Nutritional Advice El Mondo
Objectives:
Does tocilizumab reduce the risk of poor outcomes in hospitalized COVID-19 patients?
Study design:
This review article included 8 RCTs with 6,311 COVID-19 patients and 28 cohort studies with 15,484 COVID-19 patients.
8 RCTs were at low risk of bias.
Results and conclusions:
The investigators found the pooled reduced RR of 9% was not significant for 8 RCTs, at low risk of bias, with 6,311 patients examined the effect of tocilizumab on short-term mortality [pooled RR = 0.91, 95% CI = 0.78 to 1.07, I2 = 25%].
Not significant because RR of 1 was found in the 95% CI of 0.78 to 1.07. RR of 1 means no risk/association.
The investigators found only the REMAP-CAP and RECOVERY trials with the majority of their patients on concomitant corticosteroids, showed a significantly lower 30-day mortality with tocilizumab use [RR = 0.74, 95% CI = 0.59 to 0.93 and RR = 0.89, 95% CI = 0.81 to 0.97, respectively].
Significant because RR of 1 was not found in the 95% CI of 0.59 to 0.93. RR of 1 means no risk/association.
The investigators found the pooled reduced RR of 16% was significant for 7 RCTs, with 5,391 patients examined the effect of tocilizumab on risk of mechanical ventilation [pooled RR = 0.84, 95% CI = 0.76 to 0.93, I2 = 0%, with a corresponding number needed to treat of 20 [95% CI = 14.3 to 33.3]].
The investigators found the pooled reduced RR of 18% was significant for 8 RCTs, with 5,340 patients, examined the effect of tocilizumab on a composite of poor outcome [pooled RR = 0.82, 95% CI = 0.76 to 0.90, I2 = 3%].
Significant means that there is an association with a 95% confidence.
The investigators found data from the RCTs showed a significantly lower risk of 33% for infections and no higher risk of serious adverse events with tocilizumab [pooled RR = 0.67, 95% CI = 0.45 to 0.99, 8 RCTs and pooled RR = 0.85, 95% CI = 0.63 to 1.16, 7 RCTs, respectively].
The investigators found among 28 cohorts with 15,484 patients, the pooled adjusted RR for mortality was 0.53 [95% CI = 0.43 to 0.67, I2 = 76%].
The investigators concluded cumulative high certainty evidence shows that tocilizumab reduces the risk of mechanical ventilation in hospitalized patients with severe COVID-19. Moderate certainty evidence shows that tocilizumab reduces the risk of poor outcome and the risk of secondary infections in hospitalized COVID-19 patients. It is crucial that all RCTs teams urgently contribute their trials data for a meta-analysis that incorporates subgroup analyses and explores any heterogeneous treatment effects of tocilizumab.
Original title:
Efficacy and safety of tocilizumab in COVID-19 patients: A living systematic Review and meta-analysis: first update by Tleyjeh IM, Kashour Z, […], Kashour T.
Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076756/
Additional information of El Mondo:
Find more information/studies on coronavirus right here.