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Effect of Tocilizumab in Reducing the Mortality Rate in COVID-19 Patients: A Systematic Review with Meta-Analysis.
J Pers Med. 2021 Jul 01; 11(7)JP

Abstract

Data supporting the use of Tocilizumab (TCZ) in COVID-19 are contrasting and inconclusive. This meta-analysis aimed to assess TCZ effectiveness in reducing the mortality rate in COVID-19 patients. PubMed, Scopus, Embase, Cochrane, WILEY, and ClinicalTrials.gov were searched to evaluate observational studies and RCTs. The outcome was the mortality rate. Forty observational studies and seven RCTs, involving 9640 and 5556 subjects treated with Standard Therapy (ST) + TCZ or ST alone, respectively, were included. In patients treated with ST+TCZ, a higher survival (Log odds ratio = -0.41; 95% CI: -0.68 -0.14; p < 0.001) was found. Subgroups analyses were performed to better identify the possible interference of some parameters in modifying the efficacy of TCZ therapy on COVID-19 mortality. Separating observational from RCTs, no statistically significant (p = 0.70) TCZ-related reduction of mortality regarding RCTs was found, while a significant reduction (Log odds ratio = -0.52; 95% CI: -0.82 -0.22, p < 0.001) was achieved regarding the observational studies. Stratifying for the use of Invasive Mechanic Ventilation (IMV), a higher survival was found in patients treated with TCZ in the No-IMV and IMV groups (both p < 0.001), but not in the No-IMV/IMV group. Meta-regression analyses were also performed. The meta-analysis of observational studies reveals that TCZ is associated with reducing the mortality rate in both severe and critically ill patients. Although the largest RCT, RECOVERY, is in line with this result, the meta-analysis of RCTs failed to found any difference between ST + TCZ and ST. It is crucial to personalize the therapy considering the patients' characteristics.

Authors+Show Affiliations

Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Salerno, Italy. Clinical Pharmacology and Pharmacogenetics Unit, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", 84125 Salerno, Italy.Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy. Italian Society of Gerontology and Geriatrics (SIGG), Via G.C. Vanini, 5, 50129 Firenze, Italy.Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Salerno, Italy.Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Salerno, Italy. Oncology Unit, University Hospital San Giovanni di Dio e Ruggi D'Aragona, 84125 Salerno, Italy.Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Salerno, Italy.Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Salerno, Italy.Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Salerno, Italy.Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Salerno, Italy.Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy.Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Salerno, Italy. Infectious Diseases Unit, Hospital San Giovanni di Dio e Ruggi D'Aragona, 84125 Salerno, Italy.Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Salerno, Italy. Clinical Pharmacology and Pharmacogenetics Unit, University Hospital "San Giovanni di Dio e Ruggi D'Aragona", 84125 Salerno, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

34357095

Citation

Conti, Valeria, et al. "Effect of Tocilizumab in Reducing the Mortality Rate in COVID-19 Patients: a Systematic Review With Meta-Analysis." Journal of Personalized Medicine, vol. 11, no. 7, 2021.
Conti V, Corbi G, Sellitto C, et al. Effect of Tocilizumab in Reducing the Mortality Rate in COVID-19 Patients: A Systematic Review with Meta-Analysis. J Pers Med. 2021;11(7).
Conti, V., Corbi, G., Sellitto, C., Sabbatino, F., Maci, C., Bertini, N., De Bellis, E., Iuliano, A., Davinelli, S., Pagliano, P., & Filippelli, A. (2021). Effect of Tocilizumab in Reducing the Mortality Rate in COVID-19 Patients: A Systematic Review with Meta-Analysis. Journal of Personalized Medicine, 11(7). https://doi.org/10.3390/jpm11070628
Conti V, et al. Effect of Tocilizumab in Reducing the Mortality Rate in COVID-19 Patients: a Systematic Review With Meta-Analysis. J Pers Med. 2021 Jul 1;11(7) PubMed PMID: 34357095.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of Tocilizumab in Reducing the Mortality Rate in COVID-19 Patients: A Systematic Review with Meta-Analysis. AU - Conti,Valeria, AU - Corbi,Graziamaria, AU - Sellitto,Carmine, AU - Sabbatino,Francesco, AU - Maci,Chiara, AU - Bertini,Nicola, AU - De Bellis,Emanuela, AU - Iuliano,Antonio, AU - Davinelli,Sergio, AU - Pagliano,Pasquale, AU - Filippelli,Amelia, Y1 - 2021/07/01/ PY - 2021/06/03/received PY - 2021/06/27/revised PY - 2021/06/28/accepted PY - 2021/8/6/entrez PY - 2021/8/7/pubmed PY - 2021/8/7/medline KW - COVID-19 mortality KW - anti-inflammatory drugs KW - critical and severe patients KW - standard therapy KW - tocilizumab JF - Journal of personalized medicine JO - J Pers Med VL - 11 IS - 7 N2 - Data supporting the use of Tocilizumab (TCZ) in COVID-19 are contrasting and inconclusive. This meta-analysis aimed to assess TCZ effectiveness in reducing the mortality rate in COVID-19 patients. PubMed, Scopus, Embase, Cochrane, WILEY, and ClinicalTrials.gov were searched to evaluate observational studies and RCTs. The outcome was the mortality rate. Forty observational studies and seven RCTs, involving 9640 and 5556 subjects treated with Standard Therapy (ST) + TCZ or ST alone, respectively, were included. In patients treated with ST+TCZ, a higher survival (Log odds ratio = -0.41; 95% CI: -0.68 -0.14; p < 0.001) was found. Subgroups analyses were performed to better identify the possible interference of some parameters in modifying the efficacy of TCZ therapy on COVID-19 mortality. Separating observational from RCTs, no statistically significant (p = 0.70) TCZ-related reduction of mortality regarding RCTs was found, while a significant reduction (Log odds ratio = -0.52; 95% CI: -0.82 -0.22, p < 0.001) was achieved regarding the observational studies. Stratifying for the use of Invasive Mechanic Ventilation (IMV), a higher survival was found in patients treated with TCZ in the No-IMV and IMV groups (both p < 0.001), but not in the No-IMV/IMV group. Meta-regression analyses were also performed. The meta-analysis of observational studies reveals that TCZ is associated with reducing the mortality rate in both severe and critically ill patients. Although the largest RCT, RECOVERY, is in line with this result, the meta-analysis of RCTs failed to found any difference between ST + TCZ and ST. It is crucial to personalize the therapy considering the patients' characteristics. SN - 2075-4426 UR - https://www.unboundmedicine.com/medline/citation/34357095/Effect_of_Tocilizumab_in_Reducing_the_Mortality_Rate_in_COVID_19_Patients:_A_Systematic_Review_with_Meta_Analysis_ L2 - https://www.mdpi.com/resolver?pii=jpm11070628 DB - PRIME DP - Unbound Medicine ER -
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