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Tocilizumab in Hospitalized Patients with COVID-19: A Meta Analysis of Randomized Controlled Trials.
Lung. 2021 06; 199(3):239-248.LUNG

Abstract

BACKGROUND

To date, only dexamethasone has been shown to reduce mortality in coronavirus disease-19 (COVID-19) patients. Tocilizumab has been recently added to the treatment guidelines for hospitalized COVID-19 patients, but data remain conflicting.

STUDY DESIGN AND METHODS

Electronic databases such as MEDLINE, EMBASE, and Cochrane central were searched from March 1, 2020, until March 10, 2021, for randomized controlled trials evaluating the efficacy of tocilizumab in hospitalized COVID-19 patients. The outcomes assessed were all-cause mortality, mechanical ventilation, and time to discharge.

RESULTS

Nine studies (with 6490 patients) were included in the analysis. In total, 3358 patients received tocilizumab, and 3132 received standard care/placebo. Pooled analysis showed a significantly decreased risk of all-cause mortality (RR 0.89, 95% CI 0.80-0.98, p = 0.02) and progression to mechanical ventilation (RR 0.80, 95% CI 0.71-0.89, p < 0.0001) in the tocilizumab arm compared to standard therapy or placebo. In addition, there was a trend towards improved median time to hospital discharge (RR 1.28, 95% CI 1.12-1.45, p = 0.0002).

CONCLUSIONS

Tocilizumab therapy improves outcomes of mortality and need for mechanical ventilation, in hospitalized patients with COVID-19 infection compared with standard therapy or placebo. Our findings suggest the efficacy of tocilizumab therapy in hospitalized COVID-19 patients and strengthen the concept that tocilizumab is a promising therapeutic intervention to improve mortality and morbidity in COVID-19 patients.

Links

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Authors+Show Affiliations

Selvaraj V
Division of Medicine, The Miriam Hospital, 164 Summit Ave, Providence, RI, 02906, USA. vijairam.selvaraj@lifespan.org. Division of Medicine Aff2, Warren Alpert Medical School of Brown University, Providence, RI, USA. vijairam.selvaraj@lifespan.org.
Khan MS
Division of Medicine, The Miriam Hospital, 164 Summit Ave, Providence, RI, 02906, USA. Division of Medicine Aff2, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Bavishi C
Division of Medicine Aff2, Warren Alpert Medical School of Brown University, Providence, RI, USA. Division of Cardiology, Cardiovascular Institute, Rhode Island Hospital, Providence, RI, USA.
Dapaah-Afriyie K
Division of Medicine, The Miriam Hospital, 164 Summit Ave, Providence, RI, 02906, USA. Division of Medicine Aff2, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Finn A
Division of Medicine, The Miriam Hospital, 164 Summit Ave, Providence, RI, 02906, USA. Division of Medicine Aff2, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Lal A
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
Mylonakis E
Division of Medicine Aff2, Warren Alpert Medical School of Brown University, Providence, RI, USA. Division of Infectious Diseases, Rhode Island Hospital, Providence, RI, USA.

MeSH

Antibodies, Monoclonal, HumanizedCOVID-19HumansImmunologic FactorsOutcome Assessment, Health CareReceptors, Interleukin-6SARS-CoV-2COVID-19 Drug Treatment

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

34050796

Citation

Selvaraj, Vijairam, et al. "Tocilizumab in Hospitalized Patients With COVID-19: a Meta Analysis of Randomized Controlled Trials." Lung, vol. 199, no. 3, 2021, pp. 239-248.
Selvaraj V, Khan MS, Bavishi C, et al. Tocilizumab in Hospitalized Patients with COVID-19: A Meta Analysis of Randomized Controlled Trials. Lung. 2021;199(3):239-248.
Selvaraj, V., Khan, M. S., Bavishi, C., Dapaah-Afriyie, K., Finn, A., Lal, A., & Mylonakis, E. (2021). Tocilizumab in Hospitalized Patients with COVID-19: A Meta Analysis of Randomized Controlled Trials. Lung, 199(3), 239-248. https://doi.org/10.1007/s00408-021-00451-9
Selvaraj V, et al. Tocilizumab in Hospitalized Patients With COVID-19: a Meta Analysis of Randomized Controlled Trials. Lung. 2021;199(3):239-248. PubMed PMID: 34050796.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tocilizumab in Hospitalized Patients with COVID-19: A Meta Analysis of Randomized Controlled Trials. AU - Selvaraj,Vijairam, AU - Khan,Mohammad Saud, AU - Bavishi,Chirag, AU - Dapaah-Afriyie,Kwame, AU - Finn,Arkadiy, AU - Lal,Amos, AU - Mylonakis,Eleftherios, Y1 - 2021/05/29/ PY - 2021/04/16/received PY - 2021/05/11/accepted PY - 2021/5/30/pubmed PY - 2021/6/30/medline PY - 2021/5/29/entrez KW - COVID-19 KW - IL-6 KW - Meta-analysis KW - Mortality KW - Tocilizumab SP - 239 EP - 248 JF - Lung JO - Lung VL - 199 IS - 3 N2 - BACKGROUND: To date, only dexamethasone has been shown to reduce mortality in coronavirus disease-19 (COVID-19) patients. Tocilizumab has been recently added to the treatment guidelines for hospitalized COVID-19 patients, but data remain conflicting. STUDY DESIGN AND METHODS: Electronic databases such as MEDLINE, EMBASE, and Cochrane central were searched from March 1, 2020, until March 10, 2021, for randomized controlled trials evaluating the efficacy of tocilizumab in hospitalized COVID-19 patients. The outcomes assessed were all-cause mortality, mechanical ventilation, and time to discharge. RESULTS: Nine studies (with 6490 patients) were included in the analysis. In total, 3358 patients received tocilizumab, and 3132 received standard care/placebo. Pooled analysis showed a significantly decreased risk of all-cause mortality (RR 0.89, 95% CI 0.80-0.98, p = 0.02) and progression to mechanical ventilation (RR 0.80, 95% CI 0.71-0.89, p < 0.0001) in the tocilizumab arm compared to standard therapy or placebo. In addition, there was a trend towards improved median time to hospital discharge (RR 1.28, 95% CI 1.12-1.45, p = 0.0002). CONCLUSIONS: Tocilizumab therapy improves outcomes of mortality and need for mechanical ventilation, in hospitalized patients with COVID-19 infection compared with standard therapy or placebo. Our findings suggest the efficacy of tocilizumab therapy in hospitalized COVID-19 patients and strengthen the concept that tocilizumab is a promising therapeutic intervention to improve mortality and morbidity in COVID-19 patients. SN - 1432-1750 UR - https://www.unboundmedicine.com/medline/citation/34050796/Tocilizumab_in_Hospitalized_Patients_with_COVID_19:_A_Meta_Analysis_of_Randomized_Controlled_Trials_ DB - PRIME DP - Unbound Medicine ER -