Efficacy and harms of tocilizumab for the treatment of COVID-19 patients: A systematic review and meta-analysis.
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2022
2022
Historique:
received:
13
04
2021
accepted:
19
05
2022
entrez:
3
6
2022
pubmed:
4
6
2022
medline:
9
6
2022
Statut:
epublish
Résumé
We systematically assessed benefits and harms of tocilizumab (TCZ), which is an antibody blocking IL-6 receptors, in hospitalized COVID-19 patients. Five electronic databases and two preprint webpages were searched until March 4, 2021. Randomized controlled trials (RCTs) and inverse probability treatment weighting (IPTW) cohorts assessing TCZ effects in hospitalized, COVID-19 adult patients were included. Primary outcomes were all-cause mortality, clinical worsening, clinical improvement, need for mechanical ventilation, and adverse events (AE). Inverse variance random-effects meta-analyses were performed with quality of evidence (QoE) evaluated using GRADE methodology. Nine RCTs (n = 7,021) and nine IPTW cohorts (n = 7,796) were included. TCZ significantly reduced all-cause mortality in RCTs (RR 0.89, 95%CI 0.81-0.98, p = 0.03; moderate QoE) and non-significantly in cohorts (RR 0.67, 95%CI 0.44-1.02, p = 0.08; very low QoE) vs. control (standard of care [SOC] or placebo). TCZ significantly reduced the need for mechanical ventilation (RR 0.80, 95%CI 0.71-0.90, p = 0.001; moderate QoE) and length of stay (MD -1.92 days, 95%CI -3.46 to -0.38, p = 0.01; low QoE) vs. control in RCTs. There was no significant difference in clinical improvement or worsening between treatments. AEs, severe AEs, bleeding and thrombotic events were similar between arms in RCTs, but there was higher neutropenia risk with TCZ (very low QoE). Subgroup analyses by disease severity or risk of bias (RoB) were consistent with main analyses. Quality of evidence was moderate to very low in both RCTs and cohorts. In comparison to SOC or placebo, TCZ reduced all-cause mortality in all studies and reduced mechanical ventilation and length of stay in RCTs in hospitalized COVID-19 patients. Other clinical outcomes were not significantly impacted. TCZ did not have effect on AEs, except a significant increased neutropenia risk in RCTs. TCZ has a potential role in the treatment of hospitalized COVID-19 patients.
Identifiants
pubmed: 35657993
doi: 10.1371/journal.pone.0269368
pii: PONE-D-21-12021
pmc: PMC9165853
doi:
Substances chimiques
Antibodies, Monoclonal, Humanized
0
tocilizumab
I031V2H011
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0269368Déclaration de conflit d'intérêts
The authors have declared that no competing interests exist.
Références
N Engl J Med. 2021 Apr 22;384(16):1491-1502
pubmed: 33631065
J Clin Immunol. 2021 Feb;41(2):303-314
pubmed: 33188624
Thorax. 2021 Sep;76(9):907-919
pubmed: 33579777
Int J Antimicrob Agents. 2020 Sep;56(3):106103
pubmed: 32712333
J Med Virol. 2021 Apr;93(4):2270-2280
pubmed: 33200828
Clin Infect Dis. 2021 Jul 15;73(2):e445-e454
pubmed: 32651997
N Engl J Med. 2020 Dec 10;383(24):2333-2344
pubmed: 33085857
Lancet Infect Dis. 2020 Aug;20(8):e192-e197
pubmed: 32539990
BMJ. 2019 Aug 28;366:l4898
pubmed: 31462531
Multivariate Behav Res. 2011 May;46(3):399-424
pubmed: 21818162
Pharmaceuticals (Basel). 2020 Oct 17;13(10):
pubmed: 33080877
J Clin Pharm Ther. 2021 Apr;46(2):440-446
pubmed: 33098139
J Clin Epidemiol. 2011 Apr;64(4):401-6
pubmed: 21208779
Res Synth Methods. 2016 Mar;7(1):55-79
pubmed: 26332144
BMJ. 2021 Feb 11;372:n433
pubmed: 33574097
PLoS One. 2020 Dec 10;15(12):e0243705
pubmed: 33301514
Lancet. 2021 May 01;397(10285):1637-1645
pubmed: 33933206
JAMA Intern Med. 2021 Jan 1;181(1):41-51
pubmed: 33080002
BMJ. 2021 Mar 29;372:n71
pubmed: 33782057
JAMA Intern Med. 2021 Jan 1;181(1):24-31
pubmed: 33080005
J Clin Virol. 2020 Jun;127:104380
pubmed: 32353761
Lancet Rheumatol. 2020 Oct;2(10):e603-e612
pubmed: 32838323
Clin Microbiol Infect. 2021 Feb;27(2):244-252
pubmed: 32860964
Drug Res (Stuttg). 2021 May;71(5):265-274
pubmed: 33401328
BMJ. 2016 Oct 12;355:i4919
pubmed: 27733354
Stat Med. 2013 Aug 30;32(19):3388-414
pubmed: 23508673
BMJ. 2021 Jan 20;372:n84
pubmed: 33472855
Lancet Respir Med. 2021 May;9(5):511-521
pubmed: 33676589
Stat Med. 2001 Dec 30;20(24):3875-89
pubmed: 11782040
JAMA Intern Med. 2021 Jan 1;181(1):32-40
pubmed: 33080017
Pulmonology. 2021 Jan-Feb;27(1):52-66
pubmed: 32713784
Clin Exp Rheumatol. 2020 Nov-Dec;38(6):1247-1254
pubmed: 33275094
N Engl J Med. 2021 Apr 22;384(16):1503-1516
pubmed: 33631066
N Engl J Med. 2021 Jan 7;384(1):20-30
pubmed: 33332779
Clin Microbiol Infect. 2021 Feb;27(2):238-243
pubmed: 32979572
JAMA. 2021 Mar 2;325(9):880-881
pubmed: 33306087
N Engl J Med. 2021 Jan 21;384(3):289-291
pubmed: 33471984