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Systematic Review and Subgroup Meta-analysis of Randomized Trials to Determine Tocilizumab's Place in COVID-19 Pneumonia.
Infect Dis Ther. 2021 Sep; 10(3):1195-1213.ID

Abstract

INTRODUCTION

Tocilizumab randomized clinical trial results are heterogeneous because of the heterogenous population included in them.

METHODS

We conducted a meta-analysis with subgroup meta-analysis (PRISMA guidelines) between severe and non-severe COVID-19.

RESULTS

We included nine trials. Overall, the mortality rate was 24.5% (821/3357) in the tocilizumab group and 29.1% (908/3125) in the control group at day 28-30 (pooled OR, 0.85; 95% CI 0.76-0.96; p = 0.006). Considering the subgroup analysis, this benefit on mortality was confirmed and amplified in the severe COVID-19 group (pooled OR, 0.82; 95% CI 0.73-0.93; p = 0.001) but not in the non-severe COVID-19 group (pooled OR, 1.46; 95% CI 0.91-2.34; p = 0.12). For patients who were not mechanically ventilated at baseline (5523/6482), the pooled OR (0.74; 95% CI 0.64-0.85; p < 0.0001) for mechanical ventilation incidence at day 28-30 was in favor of tocilizumab (cumulative incidence of 14.8% versus 19.4% in tocilizumab and control arm, respectively). This benefit was confirmed in both subgroups, i.e., severe and non-severe COVID-19.

CONCLUSION

Tocilizumab is an effective treatment in hospitalized patients with COVID-19 and hypoxemia by improving survival and decreasing mechanical ventilation requirement. The greatest benefit is observed in severe COVID-19.

Authors+Show Affiliations

Infectious Disease Department, Nord Franche-Comté Hospital, 90400, Trevenans, France. timothee.klopfenstein@hnfc.fr.Infectious Disease Department, Nord Franche-Comté Hospital, 90400, Trevenans, France.Methodology Unit, Clinical Investigation Center INSERM 1431, Jean-Minjoz University Hospital, Besançon, France.Rheumatology Department, Nord Franche-Comté Hospital, Trevenans, France.Rheumatology Department, Nord Franche-Comté Hospital, Trevenans, France.Infectious Disease Department, Nord Franche-Comté Hospital, 90400, Trevenans, France.Rheumatology Department, Nord Franche-Comté Hospital, Trevenans, France.Intensive Care Unit Department, Nord Franche-Comté Hospital, Trevenans, France.Infectious Disease Department, Nord Franche-Comté Hospital, 90400, Trevenans, France.Rheumatology Department, Nord Franche-Comté Hospital, Trevenans, France.Intensive Care Unit Department, Nord Franche-Comté Hospital, Trevenans, France.Infectious Disease Department, Nord Franche-Comté Hospital, 90400, Trevenans, France.Infectious Disease Department, Nord Franche-Comté Hospital, 90400, Trevenans, France.Methodology Unit, Clinical Investigation Center INSERM 1431, Jean-Minjoz University Hospital, Besançon, France.Infectious Disease Department, Nord Franche-Comté Hospital, 90400, Trevenans, France. souhail.zayet@gmail.com.No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

34247325

Citation

Klopfenstein, Timothée, et al. "Systematic Review and Subgroup Meta-analysis of Randomized Trials to Determine Tocilizumab's Place in COVID-19 Pneumonia." Infectious Diseases and Therapy, vol. 10, no. 3, 2021, pp. 1195-1213.
Klopfenstein T, Gendrin V, Gerazime A, et al. Systematic Review and Subgroup Meta-analysis of Randomized Trials to Determine Tocilizumab's Place in COVID-19 Pneumonia. Infect Dis Ther. 2021;10(3):1195-1213.
Klopfenstein, T., Gendrin, V., Gerazime, A., Conrozier, T., Balblanc, J. C., Royer, P. Y., Lohse, A., Mezher, C., Toko, L., Guillochon, C., Badie, J., Pierron, A., Kadiane-Oussou, N. '. J., Puyraveau, M., & Zayet, S. (2021). Systematic Review and Subgroup Meta-analysis of Randomized Trials to Determine Tocilizumab's Place in COVID-19 Pneumonia. Infectious Diseases and Therapy, 10(3), 1195-1213. https://doi.org/10.1007/s40121-021-00488-6
Klopfenstein T, et al. Systematic Review and Subgroup Meta-analysis of Randomized Trials to Determine Tocilizumab's Place in COVID-19 Pneumonia. Infect Dis Ther. 2021;10(3):1195-1213. PubMed PMID: 34247325.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Systematic Review and Subgroup Meta-analysis of Randomized Trials to Determine Tocilizumab's Place in COVID-19 Pneumonia. AU - Klopfenstein,Timothée, AU - Gendrin,Vincent, AU - Gerazime,Aurélie, AU - Conrozier,Thierry, AU - Balblanc,Jean-Charles, AU - Royer,Pierre-Yves, AU - Lohse,Anne, AU - Mezher,Chaouki, AU - Toko,Lynda, AU - Guillochon,Cerise, AU - Badie,Julio, AU - Pierron,Alix, AU - Kadiane-Oussou,N 'dri Juliette, AU - Puyraveau,Marc, AU - Zayet,Souheil, AU - ,, Y1 - 2021/07/11/ PY - 2021/05/14/received PY - 2021/06/16/accepted PY - 2021/7/12/pubmed PY - 2021/7/12/medline PY - 2021/7/11/entrez KW - Coronavirus disease 2019 KW - Meta-analysis KW - Randomized clinical trial KW - Review KW - Tocilizumab SP - 1195 EP - 1213 JF - Infectious diseases and therapy JO - Infect Dis Ther VL - 10 IS - 3 N2 - INTRODUCTION: Tocilizumab randomized clinical trial results are heterogeneous because of the heterogenous population included in them. METHODS: We conducted a meta-analysis with subgroup meta-analysis (PRISMA guidelines) between severe and non-severe COVID-19. RESULTS: We included nine trials. Overall, the mortality rate was 24.5% (821/3357) in the tocilizumab group and 29.1% (908/3125) in the control group at day 28-30 (pooled OR, 0.85; 95% CI 0.76-0.96; p = 0.006). Considering the subgroup analysis, this benefit on mortality was confirmed and amplified in the severe COVID-19 group (pooled OR, 0.82; 95% CI 0.73-0.93; p = 0.001) but not in the non-severe COVID-19 group (pooled OR, 1.46; 95% CI 0.91-2.34; p = 0.12). For patients who were not mechanically ventilated at baseline (5523/6482), the pooled OR (0.74; 95% CI 0.64-0.85; p < 0.0001) for mechanical ventilation incidence at day 28-30 was in favor of tocilizumab (cumulative incidence of 14.8% versus 19.4% in tocilizumab and control arm, respectively). This benefit was confirmed in both subgroups, i.e., severe and non-severe COVID-19. CONCLUSION: Tocilizumab is an effective treatment in hospitalized patients with COVID-19 and hypoxemia by improving survival and decreasing mechanical ventilation requirement. The greatest benefit is observed in severe COVID-19. SN - 2193-8229 UR - https://www.unboundmedicine.com/medline/citation/34247325/Systematic_Review_and_Subgroup_Meta-analysis_of_Randomized_Trials_to_Determine_Tocilizumab's_Place_in_COVID-19_Pneumonia. L2 - https://dx.doi.org/10.1007/s40121-021-00488-6 DB - PRIME DP - Unbound Medicine ER -
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