Onorina Berardicurti1, Piero Ruscitti2, Francesco Ursini3, Settimio D'Andrea4, Jacopo Ciaffi5, Riccardo Meliconi3, Annamaria Iagnocco6, Paola Cipriani2, Roberto Giacomelli7. 1. Department of Biotechnological and Applied Clinical Sciences, Rheumatology Unit, University of L'Aquila, Italy. berardicurtio@libero.it. 2. Department of Biotechnological and Applied Clinical Sciences, Rheumatology Unit, University of L'Aquila, Italy. 3. IRRCS Istituto Ortopedico Rizzoli, Bologna, and Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy. 4. Department of Life, Health and Environment Sciences, Andrology Unit, University of L'Aquila, Italy. 5. IRRCS Istituto Ortopedico Rizzoli, Bologna, Italy. 6. Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Italy. 7. Allergology, Immunology, Rheumatology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Italy.
Abstract
OBJECTIVES: People who are exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could develop a potentially fatal disease with lung involvement and severe cytokine storm syndrome (CSS) - coronavirus disease 2019 (hereafter, COVID-19). Tocilizumab (TCZ) was administered to these subjects, despite the lack of randomised clinical trial data. Hence, summarising data on the mortality rate and related risks factors may help physicians to correctly administer TCZ. METHODS: We performed a systematic review and meta-analysis on mortality rate in TCZ- treated patients with COVID-19 according to the PRISMA guidelines. The pooled mortality rate in TCZ-treated persons was calculated and meta-regressions were done to investigate associated factors. RESULTS: We included 22 studies and 1520 TCZ-treated patients (mean age: 61 years, 95% CI: 59-64; male: 71%, 95% CI: 64-78%). The mortality estimated pooled prevalence was 19% (95% CI: 13-25, I2=100%, p<0.00001) and improvement estimated pooled prevalence was 71% (95% CI: 62-81). Factors associated with the mortality are the number of patients in intensive care unit, the number of patients requiring invasive ventilation and the sera C-reactive protein value before TCZ administration. We observed a reduction in the odds of mortality in TCZ-treated patients when compared to those treated with other therapies (OR=0.47, 95% CI: 0.22-0.98, p=0.004). CONCLUSIONS: This study showed that the mortality pooled prevalence in TCZ-treated patients is lower than the overall mortality reported in patients with severe COVID-19.
OBJECTIVES: People who are exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) could develop a potentially fatal disease with lung involvement and severe cytokine storm syndrome (CSS) - coronavirus disease 2019 (hereafter, COVID-19). Tocilizumab (TCZ) was administered to these subjects, despite the lack of randomised clinical trial data. Hence, summarising data on the mortality rate and related risks factors may help physicians to correctly administer TCZ. METHODS: We performed a systematic review and meta-analysis on mortality rate in TCZ- treated patients with COVID-19 according to the PRISMA guidelines. The pooled mortality rate in TCZ-treated persons was calculated and meta-regressions were done to investigate associated factors. RESULTS: We included 22 studies and 1520 TCZ-treated patients (mean age: 61 years, 95% CI: 59-64; male: 71%, 95% CI: 64-78%). The mortality estimated pooled prevalence was 19% (95% CI: 13-25, I2=100%, p<0.00001) and improvement estimated pooled prevalence was 71% (95% CI: 62-81). Factors associated with the mortality are the number of patients in intensive care unit, the number of patients requiring invasive ventilation and the sera C-reactive protein value before TCZ administration. We observed a reduction in the odds of mortality in TCZ-treated patients when compared to those treated with other therapies (OR=0.47, 95% CI: 0.22-0.98, p=0.004). CONCLUSIONS: This study showed that the mortality pooled prevalence in TCZ-treated patients is lower than the overall mortality reported in patients with severe COVID-19.
Authors: Muhammad Z Mushtaq; Saad B Z Mahmood; Aysha Almas; Syed Ather Wasti; Syed Ahsan Ali Journal: Int Immunopharmacol Date: 2021-11-20 Impact factor: 4.932