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Tocilizumab administration for the treatment of hospitalized patients with COVID-19: A systematic review and meta-analysis.
Respirology. 2021 11; 26(11):1027-1040.R

Abstract

Tocilizumab has been repurposed against the 'cytokine storm' in the setting of coronavirus disease 2019 (COVID-19). Our aim was to evaluate the efficacy of tocilizumab in the management of hospitalized COVID-19 patients. We searched MEDLINE, CENTRAL and medRxiv for studies of tocilizumab in hospitalized COVID-19 patients. Primary objective was the effectiveness of tocilizumab on mortality. Secondary objectives included the need for invasive mechanical ventilation (IMV), composite endpoints of mortality or IMV and intensive care unit (ICU) admission or IMV, length of hospitalization and differences in mortality in subgroups (ICU and non-ICU patients and patients receiving or not receiving concomitant corticosteroids). We included 52 studies (nine randomized controlled trials [RCTs] and 43 observational) with a total of 27,004 patients. In both RCTs and observational studies, the use of tocilizumab was associated with a reduction in mortality; 11% in RCTs (risk ratio [RR] 0.89, 95% CI 0.82 to 0.96) and 31% in observational studies (RR 0.69, 95% CI 0.58 to 0.83). The need for IMV was reduced by 19% in RCTs (RR 0.81, 95% CI 0.71 to 0.93), while no significant reduction was observed in observational studies. Both RCTs and observational studies showed a benefit from tocilizumab on the composite endpoint of mortality or IMV. Tocilizumab improved mortality both in ICU and non-ICU patients. Reduction in mortality was evident in observational studies regardless of the use of systemic corticosteroids, while that was not the case in the RCTs. Tocilizumab was associated with lower mortality and other clinically relevant outcomes in hospitalized patients with moderate-to-critical COVID-19.

Authors+Show Affiliations

Respiratory Medicine Department, University of Ioannina Faculty of Medicine, Ioannina, Greece.Department of Hygiene and Epidemiology, University of Ioannina Faculty of Medicine, Ioannina, Greece.Respiratory Medicine Department, University of Ioannina Faculty of Medicine, Ioannina, Greece.Internal Medicine Department, University of Ioannina Faculty of Medicine, Ioannina, Greece.Department of Hygiene and Epidemiology, University of Ioannina Faculty of Medicine, Ioannina, Greece.Respiratory Medicine Department, University of Ioannina Faculty of Medicine, Ioannina, Greece.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

34605114

Citation

Kyriakopoulos, Christos, et al. "Tocilizumab Administration for the Treatment of Hospitalized Patients With COVID-19: a Systematic Review and Meta-analysis." Respirology (Carlton, Vic.), vol. 26, no. 11, 2021, pp. 1027-1040.
Kyriakopoulos C, Ntritsos G, Gogali A, et al. Tocilizumab administration for the treatment of hospitalized patients with COVID-19: A systematic review and meta-analysis. Respirology. 2021;26(11):1027-1040.
Kyriakopoulos, C., Ntritsos, G., Gogali, A., Milionis, H., Evangelou, E., & Kostikas, K. (2021). Tocilizumab administration for the treatment of hospitalized patients with COVID-19: A systematic review and meta-analysis. Respirology (Carlton, Vic.), 26(11), 1027-1040. https://doi.org/10.1111/resp.14152
Kyriakopoulos C, et al. Tocilizumab Administration for the Treatment of Hospitalized Patients With COVID-19: a Systematic Review and Meta-analysis. Respirology. 2021;26(11):1027-1040. PubMed PMID: 34605114.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Tocilizumab administration for the treatment of hospitalized patients with COVID-19: A systematic review and meta-analysis. AU - Kyriakopoulos,Christos, AU - Ntritsos,Georgios, AU - Gogali,Athena, AU - Milionis,Haralampos, AU - Evangelou,Evangelos, AU - Kostikas,Konstantinos, Y1 - 2021/10/03/ PY - 2021/08/26/revised PY - 2021/05/28/received PY - 2021/09/07/accepted PY - 2021/10/5/pubmed PY - 2021/11/17/medline PY - 2021/10/4/entrez KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus disease KW - meta-analysis KW - mortality KW - tocilizumab SP - 1027 EP - 1040 JF - Respirology (Carlton, Vic.) JO - Respirology VL - 26 IS - 11 N2 - Tocilizumab has been repurposed against the 'cytokine storm' in the setting of coronavirus disease 2019 (COVID-19). Our aim was to evaluate the efficacy of tocilizumab in the management of hospitalized COVID-19 patients. We searched MEDLINE, CENTRAL and medRxiv for studies of tocilizumab in hospitalized COVID-19 patients. Primary objective was the effectiveness of tocilizumab on mortality. Secondary objectives included the need for invasive mechanical ventilation (IMV), composite endpoints of mortality or IMV and intensive care unit (ICU) admission or IMV, length of hospitalization and differences in mortality in subgroups (ICU and non-ICU patients and patients receiving or not receiving concomitant corticosteroids). We included 52 studies (nine randomized controlled trials [RCTs] and 43 observational) with a total of 27,004 patients. In both RCTs and observational studies, the use of tocilizumab was associated with a reduction in mortality; 11% in RCTs (risk ratio [RR] 0.89, 95% CI 0.82 to 0.96) and 31% in observational studies (RR 0.69, 95% CI 0.58 to 0.83). The need for IMV was reduced by 19% in RCTs (RR 0.81, 95% CI 0.71 to 0.93), while no significant reduction was observed in observational studies. Both RCTs and observational studies showed a benefit from tocilizumab on the composite endpoint of mortality or IMV. Tocilizumab improved mortality both in ICU and non-ICU patients. Reduction in mortality was evident in observational studies regardless of the use of systemic corticosteroids, while that was not the case in the RCTs. Tocilizumab was associated with lower mortality and other clinically relevant outcomes in hospitalized patients with moderate-to-critical COVID-19. SN - 1440-1843 UR - https://www.unboundmedicine.com/medline/citation/34605114/Tocilizumab_administration_for_the_treatment_of_hospitalized_patients_with_COVID_19:_A_systematic_review_and_meta_analysis_ L2 - https://doi.org/10.1111/resp.14152 DB - PRIME DP - Unbound Medicine ER -