Decreased Mortality in Coronavirus Disease 2019 Patients Treated With Tocilizumab

Decreased Mortality in Coronavirus Disease 2019 Patients Treated With Tocilizumab: A Rapid Systematic Review and Meta-analysis of Observational Studies

Jishnu Malgie ¹, Jan W Schoones ², Bart G Pijls ¹Affiliations expand

• PMID: 32964913
• PMCID: PMC7543350
• DOI: 10.1093/cid/ciaa1445

Free PMC article

Abstract

Background: We systematically reviewed the literature to answer the following research questions: (1) Does interleukin 6 (IL-6) (receptor) antagonist therapy reduce mortality in coronavirus disease 2019 (COVID-19) patients compared to patients not treated with IL-6 (receptor) antagonists; and (2) is there an increased risk of side effects in COVID-19 patients treated with IL-6 (receptor) antagonists compared to patients not treated with IL-6 (receptor) antagonists?

Methods: We systematically searched PubMed, PMC PubMed Central, Medline, World Health Organization COVID-19 Database, Embase, Web of Science, Cochrane Library, Emcare, and Academic Search Premier (through 30 June 2020). Random effects meta-analysis was used to pool the risk ratios and risk differences of individual studies. Risk of bias was appraised using the Methodological Index for Non-randomized Studies (MINORS) checklist.

Results: The search strategy retrieved 743 unique titles, of which 10 studies (all on tocilizumab [TCZ]) comprising 1358 patients were included. Nine of 10 studies were considered to be of high quality. Meta-analysis showed that the TCZ group had lower mortality than the control group. The risk ratio was 0.27 (95% confidence interval [CI], .12-.59) and the risk difference was 12% (95% CI, 4.6%-20%) in favor of the TCZ group. With only a few studies available, there were no differences observed regarding side effects.

Conclusions: Our results showed that mortality was 12% lower for COVID-19 patients treated with TCZ compared with those not treated with TCZ. The number needed to treat was 11, suggesting that for every 11 (severe) COVID-19 patients treated with TCZ, 1 death is prevented. These results require confirmation by randomized controlled trials.

Keywords: COVID-19; IL-6 receptor antagonists; mortality; tocilizumab.

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.

Comment in

• Reply to Huang et al.Malgie J, Schoones JW, Pijls BG.Clin Infect Dis. 2021 Jun 15;72(12):e1157-e1158. doi: 10.1093/cid/ciaa1739.PMID: 33201173 No abstract available.
• Impact of Tocilizumab on the Mortality of Patients With Coronavirus Disease 2019.Huang YT, Chao CM, Lai CC.Clin Infect Dis. 2021 Jun 15;72(12):e1156-e1157. doi: 10.1093/cid/ciaa1738.PMID: 33201178 Free PMC article. No abstract available.
• The Misleading “Pooled Effect Estimate” of Crude Data from Observational Studies at Critical Risk of Bias: The Case of Tocilizumab in Coronavirus Disease 2019 (COVID-19).Tleyjeh IM.Clin Infect Dis. 2021 Jun 15;72(12):e1154-e1155. doi: 10.1093/cid/ciaa1735.PMID: 33201228 Free PMC article. No abstract available.
• Compiling Observational Research During a Pandemic: A Necessary Bridge.Moehring RW, Holland TL.Clin Infect Dis. 2021 Jun 1;72(11):e750-e752. doi: 10.1093/cid/ciaa1705.PMID: 33306094 Free PMC article. No abstract available.
• Reply to Tleyjeh.Malgie J, Schoones JW, Pijls BG.Clin Infect Dis. 2021 Jun 15;72(12):e1155-e1156. doi: 10.1093/cid/ciaa1736.PMID: 33340049 No abstract available.

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