Efficacy and safety of tocilizumab in COVID-19 patients: a living systematic review and meta-analysis, first update

Tleyjeh, Imad M.; Kashour, Zakariya; Riaz, Muhammad; Hassett, Leslie; Veiga, Viviane Cordeiro; Kashour, Tarek

doi:10.1016/j.cmi.2021.04.019

Cited by 34 publications

(33 citation statements)

References 26 publications

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“…Another observational study by Somers et al, including COVID-19 patients on MV, found that patients who received tocilizumab had more superinfections than those who did not (54% vs. 26%; p <0.001) [28]. Contrarily, a recent meta-analysis of 8 RCTs of hospitalized COVID-19 patients found a lower risk of secondary infections in patients who received tocilizumab [29]. The infection follow-up period was 28 days for six RCTs and longer in the remaining two RCTs [29].…”

Section: Discussionmentioning

confidence: 99%

Single Versus Multiple Doses of Tocilizumab in Critically Ill Patients with Coronavirus Disease 2019 (COVID-19): A Two-center, Retrospective Cohort Study

Sulaiman

Juhani

Salah

et al. 2021

Preprint

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Background: In COVID-19 patients, increased IL-6 levels have been associated with poor disease prognosis. The use of tocilizumab shown to be effective in treating COVID-19 with varying success. This study aims to evaluate the effectiveness and safety of using a single dose of tocilizumab compared with multiple doses in critically ill COVID-19 patients.Methods:This study is a two-center, retrospective cohort, in which patients who received tocilizumab and were admitted to the ICU at two tertiary hospitals from March 1st, 2020, until January 31st, 2021were included. Patients were divided into two groups based on the number of doses of tocilizumab they received. Furthermore, we gathered additional data from the patients, such as but not limited to demographic data, vital signs, and laboratory markers. Multivariable logistic and generalized linear regression were used. We considered a P value of < 0.05 statistically significant. Results: Two hundred sixty-one patients were included in this study; 72.4% received a single dose of tocilizumab, while the rest (27.6%) had received multiple doses. Most of the patients were male, with an average age of 59.2. After adjusting for possible confounders, the 30-day mortality (HR 0.92; 95% CI, 0.48-1.75 p = 0.79) and in-hospital mortality (HR 0.69; 95% CI, 0.36-1.31 p = 0.25) were not significantly different between the two groups. On the flip side, patients who received multiple doses of tocilizumab have higher odds of secondary infection compared with a single dose (OR 3.06; 95% CI, 1.18-7.89 p = 0.02).Conclusion: Multiple doses of tocilizumab were not associated with a statistically significant difference in ICU and hospital mortality in critically ill patients infected with COVID-19. In contrast, it was associated with higher odds of secondary infections compared to a single dose.

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Section: Discussionmentioning

confidence: 99%

Single Versus Multiple Doses of Tocilizumab in Critically Ill Patients with Coronavirus Disease 2019 (COVID-19): A Two-center, Retrospective Cohort Study

Sulaiman

Juhani

Salah

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…Moreover, a retrospective cohort study conducted by Guaraldi et al has demonstrated that tocilizumab does not increase transaminases in COVID-19 patients ( 31 ). Two meta- analysis studies, although incoherent about the efficacy of tocilizumab, have concluded that tocilizumab is not associated with liver injury in COVID-19 patients ( 45 , 46 ). Also it has been reported that a combination of tocilizumab with other hepatotoxic agents could lead to severe liver injury ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Drug-Induced Liver Injury in COVID-19 Patients: A Systematic Review

et al. 2021

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Introduction: The severity of COVID-19 may be correlated with the risk of liver injury development. An increasing number of studies indicate that degrees of hepatotoxicity has been associated with using some medications in the management of COVID-19 patients. However, limited studies had systematically investigated the evidence of drug-induced liver injury (DILI) in COVID-19 patients. Thus, this study aimed to examine DILI in COVID-19 patients.Methods: A systematic search was carried out in PubMed/Medline, EMBASE, and Web of Science up to December 30, 2020. Search items included “SARS-CoV-2”, “Coronavirus,” COVID-19, and liver injury.Results: We included 22 related articles. Among included studies, there was five case report, five case series, four randomizes control trial (RCT), seven cohort studies, and one cross-sectional study. The drugs included in this systematic review were remdesivir, favipiravir, tocilizumab, hydroxychloroquine, and lopinavir/ritonavir. Among included studies, some studies revealed a direct role of drugs, while others couldn't certainly confirm that the liver injury was due to SARS-CoV-2 itself or administration of medications. However, a significant number of studies reported that liver injury could be attributable to drug administration.Discussion: Liver injury in COVID-19 patients could be caused by the virus itself or the administration of some types of drug. Intensive liver function monitoring should be considered for patients, especially patients who are treated with drugs such as remdesivir, lopinavir/ritonavir, and tocilizumab.

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“…Another observational study by Somers et al, including COVID-19 patients on MV, found that patients who received tocilizumab had more superinfections than those who did not (54% vs. 26%; p < 0.001) [28]. Contrarily, a recent meta-analysis of 8 RCTs of hospitalized COVID-19 patients found a lower risk of secondary infections in patients who received tocilizumab [29]. The infection follow-up period was 28 days for six RCTs and longer in the remaining two RCTs [29].…”

Section: Discussionmentioning

confidence: 99%

Single Versus Multiple Doses of Tocilizumab in Critically Ill Patients with Coronavirus Disease 2019 (COVID-19): A Two-center, Retrospective Cohort Study

Sulaiman

Juhani

Salah

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: In COVID-19 patients, increased IL-6 levels have been associated with poor disease prognosis. The use of tocilizumab shown to be effective in treating COVID-19 with varying success. This study aims to evaluate the effectiveness and safety of using a single dose of tocilizumab compared with multiple doses in critically ill COVID-19 patients.Methods:This study is a two-center, retrospective cohort, in which patients who received tocilizumab and were admitted to the ICU at two tertiary hospitals from March 1st, 2020, until January 31st, 2021were included. Patients were divided into two groups based on the number of doses of tocilizumab they received. Furthermore, we gathered additional data from the patients, such as but not limited to demographic data, vital signs, and laboratory markers. Multivariable logistic and generalized linear regression were used. We considered a P value of < 0.05 statistically significant. Results: Two hundred sixty-one patients were included in this study; 72.4% received a single dose of tocilizumab, while the rest (27.6%) had received multiple doses. Most of the patients were male, with an average age of 59.2. After adjusting for possible confounders, the ICU mortality within 30 days (OR 0.83; 95% CI, 0.33-2.08 p = 0.69) and in-hospital mortality (OR 0.64; 95% CI, 0.26-1.60 p = 0.35) were not significantly different between the two groups. On the flip side, patients who received multiple doses of tocilizumab have higher odds of secondary infection compared with a single dose (OR 3.06; 95% CI, 1.18-7.89 p = 0.02).Conclusion: Multiple doses of tocilizumab were not associated with a statistically significant difference in ICU and hospital mortality in critically ill patients infected with COVID-19. In contrast, it was associated with higher odds of secondary infections compared to a single dose.

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Efficacy and safety of tocilizumab in COVID-19 patients: a living systematic review and meta-analysis, first update

Cited by 34 publications

References 26 publications

Single Versus Multiple Doses of Tocilizumab in Critically Ill Patients with Coronavirus Disease 2019 (COVID-19): A Two-center, Retrospective Cohort Study

Single Versus Multiple Doses of Tocilizumab in Critically Ill Patients with Coronavirus Disease 2019 (COVID-19): A Two-center, Retrospective Cohort Study

Drug-Induced Liver Injury in COVID-19 Patients: A Systematic Review

Single Versus Multiple Doses of Tocilizumab in Critically Ill Patients with Coronavirus Disease 2019 (COVID-19): A Two-center, Retrospective Cohort Study

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