Addition of Tocilizumab to the Standard of Care Reduces Mortality in Severe COVID-19: A Systematic Review and Meta-Analysis
Introduction: Tocilizumab (TCZ) is an anti-interleukin-6 antibody that has been used for the treatment of severe coronavirus disease 2019 (COVID-19). However, concrete evidence of its benefit in reducing mortality in severe COVID-19 is lacking. Therefore, we performed a systematic review and meta-an...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-10-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fmed.2020.586221/full |
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| author | Umesha Boregowda Abhilash Perisetti Arpitha Nanjappa Mahesh Gajendran Gurusaravanan Kutti Sridharan Hemant Goyal |
| author_facet | Umesha Boregowda Abhilash Perisetti Arpitha Nanjappa Mahesh Gajendran Gurusaravanan Kutti Sridharan Hemant Goyal |
| author_sort | Umesha Boregowda |
| collection | DOAJ |
| description | Introduction: Tocilizumab (TCZ) is an anti-interleukin-6 antibody that has been used for the treatment of severe coronavirus disease 2019 (COVID-19). However, concrete evidence of its benefit in reducing mortality in severe COVID-19 is lacking. Therefore, we performed a systematic review and meta-analysis of relevant studies that compared the efficacy of TCZ in severe COVID-19 vs. standard of care (SOC) alone.Methods: A literature search for studies that compared “tocilizumab” and “standard of care” in the treatment of COVID-19 was done using major online databases from December 2019 to June 14, 2020. Search words “Tocilizumab,” “anti-interleukin-6 antibody,” and “COVID-19” or “coronavirus 2019” in various combinations were used. Articles in the form of abstracts, letters without original data, case reports, and reviews were excluded. Data were gathered on an Excel sheet, and statistical analysis was performed using Review Manager 5.3.Results: Sixteen studies were eligible from 693 initial studies, including 3,641 patients (64% males). There were 13 retrospective studies and three prospective studies. There were 2,488 patients in the SOC group (61.7%) and 1,153 patients (68.7%) in the TCZ group. The death rate in the TCZ group, 22.4% (258/1,153), was lower than in the SOC group, 26.21% (652/2,488) [pooled odds ratio 0.57 (95% CI 0.36–0.92), p = 0.02]. There was a significant heterogeneity (inconsistency index = 80%) among the included studies.Conclusion: The addition of TCZ to the SOC might reduce mortality in severe COVID-19. More extensive randomized clinical trials are needed to validate these findings. |
| first_indexed | 2024-12-14T22:52:21Z |
| format | Article |
| id | doaj.art-ed1fe2ca094342339e175a9e53d71a1e |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-14T22:52:21Z |
| publishDate | 2020-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-ed1fe2ca094342339e175a9e53d71a1e2022-12-21T22:44:41ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2020-10-01710.3389/fmed.2020.586221586221Addition of Tocilizumab to the Standard of Care Reduces Mortality in Severe COVID-19: A Systematic Review and Meta-AnalysisUmesha Boregowda0Abhilash Perisetti1Arpitha Nanjappa2Mahesh Gajendran3Gurusaravanan Kutti Sridharan4Hemant Goyal5Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, United StatesDepartment of Gastroenterology and Hepatology, The University of Arkansas for Medical Sciences, Little Rock, AR, United StatesDepartment of Internal Medicine, Bassett Medical Center, Cooperstown, NY, United StatesPaul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, United StatesDepartment of Internal Medicine, University of Arizona, Tucson, AZ, United StatesThe Wright Center for Graduate Medical Education, Scranton, PA, United StatesIntroduction: Tocilizumab (TCZ) is an anti-interleukin-6 antibody that has been used for the treatment of severe coronavirus disease 2019 (COVID-19). However, concrete evidence of its benefit in reducing mortality in severe COVID-19 is lacking. Therefore, we performed a systematic review and meta-analysis of relevant studies that compared the efficacy of TCZ in severe COVID-19 vs. standard of care (SOC) alone.Methods: A literature search for studies that compared “tocilizumab” and “standard of care” in the treatment of COVID-19 was done using major online databases from December 2019 to June 14, 2020. Search words “Tocilizumab,” “anti-interleukin-6 antibody,” and “COVID-19” or “coronavirus 2019” in various combinations were used. Articles in the form of abstracts, letters without original data, case reports, and reviews were excluded. Data were gathered on an Excel sheet, and statistical analysis was performed using Review Manager 5.3.Results: Sixteen studies were eligible from 693 initial studies, including 3,641 patients (64% males). There were 13 retrospective studies and three prospective studies. There were 2,488 patients in the SOC group (61.7%) and 1,153 patients (68.7%) in the TCZ group. The death rate in the TCZ group, 22.4% (258/1,153), was lower than in the SOC group, 26.21% (652/2,488) [pooled odds ratio 0.57 (95% CI 0.36–0.92), p = 0.02]. There was a significant heterogeneity (inconsistency index = 80%) among the included studies.Conclusion: The addition of TCZ to the SOC might reduce mortality in severe COVID-19. More extensive randomized clinical trials are needed to validate these findings.https://www.frontiersin.org/article/10.3389/fmed.2020.586221/fulltocilizumab (IL-6 inhibitor)COVID-19coronavirus (2019-nCoV)SARS-C0V-2 infectiontocilizumabtocilizumab (TCZ) |
| spellingShingle | Umesha Boregowda Abhilash Perisetti Arpitha Nanjappa Mahesh Gajendran Gurusaravanan Kutti Sridharan Hemant Goyal Addition of Tocilizumab to the Standard of Care Reduces Mortality in Severe COVID-19: A Systematic Review and Meta-Analysis Frontiers in Medicine tocilizumab (IL-6 inhibitor) COVID-19 coronavirus (2019-nCoV) SARS-C0V-2 infection tocilizumab tocilizumab (TCZ) |
| title | Addition of Tocilizumab to the Standard of Care Reduces Mortality in Severe COVID-19: A Systematic Review and Meta-Analysis |
| title_full | Addition of Tocilizumab to the Standard of Care Reduces Mortality in Severe COVID-19: A Systematic Review and Meta-Analysis |
| title_fullStr | Addition of Tocilizumab to the Standard of Care Reduces Mortality in Severe COVID-19: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Addition of Tocilizumab to the Standard of Care Reduces Mortality in Severe COVID-19: A Systematic Review and Meta-Analysis |
| title_short | Addition of Tocilizumab to the Standard of Care Reduces Mortality in Severe COVID-19: A Systematic Review and Meta-Analysis |
| title_sort | addition of tocilizumab to the standard of care reduces mortality in severe covid 19 a systematic review and meta analysis |
| topic | tocilizumab (IL-6 inhibitor) COVID-19 coronavirus (2019-nCoV) SARS-C0V-2 infection tocilizumab tocilizumab (TCZ) |
| url | https://www.frontiersin.org/article/10.3389/fmed.2020.586221/full |
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