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Efficacy and safety of tocilizumab in the management of COVID-19: a systematic review and meta-analysis of observational studies.
Clin Exp Rheumatol. 2021 Jul 07 [Online ahead of print]CE

Abstract

OBJECTIVES

This systematic review and meta-analysis was aimed to evaluate the efficacy and safety of tocilizumab (TCZ) in treating severe coronavirus disease 2019 (COVID-19).

METHODS

The electronic search was made using PubMed, Scopus, CENTRAL, and Google scholar to identify the retrospective observational reports. The studies published from 01 January 2020 to 30th October 2020. Participants were hospitalised COVID-19 patients. Interventions included tocilizumab versus placebo/standard of care. The comparison will be between TCZ versus standard of care (SOC)/placebo. Inconsistency between the studies was evaluated with I2 and quality of the evidences were evaluated by Newcastle-Ottawa scale.

RESULTS

Based on the inclusion criteria there were 24 retrospective studies involving 5686 subjects were included. The outcomes of the meta-analysis have revealed that the TCZ has reduced mortality (M-H, RE-OR -0.11(-0.18--0.04) 95% CI, p=0.001, I2 =88%) and increased the incidences of super-infections (M-H, RE-OR 1.49(1.13-1.96) 95% CI, p=0.004, I2=47%). However, there is no significant difference in ICU admissions rate (M-H, RE-OR -0.06(-0.23-0.12), I2=93%), need for mechanical ventilation (M-H, RE-OR of 0.00(-0.06-0.07), I=74%), LOS (IV -2.86(-0.91-3.38), I2=100%), LOS-ICU (IV: -3.93(-12.35-4.48), I2=100%), and incidences of pulmonary thrombosis (MH, RE-OR 1.01 (0.45-2.26), I2=0%) compared to SOC/control.

CONCLUSIONS

Based on cumulative low-to-moderate certainty evidence shows that TCZ could reduce the risk of mortality in hospitalised patients. However, there is no statistically significant difference observed between the TCZ and SOC/control groups in other parameters.

Authors+Show Affiliations

Independent Researcher and Consultant, Kengeri, Bangalore, Karnataka, India. glv_000@yahoo.com.Department of Pharmaceutical Chemistry and Phytochemistry, Nirmala College of Pharmacy, Mangalagiri, Andhra Pradesh, India.Independent Researcher, Kengeri, Bangalore, Karnataka, India.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

34251307

Citation

Viswanatha, Gollapalle L., et al. "Efficacy and Safety of Tocilizumab in the Management of COVID-19: a Systematic Review and Meta-analysis of Observational Studies." Clinical and Experimental Rheumatology, 2021.
Viswanatha GL, Anjana Male CKVLSN, Shylaja H. Efficacy and safety of tocilizumab in the management of COVID-19: a systematic review and meta-analysis of observational studies. Clin Exp Rheumatol. 2021.
Viswanatha, G. L., Anjana Male, C. K. V. L. S. N., & Shylaja, H. (2021). Efficacy and safety of tocilizumab in the management of COVID-19: a systematic review and meta-analysis of observational studies. Clinical and Experimental Rheumatology.
Viswanatha GL, Anjana Male CKVLSN, Shylaja H. Efficacy and Safety of Tocilizumab in the Management of COVID-19: a Systematic Review and Meta-analysis of Observational Studies. Clin Exp Rheumatol. 2021 Jul 7;. PubMed PMID: 34251307.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy and safety of tocilizumab in the management of COVID-19: a systematic review and meta-analysis of observational studies. AU - Viswanatha,Gollapalle L, AU - Anjana Male,Ch K V L S N, AU - Shylaja,Hanumanthappa, Y1 - 2021/07/07/ PY - 2021/03/10/received PY - 2021/04/14/accepted PY - 2021/7/12/entrez PY - 2021/7/13/pubmed PY - 2021/7/13/medline SP - EP - JF - Clinical and experimental rheumatology JO - Clin Exp Rheumatol N2 - OBJECTIVES: This systematic review and meta-analysis was aimed to evaluate the efficacy and safety of tocilizumab (TCZ) in treating severe coronavirus disease 2019 (COVID-19). METHODS: The electronic search was made using PubMed, Scopus, CENTRAL, and Google scholar to identify the retrospective observational reports. The studies published from 01 January 2020 to 30th October 2020. Participants were hospitalised COVID-19 patients. Interventions included tocilizumab versus placebo/standard of care. The comparison will be between TCZ versus standard of care (SOC)/placebo. Inconsistency between the studies was evaluated with I2 and quality of the evidences were evaluated by Newcastle-Ottawa scale. RESULTS: Based on the inclusion criteria there were 24 retrospective studies involving 5686 subjects were included. The outcomes of the meta-analysis have revealed that the TCZ has reduced mortality (M-H, RE-OR -0.11(-0.18--0.04) 95% CI, p=0.001, I2 =88%) and increased the incidences of super-infections (M-H, RE-OR 1.49(1.13-1.96) 95% CI, p=0.004, I2=47%). However, there is no significant difference in ICU admissions rate (M-H, RE-OR -0.06(-0.23-0.12), I2=93%), need for mechanical ventilation (M-H, RE-OR of 0.00(-0.06-0.07), I=74%), LOS (IV -2.86(-0.91-3.38), I2=100%), LOS-ICU (IV: -3.93(-12.35-4.48), I2=100%), and incidences of pulmonary thrombosis (MH, RE-OR 1.01 (0.45-2.26), I2=0%) compared to SOC/control. CONCLUSIONS: Based on cumulative low-to-moderate certainty evidence shows that TCZ could reduce the risk of mortality in hospitalised patients. However, there is no statistically significant difference observed between the TCZ and SOC/control groups in other parameters. SN - 0392-856X UR - https://www.unboundmedicine.com/medline/citation/34251307/Efficacy_and_safety_of_tocilizumab_in_the_management_of_COVID-19:_a_systematic_review_and_meta-analysis_of_observational_studies. DB - PRIME DP - Unbound Medicine ER -
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