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Efficacy and harms of tocilizumab for the treatment of COVID-19 patients: A systematic review and meta-analysis.
PLoS One. 2022; 17(6):e0269368.Plos

Abstract

INTRODUCTION

We systematically assessed benefits and harms of tocilizumab (TCZ), which is an antibody blocking IL-6 receptors, in hospitalized COVID-19 patients.

METHODS

Five electronic databases and two preprint webpages were searched until March 4, 2021. Randomized controlled trials (RCTs) and inverse probability treatment weighting (IPTW) cohorts assessing TCZ effects in hospitalized, COVID-19 adult patients were included. Primary outcomes were all-cause mortality, clinical worsening, clinical improvement, need for mechanical ventilation, and adverse events (AE). Inverse variance random-effects meta-analyses were performed with quality of evidence (QoE) evaluated using GRADE methodology.

RESULTS

Nine RCTs (n = 7,021) and nine IPTW cohorts (n = 7,796) were included. TCZ significantly reduced all-cause mortality in RCTs (RR 0.89, 95%CI 0.81-0.98, p = 0.03; moderate QoE) and non-significantly in cohorts (RR 0.67, 95%CI 0.44-1.02, p = 0.08; very low QoE) vs. control (standard of care [SOC] or placebo). TCZ significantly reduced the need for mechanical ventilation (RR 0.80, 95%CI 0.71-0.90, p = 0.001; moderate QoE) and length of stay (MD -1.92 days, 95%CI -3.46 to -0.38, p = 0.01; low QoE) vs. control in RCTs. There was no significant difference in clinical improvement or worsening between treatments. AEs, severe AEs, bleeding and thrombotic events were similar between arms in RCTs, but there was higher neutropenia risk with TCZ (very low QoE). Subgroup analyses by disease severity or risk of bias (RoB) were consistent with main analyses. Quality of evidence was moderate to very low in both RCTs and cohorts.

CONCLUSIONS

In comparison to SOC or placebo, TCZ reduced all-cause mortality in all studies and reduced mechanical ventilation and length of stay in RCTs in hospitalized COVID-19 patients. Other clinical outcomes were not significantly impacted. TCZ did not have effect on AEs, except a significant increased neutropenia risk in RCTs. TCZ has a potential role in the treatment of hospitalized COVID-19 patients.

Authors+Show Affiliations

Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET), Universidad San Ignacio de Loyola (USIL), Lima, Peru. Hospital Guillermo Kaelin de La Fuente, Lima, Peru.Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru.Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru. Department of Medicine, Henry Ford Hospital, Detroit, Michigan, United States of America.Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, Connecticut, United States of America.Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, Connecticut, United States of America.Epidemiology Unit, National Institute of Gastroenterology, La Habana, Cuba.Cello Health, Yardley, Pennsylvania, United States of America.Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, Connecticut, United States of America.Unidad de Revisiones Sistemáticas y Meta-análisis (URSIGET), Universidad San Ignacio de Loyola (USIL), Lima, Peru. Health Outcomes, Policy, and Evidence Synthesis (HOPES) Group, University of Connecticut School of Pharmacy, Storrs, Connecticut, United States of America.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

35657993

Citation

Piscoya, Alejandro, et al. "Efficacy and Harms of Tocilizumab for the Treatment of COVID-19 Patients: a Systematic Review and Meta-analysis." PloS One, vol. 17, no. 6, 2022, pp. e0269368.
Piscoya A, Parra Del Riego A, Cerna-Viacava R, et al. Efficacy and harms of tocilizumab for the treatment of COVID-19 patients: A systematic review and meta-analysis. PLoS One. 2022;17(6):e0269368.
Piscoya, A., Parra Del Riego, A., Cerna-Viacava, R., Rocco, J., Roman, Y. M., Escobedo, A. A., Pasupuleti, V., White, C. M., & Hernandez, A. V. (2022). Efficacy and harms of tocilizumab for the treatment of COVID-19 patients: A systematic review and meta-analysis. PloS One, 17(6), e0269368. https://doi.org/10.1371/journal.pone.0269368
Piscoya A, et al. Efficacy and Harms of Tocilizumab for the Treatment of COVID-19 Patients: a Systematic Review and Meta-analysis. PLoS One. 2022;17(6):e0269368. PubMed PMID: 35657993.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Efficacy and harms of tocilizumab for the treatment of COVID-19 patients: A systematic review and meta-analysis. AU - Piscoya,Alejandro, AU - Parra Del Riego,Angela, AU - Cerna-Viacava,Renato, AU - Rocco,Jonathon, AU - Roman,Yuani M, AU - Escobedo,Angel A, AU - Pasupuleti,Vinay, AU - White,C Michael, AU - Hernandez,Adrian V, Y1 - 2022/06/03/ PY - 2021/4/13/received PY - 2022/5/19/accepted PY - 2022/6/3/entrez PY - 2022/6/4/pubmed PY - 2022/6/9/medline SP - e0269368 EP - e0269368 JF - PloS one JO - PLoS One VL - 17 IS - 6 N2 - INTRODUCTION: We systematically assessed benefits and harms of tocilizumab (TCZ), which is an antibody blocking IL-6 receptors, in hospitalized COVID-19 patients. METHODS: Five electronic databases and two preprint webpages were searched until March 4, 2021. Randomized controlled trials (RCTs) and inverse probability treatment weighting (IPTW) cohorts assessing TCZ effects in hospitalized, COVID-19 adult patients were included. Primary outcomes were all-cause mortality, clinical worsening, clinical improvement, need for mechanical ventilation, and adverse events (AE). Inverse variance random-effects meta-analyses were performed with quality of evidence (QoE) evaluated using GRADE methodology. RESULTS: Nine RCTs (n = 7,021) and nine IPTW cohorts (n = 7,796) were included. TCZ significantly reduced all-cause mortality in RCTs (RR 0.89, 95%CI 0.81-0.98, p = 0.03; moderate QoE) and non-significantly in cohorts (RR 0.67, 95%CI 0.44-1.02, p = 0.08; very low QoE) vs. control (standard of care [SOC] or placebo). TCZ significantly reduced the need for mechanical ventilation (RR 0.80, 95%CI 0.71-0.90, p = 0.001; moderate QoE) and length of stay (MD -1.92 days, 95%CI -3.46 to -0.38, p = 0.01; low QoE) vs. control in RCTs. There was no significant difference in clinical improvement or worsening between treatments. AEs, severe AEs, bleeding and thrombotic events were similar between arms in RCTs, but there was higher neutropenia risk with TCZ (very low QoE). Subgroup analyses by disease severity or risk of bias (RoB) were consistent with main analyses. Quality of evidence was moderate to very low in both RCTs and cohorts. CONCLUSIONS: In comparison to SOC or placebo, TCZ reduced all-cause mortality in all studies and reduced mechanical ventilation and length of stay in RCTs in hospitalized COVID-19 patients. Other clinical outcomes were not significantly impacted. TCZ did not have effect on AEs, except a significant increased neutropenia risk in RCTs. TCZ has a potential role in the treatment of hospitalized COVID-19 patients. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/35657993/Efficacy_and_harms_of_tocilizumab_for_the_treatment_of_COVID_19_patients:_A_systematic_review_and_meta_analysis_ DB - PRIME DP - Unbound Medicine ER -