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Meta-Analysis
. 2021 Aug;77(8):1089-1094.
doi: 10.1007/s00228-021-03087-z. Epub 2021 Feb 2.

The effect of tocilizumab on mortality in hospitalized patients with COVID-19: a meta-analysis of randomized controlled trials

Chia Siang Kow  1 , Syed Shahzad Hasan  2   3
Affiliations
Meta-Analysis

The effect of tocilizumab on mortality in hospitalized patients with COVID-19: a meta-analysis of randomized controlled trials

Chia Siang Kow et al. Eur J Clin Pharmacol. 2021 Aug.

Abstract

Objective: We aimed to perform a meta-analysis of randomized controlled trials (RCTs) to summarize the overall effect of tocilizumab on the risk of mortality among patients with coronavirus disease 2019 (COVID-19).

Methods: We systematically searched PubMed, Cochrane Central Register of Controlled Trials, Google Scholar, and medRxiv (preprint repository) databases (up to 7 January 2021). Pooled effect sizes with 95% confidence interval (CI) were generated using random-effects and inverse variance heterogeneity models. The risk of bias of the included RCTs was appraised using version 2 of the Cochrane risk-of-bias tool for randomized trials.

Results: Six RCTs were included: two trials with an overall low risk of bias and four trials had some concerns regarding the overall risk of bias. Our meta-analysis did not find significant mortality benefits with the use of tocilizumab among patients with COVID-19 relative to non-use of tocilizumab (pooled hazard ratio = 0.83; 95% CI 0.66-1.05, n = 2,057). Interestingly, the estimated effect of tocilizumab on the composite endpoint of requirement for mechanical ventilation and/or all-cause mortality indicated clinical benefits, with some evidence against our model hypothesis of no significant effect at the current sample size (pooled hazard ratio = 0.62; 95% CI 0.42-0.91, n = 749).

Conclusion: Despite no clear mortality benefits in hospitalized patients with COVID-19, tocilizumab appears to reduce the likelihood of progression to mechanical ventilation.

Keywords: Bias; COVID-19; Clinical trial; Mortality; Tocilizumab.

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Conflict of interest statement

All named authors declare that they have no potential conflict of interest.

Figures

Fig. 1
Fig. 1
Flow diagram of study selection
Fig. 2
Fig. 2
Forest plot showing the a pooled odds ratio of all-cause mortality and b pooled hazard ratio of requirement for mechanical ventilation and/or all-cause mortality between patients with COVID-19 treated with tocilizumab and those not treated with tocilizumab
See this image and copyright information in PMC

References

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