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Meta-Analysis
. 2022 Mar 14;93(1):e2022014.
doi: 10.23750/abm.v93i1.12208.

Tocilizumab in addition to standard of care in the management of COVID-19: a meta-analysis of RCTs

Victor Mutua  1 , Brandon Michael Henry  2 , Chris von Csefalvay  3 , Isaac Cheruiyot  4 , Jens Vikse  5 , Giuseppe Lippi  6 , Brian Bundi  7 , Newnex Mong'are  8
Affiliations
Meta-Analysis

Tocilizumab in addition to standard of care in the management of COVID-19: a meta-analysis of RCTs

Victor Mutua et al. Acta Biomed. .

Abstract

Objective: We performed a systematic review and meta-analysis for exploring clinical benefits and safety of tocilizumab in addition to standard of care (SOC) in treating patients with coronavirus disease 2019 (COVID-19).

Methods: An electronic search was carried out in PubMed, EMBASE, Cochrane Library, and Science Direct, as well as in medRxiv preprint server, to identify eligible studies. Only randomized Controlled Trials (RCTs) that compared mortality events and/or adverse events between a tocilizumab + SOC group and a SOC-only control group were included. The primary outcome was 28-day mortality. Secondary outcomes include progression to severe disease, defined as need for mechanical ventilation (MV) or intensive care unit (ICU) admission, and adverse events (AE).

Results: A total of nine studies (6,490 participants) could be included in this meta-analysis, with 3,358 participants in the tocilizumab + SOC group and 3,132 participants in the SOC-only group. The overall mortality rate was lower in the tocilizumab group compared to the SOC-only group, though the difference was not statistically significant (odds ratio [OR], 0.87; 95% CI, 0.73-1.04; I2, 15%). This finding was unaffected by subgroup analyses based on initial use of steroids or mechanical ventilation at baseline. Patients receiving tocilizumab were 26% less likely to progress to MV, and this difference was statistically significant (OR, 0.74; 95% CI, 0.64-0.86; I2, 0%). Among patients who were not in ICU at randomization, the tocilizumab group had 34 % lower rate of ICU admission compared to the SOC-only group (OR, 0.66; 95% CI, 0.40-2.14; I2, 29%). The occurrence of serious infections was lower in the tocilizumab group (OR, 0.57; 95% CI, 0.36-0.89; I2, 21%).

Conclusion: Tocilizumab is generally well-tolerated in COVID-19. Although this drug does not appear to have a significant benefits on survival, it may have a role in preventing progression to intensive care and MV.

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Conflict of interest statement

Each author declares that he or she has no commercial associations (e.g. consultancies, stock ownership, equity interest, patent/licensing arrangement etc.) that might pose a conflict of interest in connection with the submitted article.

Figures

Figure 1:
Figure 1:
Risk of bias summary
Figure 2:
Figure 2:
Leave-one-out forest plot
Figure 3:
Figure 3:
Subgroup analysis for mortality based on severity of disease
Figure 4:
Figure 4:
Subgroup analysis for mortality based on percentage of participants on steroid use at enrollment
Figure 5:
Figure 5:
Subgroup analysis for mortality based on use of Mechanical ventilation (MV) at enrollment.
Figure 6:
Figure 6:
Forest plot for progression to mechanical ventilation or death
Figure 1.
Figure 1.
Flow of studies through the meta-analysis.
Figure 2.
Figure 2.
Forest plot for mortality between Tocilizumab and SOC group.
Figure 3.
Figure 3.
Forest plot for need/progression to Mechanical ventilation.
Figure 4.
Figure 4.
Forest plot for ICU admission among patients who were not already in ICU at randomization.
Figure 5.
Figure 5.
Forest plot for the risk of adverse event(s) between the tocilizumab and control group.
See this image and copyright information in PMC

References

    1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet. 2020;395(10223):497–506. - PMC - PubMed
    1. Surveillances V. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19)—China, 2020. China CDC Wkly. 2020;2(8):113–22. - PMC - PubMed
    1. Lippi G, Plebani M. Cytokine “storm”, cytokine “breeze”, or both in COVID-19? Clin Chem Lab Med CCLM. 2021;59(4):637–9. - PubMed
    1. Aziz M, Haghbin H, Abu Sitta E, et al. Efficacy of tocilizumab in COVID-19: a systematic review and meta-analysis. J Med Virol. 2021;93(3):1620–30. - PubMed
    1. Lan S-H, Lai C-C, Huang H-T, Chang S-P, Lu L-C, Hsueh P-R. Tocilizumab for severe COVID-19: a systematic review and meta-analysis. Int J Antimicrob Agents. 2020;56(3):106103. - PMC - PubMed

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