of tocilizumab in severe and critical COVID-19 are contradictory. The aim of this meta-analysis was to combine the results of clinical studies of different designs to investigate the efficacy and safety of tocilizumab in severely-to-critically ill COVID-19 patients.

METHODS

A systematic search was performed in PubMed, Embase, CENTRAL, ClinicalTrials.gov, Scopus, and preprint servers up to 26 December 2020. Since a substantial heterogeneity was expected, a random-effects model was applied to calculate the pooled effect size (ES) and 95% confidence interval (CI) for each study outcome.

RESULTS

Forty-five comparative studies involving 13,189 patients and 28 single-arm studies involving 1,770 patients were analyzed. The risk of mortality (RR of 0.76 [95%CI 0.65 to 0.89], P < 0.01) and intubation (RR of 0.48 [95%CI 0.24 to 0.97], P = 0.04) were lower in tocilizumab patients compared with controls. We did not find any significant difference in secondary infections, length of hospital stay, hospital discharge before day 14, and ICU admission between groups.

CONCLUSION

Tocilizumab can improve clinical outcomes and reduce mortality rates in severe to critical COVID-19 patients. Large-scale randomized controlled trials are still required to improve the statistical power of meta-analysis.

Authors+Show Affiliations

Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Department of Pharmacoeconomics and Pharma Management, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Medical Department, Orchid Pharmed Company, Tehran, Iran.Medical Department, Orchid Pharmed Company, Tehran, Iran.Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.Department of Clinical Pharmacy, Faculty of Medicine, Aja University of Medical Sciences, Tehran, Iran.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review
Video-Audio Media

Language

eng

PubMed ID

33823733

Citation

Rezaei, Soheila, et al. "Efficacy and Safety of Tocilizumab in Severe and Critical COVID-19: a Systematic Review and Meta-Analysis." Expert Review of Clinical Immunology, vol. 17, no. 5, 2021, pp. 499-511.
Rezaei S, Fatemi B, Karimi Majd Z, et al. Efficacy and safety of Tocilizumab in severe and critical COVID-19: A Systematic Review and Meta-Analysis. Expert Rev Clin Immunol. 2021;17(5):499-511.
Rezaei, S., Fatemi, B., Karimi Majd, Z., Minaei, H., Peikanpour, M., Anjidani, N., Taheri, A., Dastan, F., & Mosaed, R. (2021). Efficacy and safety of Tocilizumab in severe and critical COVID-19: A Systematic Review and Meta-Analysis. Expert Review of Clinical Immunology, 17(5), 499-511. https://doi.org/10.1080/1744666X.2021.1908128
Rezaei S, et al. Efficacy and Safety of Tocilizumab in Severe and Critical COVID-19: a Systematic Review and Meta-Analysis. Expert Rev Clin Immunol. 2021;17(5):499-511. PubMed PMID: 33823733.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy and safety of Tocilizumab in severe and critical COVID-19: A Systematic Review and Meta-Analysis. AU - Rezaei,Soheila, AU - Fatemi,Behzad, AU - Karimi Majd,Zahra, AU - Minaei,Hossein, AU - Peikanpour,Mohammad, AU - Anjidani,Nassim, AU - Taheri,Ali, AU - Dastan,Farzaneh, AU - Mosaed,Reza, Y1 - 2021/04/07/ PY - 2021/4/8/pubmed PY - 2021/5/18/medline PY - 2021/4/7/entrez KW - ARDS KW - covid-19 KW - intubation KW - meta-analysis KW - mortality KW - tocilizumab SP - 499 EP - 511 JF - Expert review of clinical immunology JO - Expert Rev Clin Immunol VL - 17 IS - 5 N2 - OBJECTIVES: Currently published papers and clinical guidelines regarding the effects of tocilizumab in severe and critical COVID-19 are contradictory. The aim of this meta-analysis was to combine the results of clinical studies of different designs to investigate the efficacy and safety of tocilizumab in severely-to-critically ill COVID-19 patients. METHODS: A systematic search was performed in PubMed, Embase, CENTRAL, ClinicalTrials.gov, Scopus, and preprint servers up to 26 December 2020. Since a substantial heterogeneity was expected, a random-effects model was applied to calculate the pooled effect size (ES) and 95% confidence interval (CI) for each study outcome. RESULTS: Forty-five comparative studies involving 13,189 patients and 28 single-arm studies involving 1,770 patients were analyzed. The risk of mortality (RR of 0.76 [95%CI 0.65 to 0.89], P < 0.01) and intubation (RR of 0.48 [95%CI 0.24 to 0.97], P = 0.04) were lower in tocilizumab patients compared with controls. We did not find any significant difference in secondary infections, length of hospital stay, hospital discharge before day 14, and ICU admission between groups. CONCLUSION: Tocilizumab can improve clinical outcomes and reduce mortality rates in severe to critical COVID-19 patients. Large-scale randomized controlled trials are still required to improve the statistical power of meta-analysis. SN - 1744-8409 UR - https://www.unboundmedicine.com/medline/citation/33823733/Efficacy_and_safety_of_Tocilizumab_in_severe_and_critical_COVID_19:_A_Systematic_Review_and_Meta_Analysis_ L2 - https://www.tandfonline.com/doi/full/10.1080/1744666X.2021.1908128 DB - PRIME DP - Unbound Medicine ER -