Comparative effectiveness of pharmacological interventions on mortality and the average length of hospital stay of patients with COVID-19: a systematic review and meta-analysis of randomized controlled trials

Akbari, Abolfazl; Razmi, Mahya; Sedaghat, Alireza; Dana, Seyyed Mohammad Matin Alavi; Amiri, Mahdi; Halvani, Ali Mohammad; Yazdani, Soroush; Negah, Sajad Sahab

doi:10.1080/14787210.2022.1997587

Cited by 5 publications

(2 citation statements)

References 141 publications

(89 reference statements)

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“…Early control of cytokine storm by anti-inflammatory treatments may improve the survival rate of patients with COVID-19. 34 It is well-known that pretreatment of human macrophages with estrogen can reduce tumor necrosis factor alpha (TNF-α) expression by inhibiting nuclear factor-kappa B (NFk-B) and JAK2 signaling pathways. 35 Estrogen also attenuates monocyte and macrophage recruitment by downregulating the expression of chemokine ligand 2 during inflammation and dampening toll-like receptor 4-mediated NFk-B activation.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Outcomes Associated with Menopausal Status in COVID-19 Patients: A Systematic Review and Meta-analysis

Akbari,

Zarifian,

Hadizadeh

et al. 2023

Rev Bras Ginecol Obstet

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Objective Menopause causes several changes in the body that may affect the response to COVID -19. We aimed to investigate the possible association between menopausal status and incidence and outcomes in COVID-19 patients. Methods Combinations of keywordsCOVID-19, menopause, and estrogen were used to search the PubMed, Embase, Web-of-Science, and Scopus databases for articles reporting the incidence and outcomes of COVID-19 (discharge, length-of-admission, intensive care, or mortality) in premenopausal women, available through December 29, 2022. Data from studies comparing the incidence of COVID-19 infection with the age-matched male population were pooled and meta-analyzed using a random-effects model. Results Overall, 1,564 studies were retrieved, of which 12 were finally included in the systematic review to compare disease outcomes, and 6 were meta-analyzed for the incidence of COVID-19 in premenopausal and postmenopausal women. All studies reported better COVID-19-associated outcomes in premenopausal women compared with postmenopausal women. After adjusting for confounding factors, three studies found better outcomes in postmenopausal women, and two found no association between menopausal status and COVID-19 outcomes. Our meta-analysis found a higher incidence of COVID-19 infection among premenopausal women than postmenopausal women, when compared with age-matched men (odds ratio = 1.270; 95% confidence interval: 1.086–1.486; p = 0.003). Conclusion The incidence of COVID-19 was significantly higher in premenopausal women than in postmenopausal women when compared with age-matched men. Although premenopausal women may have more favorable COVID-19-associated outcomes, the presumed preventive effect of estrogens on the incidence and related outcomes of COVID-19 in premenopausal women cannot be proven at present. Further longitudinal studies comparing pre- and post-menopausal women are required to provide further insight into this matter.

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Section: Discussionmentioning

confidence: 99%

Incidence and Outcomes Associated with Menopausal Status in COVID-19 Patients: A Systematic Review and Meta-analysis

Akbari,

Zarifian,

Hadizadeh

et al. 2023

Rev Bras Ginecol Obstet

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“…A systematic review evaluating the effects of five pharmacologic interventions (i.e., anti‐inflammatory, antiviral, antiparasitic, antibody, and antibiotics) on the length of hospital stay showed that anti‐inflammatory (mean difference (MD) −1.41; 95%CI, −1.75, −1.07) and antiparasitic drugs (MD −0.65; 95%CI, −1.26, −0.03) significantly reduced the length of hospital stay 149 . However, in the present study we did not find any significant differences between the tocilizumab and control groups, in terms of the length of hospital stay or ICU stay ( p > 0.05).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of tocilizumab in the treatment of COVID‐19: An umbrella review

Tolzali

Noori

Shokri

et al. 2022

Reviews in Medical Virology

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Tocilizumab is an interleukin (IL)‐6 receptor inhibitor that has been proposed as a therapeutic agent for treating coronavirus disease 2019 (COVID‐19). The aim of this umbrella review was to determine the efficacy of tocilizumab in treating COVID‐19, and to provide an overview of all systematic reviews on this topic. We systematically searched PubMed, Scopus, the Web of Science collection, the Cochrane library, Epistemonikos, and Google Scholar, as well as the medRxiv preprint server. These databases were searched up to 30 September 2021, using the following keywords: ‘SARS‐CoV‐2’, ‘COVID‐19’, ‘tocilizumab’, ‘RHPM‐1’, ‘systematic review’, and ‘meta‐analysis’. Studies were included if they were systematic reviews (with or without meta‐analysis) investigating the efficacy or safety of tocilizumab in confirmed COVID‐19 patients. The AMSTAR 2 checklist was used to assess quality of the included articles, while publication bias was examined using Egger's test. A total of 50 eligible systematic reviews were included. The pooled estimates showed significant reductions in clinical failure (risk ratio (RR) 0.75; 95% confidence interval (CI), 0.61–0.93), deaths (RR 0.78; 95%CI, 0.71–0.85) and the need for mechanical ventilation (RR 0.77; 95%CI, 0.64–0.92) for those receiving tocilizumab compared with the control group. Also, an emerging survival benefit was demonstrated for those who received tocilizumab, over those in the control group (adjusted hazard ratio (aHR) 0.52; 95%CI, 0.43–0.63). In addition, tocilizumab substantially increased the number of ventilator‐free days, compared with the control treatments (weighted mean difference (WMD) 3.38; 95%CI, 0.51–6.25). Furthermore, lymphocyte count (WMD 0.26 × 10 9 /L; 95%CI, 0.14–0.37), IL‐6 (WMD 176.99 pg/mL; 95%CI, 76.34–277.64) and D‐dimer (WMD 741.08 ng/mL; 95%CI, 109.42–1372.75) were all significantly elevated in those receiving tocilizumab. However, the level of lactate dehydrogenase (LDH) (WMD −30.88 U/L; 95%CI, −51.52, −10.24) and C‐reactive protein (CRP) (WMD ‐104.83 mg/L; 95%CI, −133.21, −76.46) were both significantly lower after treatment with tocilizumab. Tocilizumab treatment reduced the risk of intubation, mortality and the length of hospital stay, without increasing the risk of superimposed infections in COVID‐19 patients. Therefore, tocilizumab can be considered an effective therapeutic agent for treating patients with COVID‐19.

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Role of autoantibodies targeting interferon type 1 in COVID-19 severity: A systematic review and meta-analysis

Akbari,

Hadizadeh,

Amiri

et al. 2023

Journal of Translational Autoimmunity

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Comparative effectiveness of pharmacological interventions on mortality and the average length of hospital stay of patients with COVID-19: a systematic review and meta-analysis of randomized controlled trials

Cited by 5 publications

References 141 publications

Incidence and Outcomes Associated with Menopausal Status in COVID-19 Patients: A Systematic Review and Meta-analysis

Incidence and Outcomes Associated with Menopausal Status in COVID-19 Patients: A Systematic Review and Meta-analysis

Efficacy of tocilizumab in the treatment of COVID‐19: An umbrella review

Role of autoantibodies targeting interferon type 1 in COVID-19 severity: A systematic review and meta-analysis

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