Nutritional Advice El Mondo
Objectives:
Clinical trials assessing the efficacy of IL-6 antagonists in patients hospitalized for COVID-19 have variously reported benefit, no effect and harm. Therefore, this review article has been conducted.
Does administration of IL-6 antagonists reduce 28-day all-cause mortality among patients hospitalized for COVID-19?
Study design:
This review article included 27 RCTs with a total of 10,930 patients (median age, 61 years (52-68 years) and 3,560 (33%) were women).
The IL-6 antagonists assessed were tocilizumab (19 trials allocating 4,299 patients to tocilizumab and 3,749 patients to usual care or placebo), sarilumab (9 trials allocating 2,073 patients to sarilumab and 753 patients to usual care or placebo) and siltuximab (1 trial allocating 77 patients to siltuximab and 72 patients to usual care or placebo).
Risk of bias was assessed to be low in 22 of the trials contributing to the meta-analysis of 28-day all-cause mortality, comprising 78% of the weight in the analysis.
Results and conclusions:
The investigators found by 28 days, there were 1,407 deaths among 6,449 patients randomized to IL-6 antagonists and 1,158 deaths among 4,481 patients randomized to usual care or placebo [summary OR = 0.86, 95% CI = 0.79 to 0.95, p = 0.003 based on a fixed-effects meta-analysis].
This corresponds to an absolute mortality risk of 22% for IL-6 antagonists compared with an assumed mortality risk of 25% for usual care or placebo.
The corresponding summary ORs were 0.83 [95% CI = 0.74 to 0.92, p 0.001] for tocilizumab and 1.08 [95% CI = 0.86 to 1.36, p = 0.52] for sarilumab.
The investigators found the summary ORs for the association with mortality compared with usual care or placebo in those receiving corticosteroids were 0.77 [95% CI = 0.68 to 0.87] for tocilizumab and 0.92 [95% CI = 0.61 to 1.38] for sarilumab.
The investigators found the ORs for the association with progression to invasive mechanical ventilation or death, compared with usual care or placebo, were 0.77 [95% CI = 0.70 to 0.85] for all IL-6 antagonists, 0.74 [95% CI = 0.66 to 0.82] for tocilizumab and 1.00 [95% CI = 0.74 to 1.34] for sarilumab.
The investigators found secondary infections by 28 days occurred in 21.9% of patients treated with IL-6 antagonists vs 17.6% of patients treated with usual care or placebo [OR accounting for trial sample sizes = 0.99, 95% CI = 0.85 to 1.16].
The investigators concluded in this prospective meta-analysis of clinical trials of patients hospitalized for COVID-19, administration of IL-6 antagonists, compared with usual care or placebo, is associated with lower 28-day all-cause mortality.
Administration of IL-6 antagonists is not associated with an increased risk of 28-day infection compared with usual care or placebo.
Original title:
Association Between Administration of IL-6 Antagonists and Mortality Among Patients Hospitalized for COVID-19: A Meta-analysis by Shankar-Hari M, Vale CL, […], Sterne JAC.
Link:
https://jamanetwork.com/journals/jama/fullarticle/2781880
Additional information of El Mondo:
Find more information/studies on coronavirus right here.
Tocilizumab is a recombinant humanized monoclonal antibody that acts as an interleukin 6 (IL-6) receptor antagonist (blocker). Tocilizumab can effectively block the IL-6 signal transduction pathway.
Interleukin 6 (IL-6) is a 184-amino acid protein cytokine that is produced by many types of cells and is expressed during states of cellular stress, such as inflammation, infection, wound sites and cancer.