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Tocilizumab and Systemic Corticosteroids in the Management of Patients with COVID-19: A Systematic Review and Meta-Analysis.
Int J Infect Dis. 2021 Sep; 110:320-329.IJ

Abstract

BACKGROUND

To date, there is no effective treatment for the new coronavirus disease (COVID-19). We aimed to systematically review the literature on the association between the combination of tocilizumab (TCZ) and systemic corticosteroid therapy (SCT) on outcomes of COVID-19 patients.

METHODS

We searched MEDLINE, Cochrane Central, and preprints, for studies in which health outcomes were compared between adults with severe COVID-19 who received TCZ and SCT and those who received standard of care without TCZ. Record screening, data extraction, and risk of bias assessment were performed in duplicate. Random effect models were used when pooling crude numbers and adjusted effect estimates of study outcomes.

RESULTS

Our search identified seventeen studies. The pooled crude mortality rate was lower in the combination arm (relative risk, RR=0.62, 95% confidence interval [CI]=0.42 - 0.91; I2=60%). The adjusted mortality rates were also lower in the combination arm (RR=0.58, 95% CI=0.42 - 0.81; I2=71%). The rate of superinfections did not differ between the two interventions.

CONCLUSIONS

The findings of this study show that combination of TCZ and SCT compared to SOC has lower mortality rates. There is an urgent need for well-designed randomized trials to assess the safety and efficacy of this combination in subjects with severe COVID-19.

Authors+Show Affiliations

Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.Pharmaceutical Care Division, King Faisal Specialist Hospital Specialist Hospital and research Center, Riyadh Saudi Arabia. Electronic address: amohaizeie@kfshrc.edu.sa.College of Pharmacy, King Saud University.College of Pharmacy, King Saud University.Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

34273515

Citation

Alkofide, Hadeel, et al. "Tocilizumab and Systemic Corticosteroids in the Management of Patients With COVID-19: a Systematic Review and Meta-Analysis." International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, vol. 110, 2021, pp. 320-329.
Alkofide H, Almohaizeie A, Almuhaini S, et al. Tocilizumab and Systemic Corticosteroids in the Management of Patients with COVID-19: A Systematic Review and Meta-Analysis. Int J Infect Dis. 2021;110:320-329.
Alkofide, H., Almohaizeie, A., Almuhaini, S., Alotaibi, B., & Alkharfy, K. M. (2021). Tocilizumab and Systemic Corticosteroids in the Management of Patients with COVID-19: A Systematic Review and Meta-Analysis. International Journal of Infectious Diseases : IJID : Official Publication of the International Society for Infectious Diseases, 110, 320-329. https://doi.org/10.1016/j.ijid.2021.07.021
Alkofide H, et al. Tocilizumab and Systemic Corticosteroids in the Management of Patients With COVID-19: a Systematic Review and Meta-Analysis. Int J Infect Dis. 2021;110:320-329. PubMed PMID: 34273515.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tocilizumab and Systemic Corticosteroids in the Management of Patients with COVID-19: A Systematic Review and Meta-Analysis. AU - Alkofide,Hadeel, AU - Almohaizeie,Abdullah, AU - Almuhaini,Sara, AU - Alotaibi,Bashayer, AU - Alkharfy,Khalid M, Y1 - 2021/07/14/ PY - 2021/01/12/received PY - 2021/07/06/revised PY - 2021/07/08/accepted PY - 2021/7/18/pubmed PY - 2021/9/29/medline PY - 2021/7/17/entrez KW - COVID-19 KW - coronavirus KW - severe COVID-19 KW - systemic corticosteroid therapy KW - tocilizumab SP - 320 EP - 329 JF - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases JO - Int J Infect Dis VL - 110 N2 - BACKGROUND: To date, there is no effective treatment for the new coronavirus disease (COVID-19). We aimed to systematically review the literature on the association between the combination of tocilizumab (TCZ) and systemic corticosteroid therapy (SCT) on outcomes of COVID-19 patients. METHODS: We searched MEDLINE, Cochrane Central, and preprints, for studies in which health outcomes were compared between adults with severe COVID-19 who received TCZ and SCT and those who received standard of care without TCZ. Record screening, data extraction, and risk of bias assessment were performed in duplicate. Random effect models were used when pooling crude numbers and adjusted effect estimates of study outcomes. RESULTS: Our search identified seventeen studies. The pooled crude mortality rate was lower in the combination arm (relative risk, RR=0.62, 95% confidence interval [CI]=0.42 - 0.91; I2=60%). The adjusted mortality rates were also lower in the combination arm (RR=0.58, 95% CI=0.42 - 0.81; I2=71%). The rate of superinfections did not differ between the two interventions. CONCLUSIONS: The findings of this study show that combination of TCZ and SCT compared to SOC has lower mortality rates. There is an urgent need for well-designed randomized trials to assess the safety and efficacy of this combination in subjects with severe COVID-19. SN - 1878-3511 UR - https://www.unboundmedicine.com/medline/citation/34273515/Tocilizumab_and_Systemic_Corticosteroids_in_the_Management_of_Patients_with_COVID_19:_A_Systematic_Review_and_Meta_Analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1201-9712(21)00578-6 DB - PRIME DP - Unbound Medicine ER -