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Review
. 2021 Sep;10(3):1195-1213.
doi: 10.1007/s40121-021-00488-6. Epub 2021 Jul 11.

Systematic Review and Subgroup Meta-analysis of Randomized Trials to Determine Tocilizumab's Place in COVID-19 Pneumonia

Timothée Klopfenstein  1 , Vincent Gendrin  2 , Aurélie Gerazime  3 , Thierry Conrozier  4 , Jean-Charles Balblanc  4 , Pierre-Yves Royer  2 , Anne Lohse  4 , Chaouki Mezher  5 , Lynda Toko  2 , Cerise Guillochon  4 , Julio Badie  5 , Alix Pierron  2 , N 'dri Juliette Kadiane-Oussou  2 , Marc Puyraveau  3 , Souheil Zayet  6 ; HNF Hospital tocilizumab multidisciplinary team
Affiliations
Review

Systematic Review and Subgroup Meta-analysis of Randomized Trials to Determine Tocilizumab's Place in COVID-19 Pneumonia

Timothée Klopfenstein et al. Infect Dis Ther. 2021 Sep.

Abstract

Introduction: Tocilizumab randomized clinical trial results are heterogeneous because of the heterogenous population included in them.

Methods: We conducted a meta-analysis with subgroup meta-analysis (PRISMA guidelines) between severe and non-severe COVID-19.

Results: We included nine trials. Overall, the mortality rate was 24.5% (821/3357) in the tocilizumab group and 29.1% (908/3125) in the control group at day 28-30 (pooled OR, 0.85; 95% CI 0.76-0.96; p = 0.006). Considering the subgroup analysis, this benefit on mortality was confirmed and amplified in the severe COVID-19 group (pooled OR, 0.82; 95% CI 0.73-0.93; p = 0.001) but not in the non-severe COVID-19 group (pooled OR, 1.46; 95% CI 0.91-2.34; p = 0.12). For patients who were not mechanically ventilated at baseline (5523/6482), the pooled OR (0.74; 95% CI 0.64-0.85; p < 0.0001) for mechanical ventilation incidence at day 28-30 was in favor of tocilizumab (cumulative incidence of 14.8% versus 19.4% in tocilizumab and control arm, respectively). This benefit was confirmed in both subgroups, i.e., severe and non-severe COVID-19.

Conclusion: Tocilizumab is an effective treatment in hospitalized patients with COVID-19 and hypoxemia by improving survival and decreasing mechanical ventilation requirement. The greatest benefit is observed in severe COVID-19.

Keywords: Coronavirus disease 2019; Meta-analysis; Randomized clinical trial; Review; Tocilizumab.

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Figures

Fig. 1
Fig. 1
PRISMA flowchart detailing the article selection process
Fig. 2
Fig. 2
Forest plot for the effect of tocilizumab on mortality at days 28–30 in randomized trials
Fig. 3
Fig. 3
Forest plot for the effect of tocilizumab on mortality at days 28–30 in randomized trials in severity event subgroup
Fig. 4
Fig. 4
Forest plot for the effect of tocilizumab on mechanical ventilation incidence at days 28–30 in randomized trials
Fig. 5
Fig. 5
Forest plot for the effect of tocilizumab on mechanical ventilation incidence at days 28–30 in randomized trials in severity event subgroup
Fig. 6
Fig. 6
Forest plot for relative risk of serious adverse events for tocilizumab versus control in randomized trials
Fig. 7
Fig. 7
Funnel plot for the effect of tocilizumab on mortality at days 28–30 in randomized trials
Fig. 8
Fig. 8
Funnel plot for the effect of tocilizumab on mechanical ventilation incidence at days 28–30 in randomized trials
Fig. 9
Fig. 9
Funnel plot for relative risk of serious adverse events for tocilizumab versus control in randomized trials
Fig. 10
Fig. 10
Funnel plot for the effect of tocilizumab on mortality at days 28–30 in randomized trials in severity event subgroup
Fig. 11
Fig. 11
Funnel plot for the effect of tocilizumab on mechanical ventilation incidence at days 28–30 in randomized trials in severity event subgroup
See this image and copyright information in PMC

References

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