Combination therapy of tocilizumab and steroid for COVID‐19 patients: A meta‐analysis

Moosazadeh, Mahmood; Mousavi, Tahoora

doi:10.1002/jmv.27489

Cited by 19 publications

(7 citation statements)

References 30 publications

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“…In our study, all patients took corticosteroids, based on the favourable evidence for the use of corticosteroids in combination with tocilizumab in patients with severe COVID-19 [ 36 , 38 , 45 , 51 ]. Thus, the recent meta-analysis by Moosazadeh M confirms that the risk of death in COVID-19 patients treated with corticosteroids and tocilizumab was lower than in the tocilizumab alone and control groups (26% and 52%, respectively) [ 52 ].…”

Section: Discussionmentioning

confidence: 97%

Application of Machine Learning in Hospitalized Patients with Severe COVID-19 Treated with Tocilizumab

Ramón

Zaragozá

Torres

et al. 2022

JCM

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Among the IL-6 inhibitors, tocilizumab is the most widely used therapeutic option in patients with SARS-CoV-2-associated severe respiratory failure (SRF). The aim of our study was to provide evidence on predictors of poor outcome in patients with COVID-19 treated with tocilizumab, using machine learning (ML) techniques. We conducted a retrospective study, analyzing the clinical, laboratory and sociodemographic data of patients admitted for severe COVID-19 with SRF, treated with tocilizumab. The extreme gradient boost (XGB) method had the highest balanced accuracy (93.16%). The factors associated with a worse outcome of tocilizumab use in terms of mortality were: baseline situation at the start of tocilizumab treatment requiring invasive mechanical ventilation (IMV), elevated ferritin, lactate dehydrogenase (LDH) and glutamate-pyruvate transaminase (GPT), lymphopenia, and low PaFi [ratio between arterial oxygen pressure and inspired oxygen fraction (PaO2/FiO2)] values. The factors associated with a worse outcome of tocilizumab use in terms of hospital stay were: baseline situation at the start of tocilizumab treatment requiring IMV or supplemental oxygen, elevated levels of ferritin, glutamate-oxaloacetate transaminase (GOT), GPT, C-reactive protein (CRP), LDH, lymphopenia, and low PaFi values. In our study focused on patients with severe COVID-19 treated with tocilizumab, the factors that were weighted most strongly in predicting worse clinical outcome were baseline status at the start of tocilizumab treatment requiring IMV and hyperferritinemia.

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Section: Discussionmentioning

confidence: 97%

Application of Machine Learning in Hospitalized Patients with Severe COVID-19 Treated with Tocilizumab

Ramón

Zaragozá

Torres

et al. 2022

JCM

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“…The tool is suitable for reviews including randomised and non-randomised studies. It includes 16 domains (7 considered critical) relating to the research question, review design, search strategy, study selection, data extraction, justification for excluded stud- Lee, 2020 [13] Li, 2020 [14] Yang, 2020 [15] Cantini, 2020 [16] Cheng, 2020 [17] Wang, 2020 [18] Sarma, 2020 [19] Tlayjeh, 2020 [20] WHO REACT Working Group, 2020 [21] Ye, 2020 [22] Van Paassen, 2020 [23] Chaudhuri, 2021 [24] Hasan, 2021 [25] Ma, 2021 [26] Pasin, 2021 [27] Pulakurthi, 2021 [28] Sahu, 2021 [29] Tu, 2021 [30] Cano, 2021 [31] Moosazadeh, 2021 [32] Nguyen, 2021 [33] Ferreto, 2021 [34] Yu, 2021 [35] Sahilu, 2021 [36] Boppana, 2021 [37] Wagner, 2021 [38] ies, description of included studies, risk of bias, sources of funding, meta-analysis, heterogeneity, publication bias, and conflicts of interest (see Table 2 for details of each question). Two review authors (MC, IP) independently assessed the quality of evidence in the included reviews and the methodological quality of the SRs.…”

Section: Assessment Of Methodological Quality Of Systematic Reviewsmentioning

confidence: 99%

Untitled

2022

infez med

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A reappraisal of the validity of the conclusions of systematic reviews (SRs) and meta-analyses related to corticosteroids use for the treatment of COVID-19. Material and Methods: An overview of SRs (umbrella review). The methodological quality of the SRs was assessed using tha AMSTAR-2 checklist; quality of the evidence was appraised following the GRADE approach. Results: 35 SRs were included in this overview. Data were from 307 overlapping reports, based on 121 individual primary studies (25 randomized clinical trials (RCTs), 96 non-RCTs. In critically ill patients the use of steroids significantly reduced mortality compared to standard of care in 80% of the SRs, more often with moderate/high level of certainty; however, in patients not requiring oxygen supplementation the use of steroids increased the overall mortality in 2/3 of the comparisons. Clinical progression of diseases (need for me-chanical ventilation, or for intensive care admission) was more commonly observed among controls compared to steroids recipients (in 9 out of 14 comparisons; certainty of evidence from very-low to moderate). The occurrence of adverse events was similar among steroids recipients and controls. Other outcomes (i.e., viral clearance, length of hospital stay) or issue related to optimal dose and type of steroids were addressed in a minority of SRs, with a high level of uncertainty, so that no definitive conclusions can be drawn. Conclusions: There is moderate certainty of evidence that corticosteroids reduce mortality and progression of disease in critically ill COVID-19 patients compared to standard of care, without increasing the occurrence of adverse events.

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“…Massive lymphocyte death was discovered during autopsy examinations on lymphoid organs taken from numerous individuals who passed away from the condition; this death was ascribed to high levels of IL-6. Tocilizumab, an IL-6 receptor antagonist, treatment increased the number of circulating lymphocytes, further indicating that an increase in IL-6 is a major factor in the development of lymphopenia ( 111 ). Even more, treatment of critical ICU patients with intubation, mechanical ventilation and extracorporeal membrane oxygenation (ECMO) with adipose-tissue derived Mesenchymal Stromal Cells (MSCs) increase CD4+, CD8+ and B-cells, suggesting that inflammation synergizes with other mechanisms causing lymphopenia ( 112 ).…”

Section: High Mortality Risk Covid-19 Patients: Size Of the Nichementioning

confidence: 99%

Rationale for combined therapies in severe-to-critical COVID-19 patients

Gonzaga,

Andreu,

Hernández-Blasco

et al. 2023

Front. Immunol.

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An unprecedented global social and economic impact as well as a significant number of fatalities have been brought on by the coronavirus disease 2019 (COVID-19), produced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Acute SARS-CoV-2 infection can, in certain situations, cause immunological abnormalities, leading to an anomalous innate and adaptive immune response. While most patients only experience mild symptoms and recover without the need for mechanical ventilation, a substantial percentage of those who are affected develop severe respiratory illness, which can be fatal. The absence of effective therapies when disease progresses to a very severe condition coupled with the incomplete understanding of COVID-19’s pathogenesis triggers the need to develop innovative therapeutic approaches for patients at high risk of mortality. As a result, we investigate the potential contribution of promising combinatorial cell therapy to prevent death in critical patients.

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Combination therapy of tocilizumab and steroid for COVID‐19 patients: A meta‐analysis

Cited by 19 publications

References 30 publications

Application of Machine Learning in Hospitalized Patients with Severe COVID-19 Treated with Tocilizumab

Application of Machine Learning in Hospitalized Patients with Severe COVID-19 Treated with Tocilizumab

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Rationale for combined therapies in severe-to-critical COVID-19 patients

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