Comparing the efficacy of tocilizumab with corticosteroid therapy in treating COVID-19 patients: a systematic review and meta-analysis - PubMed (original) (raw)

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Comparing the efficacy of tocilizumab with corticosteroid therapy in treating COVID-19 patients: a systematic review and meta-analysis

Phei Ching Lim et al. Daru. 2022 Jun.

Abstract

Purpose: Tocilizumab has shown equivocal outcomes in reducing mortality in COVID-19. The corticosteroids appear to be an affordable alternative to tocilizumab. This study aims to estimate the efficacy of tocilizumab and the corticosteroids particularly dexamethasone and methylprednisolone and to identify possible determinants of their efficacy.

Methods: Five electronic databases were searched for studies involving tocilizumab, dexamethasone, and methylprednisolone in treating COVID-19. We included case-control and randomized or partially randomized trials. Meta-regression for patient baseline characteristics, co-medications, and tocilizumab dose regimens was performed to identify contributing factors to drug efficacy.

Results: Thirteen randomized controlled trials (RCTs) and twenty-four case-control studies were included in our meta-analysis involving 18,702 patients. Meta-analysis among the RCTs showed that a summary estimate favoring mortality reduction (OR 0.71, 95%CI 0.55 - 0.92) contributed mainly by tocilizumab and dexamethasone. Among case-control studies, meta-analysis showed mortality reduction (OR 0.52, 95%CI 0.36 - 0.75) contributed by tocilizumab and tocilizumab-methylprednisolone combination. Methylprednisolone alone did not reduce mortality except for one study involving high dose pulse therapy. Meta-analysis also found that all three drugs did not significantly reduce mechanical ventilation (OR 0.72, 95%CI 0.32 - 1.60).

Conclusion: Tocilizumab and dexamethasone emerge as viable options in reducing mortality in severe COVID-19 patients. A tocilizumab-corticosteroid combination strategy may improve therapeutic outcome in cases where single therapy fails.

Keywords: COVID-19; Dexamethasone; Meta-analysis; Methylprednisolone; Tocilizumab.

© 2022. Springer Nature Switzerland AG.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1

Fig. 1

Flow chart for study screening and selection according to PRISMA guidelines

Fig. 2

Fig. 2

Forest plot for the effect for all treatments (tocilizumab, methylprednisolone, and dexamethasone) on mortality in randomised controlled trials

Fig. 3

Fig. 3

Forest plot for the effect of all treatments (tocilizumab, methylprednisolone, and dexamethasone) on mortality in case–control studies

Fig. 4

Fig. 4

Forest plot for the effect of tocilizumab alone on mortality

Fig. 5

Fig. 5

Forest plot for effect of all treatments (tocilizumab, methylprednisolone, and dexamethasone) on the event of invasive mechanical ventilation

Fig. 6

Fig. 6

Funnel plot for (a) randomised clinical trials, and (b) case–control studies included in the meta-analysis

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References

    1. The John Hopkins Coronavirus Resource Center. Cumulative cases. In: The John Hopkins Coronavirus Resource Center. The John Hopkins and Medicine System. 2021. https://coronavirus.jhu.edu/data/cumulative-cases. Accessed 15 January 2021.
    1. Torres Acosta MA, Singer BD. Pathogenesis of COVID-19-induced ARDS: implications for an ageing population. Eur Respir J. 2020 doi: 10.1183/13993003.02049-2020. - DOI - PMC - PubMed
    1. Leisman DE, Ronner L, Pinotti R, Taylor MD, Sinha P, Calfee CS, et al. Cytokine elevation in severe and critical COVID-19: a rapid systematic review, meta-analysis, and comparison with other inflammatory syndromes. Lancet Respir Med. 2020;8:1233–1244. doi: 10.1016/S2213-2600(20)30404-5. - DOI - PMC - PubMed
    1. Kordzadeh-Kermani E, Khalili H, Karimzadeh I. Pathogenesis, clinical manifestations and complications of coronavirus disease 2019 (COVID-19) Future Microbiol. 2020;15:1287–1305. doi: 10.2217/fmb-2020-0110. - DOI - PMC - PubMed
    1. Guirao JJ, Cabrera CM, Jiménez N, Rincón L, Urra JM. High serum IL-6 values increase the risk of mortality and the severity of pneumonia in patients diagnosed with COVID-19. Mol Immunol. 2020;128:64–68. doi: 10.1016/j.molimm.2020.10.006. - DOI - PMC - PubMed

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