托珠单抗治疗COVID-19:随机对照试验的系统评价和荟萃分析

Tarun Krishna Boppana, Saurabh Mittal, Karan Madan, Anant Mohan, Vijay Hadda, Randeep Guleria
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引用次数: 5

摘要

我们需要针对2019年严重冠状病毒病(COVID-19)的有效治疗方式。由于死亡的主要原因是高炎症状态,白细胞介素-6拮抗剂tocilizumab已被用于多项临床研究。我们进行了这项系统回顾和荟萃分析,以评估tocilizumab在降低COVID-19死亡率方面的有效性。系统检索Pubmed和Embase数据库,提取有关使用托珠单抗治疗COVID-19的随机对照试验(rct)。进行了总体合并死亡率分析,并报告了优势比。采用Cochrane偏倚风险评估工具评估偏倚风险。采用I2统计量评估异质性。选取9项随机对照试验,共6489例患者进行meta分析。7项试验报告了28天死亡率,1项试验分别报告了21天和30天死亡率。类固醇组3358名参与者中有846人死亡,而随机分配到对照组的3131名患者中有943人死亡(随机效应优势比0.87,95%置信区间0.73-1.03,p=0.11)。试验间存在一定的异质性,I2值为15%,p值为0.31。托珠单抗组患者入住ICU的需求有所减少。托珠单抗组继发感染的风险较高(固定效应优势比0.72,95%置信区间0.55-0.95,p=0.02)。这项随机对照试验的荟萃分析表明,使用托珠单抗与降低COVID-19患者的全因死亡率无关,并且继发感染的几率更高。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Tocilizumab for COVID-19: A systematic review and meta-analysis of randomized controlled trials.

The effective treatment modalities for severe coronavirus disease 2019 (COVID-19) are needed. As the primary cause of mortality is a hyperinflammatory state, the interleukin-6 antagonist tocilizumab has been used in multiple clinical studies. We conducted this systematic review and meta-analysis to estimate the effectiveness of tocilizumab in reduction of mortality due to COVID-19. A systematic search of the Pubmed and Embase databases was performed to extract randomized controlled trials (RCTs) regarding the use of tocilizumab therapy for COVID-19. An overall pooled mortality analysis was performed, and odds ratios were reported. Cochrane risk of bias assessment tool was used to assess the risk of bias. Heterogeneity was assessed using the I2 statistic. Nine RCTs, including 6489 patients, were selected for meta-analysis. Seven trials reported 28-day mortality, and one trial each reported 21-day and 30-day mortality. There were 846 deaths among 3358 participants in the steroid group while 943 deaths among 3131 patients randomized to the control group (random-effects odds ratio 0.87, 95% confidence interval 0.73-1.03, p=0.11). There was some heterogeneity among the trials as the I2 value was 15%, with a p-value of 0.31. There was a reduction in the need for ICU admission in the tocilizumab group. A higher risk of secondary infections was noted in the tocilizumab group (fixed-effects odds ratio 0.72, 95% confidence interval 0.55-0.95, p=0.02). This meta-analysis of RCTs demonstrated that the use of tocilizumab was not associated with a reduction in all-cause mortality in patients with COVID-19 and had higher odds of secondary infections.

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