PMID- 33812260
OWN - NLM
STAT- MEDLINE
DCOM- 20210624
LR  - 20221221
IS  - 1878-1705 (Electronic)
IS  - 1567-5769 (Print)
IS  - 1567-5769 (Linking)
VI  - 96
DP  - 2021 Jul
TI  - The effect of tocilizumab on COVID-19 patient mortality: A systematic review and 
      meta-analysis of randomized controlled trials.
PG  - 107602
LID - S1567-5769(21)00238-1 [pii]
LID - 10.1016/j.intimp.2021.107602 [doi]
AB  - OBJECTIVES: This systematic review and meta-analysis of randomized controlled 
      trials (RCTs) aimed to investigate the clinical efficacy and safety of 
      tocilizumab for treating patients with COVID-19. METHODS: The PubMed, Embase, 
      Cochrane Library, Clinicaltrials.gov, WHO International Clinical Trials Registry 
      Platform and the preprint server of medRxiv.org were searched from their 
      inception to February 20, 2021. Only RCTs that compared the treatment efficacy 
      and safety of tocilizumab with the placebo or the standard of care for adult 
      patients with COVID-19 were included in this meta-analysis. The primary outcome 
      was 28-day mortality. RESULTS: This meta-analysis included eight RCTs which 
      enrolled a total of 6314 patients for randomization, in which 3267 and 3047 
      patients were assigned to the tocilizumab and control groups, respectively. The 
      mortality at day 28 was 24.4% and 29.9% in patients in the tocilizumab and 
      control groups, respectively, meaning there was no significant difference 
      observed between these two groups (OR, 0.92; 95% CI, 0.66-1.28; I(2) = 62). This 
      finding did not change in the subgroup analysis according to the initial use of 
      MV or steroid while enrollment. The patients receiving tocilizumab had a lower 
      rate of mechanical ventilation (MV) and intensive care unit (ICU) admission at 
      day 28 compared with the control group (MV use: OR, 0.75; 95% CI, 0.62-0.90; 
      I(2) = 11; ICU admission: OR, 0.51; 95% CI, 0.28-0.92; I(2) = 30). There were no 
      significant differences between these two treatment groups in terms of the risk 
      of treatment-emergent adverse events (AEs) (OR, 1.03; 95% CI, 0.71-1.49; 
      I(2) = 43), serious AEs (OR, 0.86; 95% CI, 0.67-1.12; I(2) = 0) or infection (OR, 
      0.87; 95% CI, 0.63-1.20; I(2) = 0). CONCLUSIONS: Tocilizumab does not provide a 
      survival benefit for patients with COVID-19, but it may help reduce the risk of 
      MV and ICU admission. In addition, tocilizumab is a safe agent to use for the 
      treatment of COVID-19.
CI  - Copyright (c) 2021 Elsevier B.V. All rights reserved.
FAU - Lin, Wei-Ting
AU  - Lin WT
AD  - Department of Orthopedic, Chi Mei Medical Center, Tainan 71004, Taiwan.
FAU - Hung, Shun-Hsing
AU  - Hung SH
AD  - Division of Urology, Department of Surgery, Chi-Mei Hospital, Chia Li, Tainan, 
      Taiwan.
FAU - Lai, Chih-Cheng
AU  - Lai CC
AD  - Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan 
      Branch, Tainan, Taiwan.
FAU - Wang, Cheng-Yi
AU  - Wang CY
AD  - Department of Internal Medicine, Cardinal Tien Hospital, New Taipei City, Taiwan.
FAU - Chen, Chao-Hsien
AU  - Chen CH
AD  - Division of Pulmonary, Department of Internal Medicine, MacKay Memorial Hospital, 
      Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, 
      Taiwan. Electronic address: stardust.macaque@gmail.com.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20210324
PL  - Netherlands
TA  - Int Immunopharmacol
JT  - International immunopharmacology
JID - 100965259
RN  - 0 (Antibodies, Monoclonal, Humanized)
RN  - I031V2H011 (tocilizumab)
SB  - IM
MH  - Antibodies, Monoclonal, Humanized/*therapeutic use
MH  - COVID-19/*mortality
MH  - Humans
MH  - SARS-CoV-2
MH  - Treatment Outcome
MH  - *COVID-19 Drug Treatment
PMC - PMC7988468
OTO - NOTNLM
OT  - COVID-19
OT  - Mortality
OT  - SARS-CoV-2
OT  - Tocilizumab
COIS- The authors declare that they have no known competing financial interests or 
      personal relationships that could have appeared to influence the work reported in 
      this paper.
EDAT- 2021/04/04 06:00
MHDA- 2021/06/25 06:00
PMCR- 2021/03/24
CRDT- 2021/04/03 20:20
PHST- 2021/03/02 00:00 [received]
PHST- 2021/03/18 00:00 [accepted]
PHST- 2021/04/04 06:00 [pubmed]
PHST- 2021/06/25 06:00 [medline]
PHST- 2021/04/03 20:20 [entrez]
PHST- 2021/03/24 00:00 [pmc-release]
AID - S1567-5769(21)00238-1 [pii]
AID - 107602 [pii]
AID - 10.1016/j.intimp.2021.107602 [doi]
PST - ppublish
SO  - Int Immunopharmacol. 2021 Jul;96:107602. doi: 10.1016/j.intimp.2021.107602. Epub 
      2021 Mar 24.