Objectives Currently published papers and clinical guidelines regarding the effects of tocilizumab in severe and critical COVID-19 are contradictory. The aim of this meta-analysis was to combine the results of clinical studies of different designs to investigate the efficacy and safety of tocilizumab in severely-to-critically ill COVID-19 patients. Methods A systematic search was performed in PubMed, Embase, CENTRAL, ClinicalTrials.gov, Scopus, and preprint servers up to 26 December 2020. Since a substantial heterogeneity was expected, a random-effects model was applied to calculate the pooled effect size (ES) and 95% confidence interval (CI) for each study outcome. Results Forty-five comparative studies involving 13,189 patients and 28 single-arm studies involving 1,770 patients were analyzed. The risk of mortality (RR of 0.76 [95%CI 0.65 to 0.89], P < 0.01) and intubation (RR of 0.48 [95%CI 0.24 to 0.97], P = 0.04) were lower in tocilizumab patients compared with controls. We did not find any significant difference in secondary infections, length of hospital stay, hospital discharge before day 14, and ICU admission between groups. Conclusion Tocilizumab can improve clinical outcomes and reduce mortality rates in severe to critical COVID-19 patients. Large-scale randomized controlled trials are still required to improve the statistical power of meta-analysis.

Chronic rhinosinusitis is a common disease which causes persisting inflammatory conditions of one or more sinuses. This study was designed to evaluate the effect of thyme honey nasal spray as an adjunctive medication on chronic rhinosinusitis after functional endoscopic sinus surgery. This was a randomized, placebo controlled, double-blind clinical study. 64 patients with chronic rhinosinusitis undergoing functional endoscopic sinus surgery were enrolled in this study. Patients were randomized and blinded to receive either placebo or thyme honey nasal spray in addition to the standard regimen postoperatively. Patients were visited on postoperative days 7, 30 and 60. The sino-nasal outcome test, endoscopic grading system and sinus CT-scan were scored before operation and on the day 60 after surgery. 54 patients completed the study. Significant improvement was observed in both treatment groups. There were no significant changes in SNOT-22, endoscopy and CT-scan scores between the two study groups. However, a greater reduction in endoscopic scores was shown in thyme honey group. The incidence of adverse effects was not significantly different between the groups, but synechiae formation and epistaxis were lower in treatment group. Thyme honey nasal spray seems to be a low-priced potential adjuvant remedy with excellent safety profile, to reduce inflammation and polyp formation and also fostering mucosal healing for patients suffering from chronic rhinosinusitis. However, further studies are recommended.

Tehran University of Medical Sciences.

Objectives: Antimuscarinic agents are known to have poor persistence because of bothersome adverse events and insufficient efficacy. Mirabegron is a new agent served as the treatment for patients with overactive bladder (OAB). In the absence of head-to-head trials, we evaluated comparative cost-effectiveness of mirabegron versus solifenacin in OAB patients from national health system (NHS) perspective in Iran. Methods: In this study a Markov model with a 5-year time horizon was developed consisted of five health states and OAB patients with an average age of 60 years. Transition probabilities were based on published clinical trials and network meta-analyses. Resource use and costs included those for medications and adverse events were extracted from literature and tariff book and presented in 2018 US dollars discounted at the rate of 5%. Cost-effectiveness ratios and quality-adjusted life years (QALYs) were computed for the agents. Both deterministic and probabilistic sensitivity analysis (PSA) was used to test the robustness of results. Results: Average per patient treatment costs was $2,168and $2,194 for solifenacin and mirabegron, respectively. Mirabegron is expected to produce QALYs than solifenacin (3.500 vs 3.489). In consequence, the incremental cost-effectiveness ratio of mirabegron was found to be $2,562 compared to solifenacin. Deterministic sensitivity analyses showed that the model is sensitive to changes in drug acquisition cost and urinary pad prices. In addition, the probability of mirabegron being cost-effective was found to be 74% of 1000 simulations at the threshold of $5,400 per QALY. Conclusions: Compared to solifenacin, mirabegron was indicated to be cost-effective in patients with overactive bladder for the Iranian healthcare system.

digital health solutions. Published MIBs outlined evidence from both real world observational studies and controlled trials. CONCLUSIONS: Although noncompulsory, the number of published MIBs is rising, suggesting an increasing focus on new innovations within the UK NHS. MIBs provide a forum for communicating the effectiveness, safety, costs and resource implications of medical technology solutions across a range of applications. Since MIBs do not include recommendations, more detailed guidance is needed to help manufacturers develop robust evidence-bases and assist stakeholders with decision-making regarding which are the most clinically-effective, resource-efficient and/or cost-effective options in comparison with standard care.