Tocilizumab in Patients Hospitalized with Covid-19 Pneumonia

Lundh, Andreas

doi:10.1056/nejmc2100217

Cited by 42 publications

(25 citation statements)

References 28 publications

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“…According to our analysis, however, the association of tocilizumab with clinical benefits is even stronger among severe COVID-19 patients. The most recently published prospective randomized clinical trial backs our conclusion, suggesting that COVID-19 patients with moderate or severe disease were more likely to benefit from tocilizumab [ 33 ]. It is of great necessity to conduct more clinical trials to pinpoint the subgroups of COVID-19 patients that are most likely to benefit tocilizumab treatment.…”

Section: Discussionmentioning

confidence: 76%

“…Overall, 10 201 patients from 25 different publications were included in this study. Seven of the studies assessed patients from the USA [ 10 , 15 – 20 ], 13 of the studies assessed patients from west Europe [ 8 , 21 – 32 ], two assessed patients from multiple countries [ 33 , 34 ], one assessed patients from Brazil [ 35 ], and two studies were from India [ 36 , 37 ]. The main characteristics of the 25 included studies were summarized in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Their findings revealed a correlation of early Tocilizumab administration with lower mortality rates among critically ill COVID-19 patients with a rapid disease trajectory[ 19 ]. More importantly, Tocilizumab demonstrated satisfactory safety in clinics because COVID-19 patients receiving Tocilizumab do not show higher incidences of adverse events, including secondary infections and hepatotoxicity [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…There are some confounders that should contribute to the inconsistency. Most importantly, both the trials recruited general, but not severe, COVID-19 patients for study [ 19 , 33 ]. According to our analysis, however, the association of tocilizumab with clinical benefits is even stronger among severe COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

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Tocilizumab treatment for COVID-19 patients: a systematic review and meta-analysis

et al. 2021

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Background Coronavirus disease 2019 (COVID-19) has killed over 2.5 million people worldwide, but effective care and therapy have yet to be discovered. We conducted this analysis to better understand tocilizumab treatment for COVID-19 patients. Main text We searched major databases for manuscripts reporting the effects of tocilizumab on COVID-19 patients. A total of 25 publications were analyzed with Revman 5.3 and R for the meta-analysis. Significant better clinical outcomes were found in the tocilizumab treatment group when compared to the standard care group [odds ratio (OR) = 0.70, 95% confidential interval (C): 0.54–0.90, P = 0.007]. Tocilizumab treatment showed a stronger correlation with good prognosis among COVID-19 patients that needed mechanical ventilation (OR = 0.59, 95% CI, 0.37–0.93, P = 0.02). Among stratified analyses, reduction of overall mortality correlates with tocilizumab treatment in patients less than 65 years old (OR = 0.68, 95% CI: 0.60–0.77, P < 0.00001), and with intensive care unit patients (OR = 0.62, 95% CI: 0.55–0.70, P < 0.00001). Pooled estimates of hazard ratio showed that tocilizumab treatment predicts better overall survival in COVID-19 patients (HR = 0.45, 95% CI: 0.24–0.84, P = 0.01), especially in severe cases (HR = 0.58, 95% CI 0.49–0.68, P < 0.00001). Conclusions Our study shows that tocilizumab treatment is associated with a lower risk of mortality and mechanical ventilation requirement among COVID-19 patients. Tocilizumab may have substantial effectiveness in reducing mortality among COVID-19 patients, especially among critical cases. This systematic review provides an up-to-date evidence of potential therapeutic role of tocilizumab in COVID-19 management. Graphical abstract

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Section: Discussionmentioning

confidence: 76%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Tocilizumab treatment for COVID-19 patients: a systematic review and meta-analysis

et al. 2021

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“…time from randomization to worsening by 2 points on an 8-category ordinal scale, was changed. Although we acknowledge that the authors fulfilled a reported process, i.e., change at the beginning of the trial with the agreement of the data safety monitoring board and a new sample size calculation -which was performed with more transparency than in other COVID-19 trials [11] -, such a change remains an issue. It may illustrate that, beyond this trial, outcomes used in many COVID-19 RCTs may not be well suited, maybe because these trials have been planned while one had poor knowledge on the disease at the time of onset of trials.…”

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confidence: 99%

Ivermectin as a potential treatment for COVID-19?

et al. 2021

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Prior immunosuppressive therapy is associated with mortality in COVID‐19 patients: A retrospective study of 835 patients

Akama-Garren

2021

Journal of Medical Virology

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Though it is widely believed that chronic immunosuppressive medications increase the severity of coronavirus disease 2019 (COVID‐19) illness, there is little data to support this. We performed a retrospective study of COVID‐19 positive patients diagnosed at a single academic medical center between March 10, 2020 and October 13, 2020. A total of 835 patients diagnosed with COVID‐19 by polymerase chain reaction were included (median age 64 years; 52% female). Of these, 46 (5.5%) had a prescription for an immunosuppressive therapy before diagnosis, most commonly oral steroids (20, 43%), mycophenolate (12, 26%), or tacrolimus (11, 24%). Patients on immunosuppressive therapy with COVID‐19 had increased mortality (30% vs. 17%, p = 0.036; odds ratio 2.1, 95% confidence interval 1.11–4.04), which remained significant ( p = 0.040) after performing multivariate logistic regression controlling for gender, age, race, and comorbidity status. Laboratory markers of inflammation were uniformly elevated in both patients on or not on immunosuppressive therapies who died, but lymphocytes and neutrophils were decreased in both COVID‐19 patients on immunosuppressive therapies who died and who remained alive. These findings demonstrate that COVID‐19 disease is more severe in patients taking prior immunosuppressive medications. This finding emphasizes the need for aggressive monitoring and supportive care for immunosuppressed patients who are diagnosed with COVID‐19.

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Tocilizumab in Patients Hospitalized with Covid-19 Pneumonia

Cited by 42 publications

References 28 publications

Tocilizumab treatment for COVID-19 patients: a systematic review and meta-analysis

Tocilizumab treatment for COVID-19 patients: a systematic review and meta-analysis

Ivermectin as a potential treatment for COVID-19?

Prior immunosuppressive therapy is associated with mortality in COVID‐19 patients: A retrospective study of 835 patients

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