Efficacy and safety of tocilizumab in COVID-19 patients: A Meta-Analysis

Liu, Lipeng; Zong, Suyu; Li, Jun; Zhang, Aoli; Liu, Chao; Guo, Ye; Yang, Wenyu; Chen, Xiaojuan; Zhang, Ying-Chi; Zhu, Xiaofan

doi:10.21203/rs.3.rs-50446/v1

Cited by 3 publications

(3 citation statements)

References 44 publications

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“…Regarding safety, almost all published meta-analysis studies reported no significant differences in the rate of clinically important infections between the tocilizumab and SOC groups [ 89 , 92 , 95 , 96 ]. Similarly, in our study, no significant association between tocilizumab administration and secondary infections was found (RR [95%CI] of 1.24 [0.98, 1.56]).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of Tocilizumab in severe and critical COVID-19: A Systematic Review and Meta-Analysis

Rezaei

Fatemi

Majd

et al. 2021

Expert Review of Clinical Immunology

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Objectives Currently published papers and clinical guidelines regarding the effects of tocilizumab in severe and critical COVID-19 are contradictory. The aim of this meta-analysis was to combine the results of clinical studies of different designs to investigate the efficacy and safety of tocilizumab in severely-to-critically ill COVID-19 patients. Methods A systematic search was performed in PubMed, Embase, CENTRAL, ClinicalTrials.gov, Scopus, and preprint servers up to 26 December 2020. Since a substantial heterogeneity was expected, a random-effects model was applied to calculate the pooled effect size (ES) and 95% confidence interval (CI) for each study outcome. Results Forty-five comparative studies involving 13,189 patients and 28 single-arm studies involving 1,770 patients were analyzed. The risk of mortality (RR of 0.76 [95%CI 0.65 to 0.89], P < 0.01) and intubation (RR of 0.48 [95%CI 0.24 to 0.97], P = 0.04) were lower in tocilizumab patients compared with controls. We did not find any significant difference in secondary infections, length of hospital stay, hospital discharge before day 14, and ICU admission between groups. Conclusion Tocilizumab can improve clinical outcomes and reduce mortality rates in severe to critical COVID-19 patients. Large-scale randomized controlled trials are still required to improve the statistical power of meta-analysis.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of Tocilizumab in severe and critical COVID-19: A Systematic Review and Meta-Analysis

Rezaei

Fatemi

Majd

et al. 2021

Expert Review of Clinical Immunology

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“…The outcomes of the meta-analysis revealed that the TCZ administration has higher chances of producing the events such as superinfections, fungaemia, bacteraemia, pneumonia, and pulmonary thrombosis compared to control/SOC. Further, we found that there are 7 systematic reviews and meta-analyses published based on observational studies on the role of tocilizumab in the treatment of COVID-19 (48)(49)(50)(51)(52)(53)(54). However, a meta-analysis published by Aziz et al (48)…”

Section: Effect Of Tcz On Length Of Hospital Stay In Icu (Los-icu)mentioning

confidence: 99%

“…has included 28 studies consisting of 991 COVID-19 confirmed patients receiving TCZ. They have concluded that TCZ administration has reduced the death rate in severe COVID-19 cases(50). Moreover, Surjit Singh et al have performed a meta-analysis including a total of 13 observational studies comprising 2750 patients.…”

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confidence: 99%

Efficacy and safety of tocilizumab in the management of COVID-19: a systematic review and meta-analysis of observational studies

Viswanatha¹,

Male²,

Shylaja³

2022

Pathogenesis of Rheumatoid Arthritis: One Year in Review 2022

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Objective. This systematic review and meta-analysis was aimed to evaluate the efficacy and safety of tocilizumab (TCZ) in treating severe coronavirus disease 2019 . Methods. The electronic search was made using PubMed, Scopus, CEN-TRAL, and Google scholar to identify the retrospective observational reports. The studies published from 01 January 2020 to 30th October 2020. Participants were hospitalised COVID-19 patients. Interventions included tocilizumab versus placebo/standard of care. The comparison will be between TCZ versus standard of care (SOC)/ placebo. Inconsistency between the studies was evaluated with I 2 and quality of the evidences were evaluated by Newcastle-Ottawa scale. Results. Based on the inclusion criteria there were 24 retrospective studies involving 5686 subjects were included. The outcomes of the meta-analysis have revealed that the TCZ has reduced mortality (M-H, RE-OR -0.11(-0.18 --0.04) 95% CI, p=0.001, I 2 =88%) and increased the incidences of super-infections ) 95% CI, p=0.004, I 2 =47%). However, there is no significant difference in ICU admissions rate (M-H, RE-OR -0.06(-0.23-0.12), I 2 =93%), need for mechanical ventilation (M-H, RE-OR of 0.00(-0.06-0.07), I=74%), LOS , I 2 =100%), , I 2 =100%), and incidences of pulmonary thrombosis , I 2 =0%) compared to SOC/control. Conclusion.Based on cumulative lowto-moderate certainty evidence shows that TCZ could reduce the risk of mortality in hospitalised patients. However, there is no statistically significant difference observed between the TCZ and SOC/control groups in other parameters.

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Efficacy and safety of tocilizumab in the management of COVID-19: A systematic review and meta-analysis of observational studies

Viswanatha¹,

Male²,

Shylaja³

2021

Preprint

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BackgroundThis systematic review and meta-analysis was aimed to evaluate the therapeutic benefits and safety of tocilizumab (TCZ) in treating severe coronavirus disease 2019 (COVID-19) and associated health complications.MethodsThe electronic search was performed using PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials (RCTs), and Google scholar databases to identify the retrospective observational reports. The studies published from 01 January 2020 to 30th September 2020 involving comparison of TCZ group with SOC/control treatment group were included. The studies included in this work involve RT-PCR confirmed cases of COVID-19 (Population), having tocilizumab and corresponding SOC/control as interventions (Intervention), comparison between tocilizumab versus SOC/control (Comparison) for the parameter of interest. Mortality, incidences of ICU admission, need of mechanical ventilation (MV), length of stay in the hospital (LOS), and length of stay in the ICU (LOS-ICU), and the incidences of super-infection, bacteraemia, fugleman, pneumonia, and pulmonary thrombosis were evaluated as the primary outcomes. The comparison will be between TCZ versus standard of care (SOC)/placebo.ResultsBased on the inclusion criteria there were 24 retrospective studies involving 5686 subjects were included. The outcomes of the meta-analysis have revealed that the TCZ has reduced the mortality (Mantel-Haenszel (M-H), random effects risk difference (RE-RD) of - 0.11 (-0.18 to -0.04), at 95% CI, p = 0.001, I2 = 88%) and increased the incidences of super-infections (M-H, RE-Risk ratio (RR) of 1.49 (1.13 to 1.96) at 95% CI, p=0.004, I2 = 47%). However, there is no significant difference in ICU admissions rate (M-H, RE-RD of -0.06 (-0.23 to 0.12) at 95% CI, p=0.54, I2 = 93%), need of MV (M-H, RE-RD of 0.00 (-0.06 to 0.07) at 95% CI, p=0.96, I2 = 74%), LOS (Inverse variance (IV): -2.86 (-0.91 to 3.38) at 95% CI, p=0.37, I2 = 100%), LOS-ICU (IV: -3.93 (-12.35 to 4.48) at 95% CI, p=0.36, I2 = 100%), and incidences of pulmonary thrombosis (M-H, fixed effect odds ratio (FE-OR) of 1.01 (0.45 to 2.26) at 95% CI, p=0.99, I2 = 0%) compared to SOC/control.ConclusionThis meta-analysis was performed using retrospective clinical reports on the use of tocilizumab in COVID-19 and based on the outcomes of the meta-analysis we can conclude that administration of TCZ would reduce the risk of mortality, and however there is no much difference observed between the TCZ and SOC/control groups in other parameters such as ICU admission rate, need of mechanical ventilation and length of hospital stay (ICU and Non-ICU). On the other hand, TCZ treated subjects possess higher chances of super-infections and pneumonia compared with SOC/control group. However, there is a need for multi-centric randomized trials to determine the potential therapeutic role of TCZ in mitigating COVID-19 and associated health complications.

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Efficacy and safety of tocilizumab in COVID-19 patients: A Meta-Analysis

Cited by 3 publications

References 44 publications

Efficacy and safety of Tocilizumab in severe and critical COVID-19: A Systematic Review and Meta-Analysis

Efficacy and safety of Tocilizumab in severe and critical COVID-19: A Systematic Review and Meta-Analysis

Efficacy and safety of tocilizumab in the management of COVID-19: a systematic review and meta-analysis of observational studies

Efficacy and safety of tocilizumab in the management of COVID-19: A systematic review and meta-analysis of observational studies

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