Improved Survival Outcome in Patients With Sars-Cov-2 (Covid-19) Ards With Tocilizumab Administration

Wadud, Nafisa; Ahmed, Naim; Shergill, Mannu; Khan, Maida; Krishna, Murali; Gilani, Aamir; Zarif, Samer El; Galaydick, Jodi; Linga, Karthika; Kooragayalu, Shravan; Galea, Julia; Stuczynski, Lauren; Osundele, Maria

doi:10.1016/j.chest.2020.08.654

Cited by 6 publications

(5 citation statements)

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“…A total of 47 studies, 40 observational studies [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 ] reported in Table 2 and 7 RCTs [ 66 , 67 , 68 , 69 , 70 , 71 , 72 ] reported in Table 3 , were included in the final analysis.…”

Section: Resultsmentioning

confidence: 99%

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Effect of Tocilizumab in Reducing the Mortality Rate in COVID-19 Patients: A Systematic Review with Meta-Analysis

Conti

Corbi

Sellitto

et al. 2021

JPM

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Data supporting the use of Tocilizumab (TCZ) in COVID-19 are contrasting and inconclusive. This meta-analysis aimed to assess TCZ effectiveness in reducing the mortality rate in COVID-19 patients. PubMed, Scopus, Embase, Cochrane, WILEY, and ClinicalTrials.gov were searched to evaluate observational studies and RCTs. The outcome was the mortality rate. Forty observational studies and seven RCTs, involving 9640 and 5556 subjects treated with Standard Therapy (ST) + TCZ or ST alone, respectively, were included. In patients treated with ST+TCZ, a higher survival (Log odds ratio = −0.41; 95% CI: −0.68 −0.14; p < 0.001) was found. Subgroups analyses were performed to better identify the possible interference of some parameters in modifying the efficacy of TCZ therapy on COVID-19 mortality. Separating observational from RCTs, no statistically significant (p = 0.70) TCZ-related reduction of mortality regarding RCTs was found, while a significant reduction (Log odds ratio = −0.52; 95% CI: −0.82 −0.22, p < 0.001) was achieved regarding the observational studies. Stratifying for the use of Invasive Mechanic Ventilation (IMV), a higher survival was found in patients treated with TCZ in the No-IMV and IMV groups (both p < 0.001), but not in the No-IMV/IMV group. Meta-regression analyses were also performed. The meta-analysis of observational studies reveals that TCZ is associated with reducing the mortality rate in both severe and critically ill patients. Although the largest RCT, RECOVERY, is in line with this result, the meta-analysis of RCTs failed to found any difference between ST + TCZ and ST. It is crucial to personalize the therapy considering the patients’ characteristics.

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Section: Resultsmentioning

confidence: 99%

“…Overall, a significant effect in reducing the death rates was found by analyzing the studies [ 35 , 47 , 51 , 57 , 62 , 65 ] evaluating critically ill patients receiving IMV when TCZ was administered.…”

Section: Discussionmentioning

confidence: 99%

Effect of Tocilizumab in Reducing the Mortality Rate in COVID-19 Patients: A Systematic Review with Meta-Analysis

Conti

Corbi

Sellitto

et al. 2021

JPM

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“…Mean length of stay in our cohort was 11.5 ± 8.4 days. Wadud et al documented that those patients who received tocilizumab had a higher length of hospital stay as compared to those who did not receive tocilizumab [41] .…”

Section: Discussionmentioning

confidence: 99%

Tocilizumab in critically ill COVID-19 patients: An observational study

Mushtaq

Mahmood

Almas

et al. 2022

International Immunopharmacology

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“…Multiple studies have reported the possible benefits of tocilizumab in COVID-19 patients with ARDS [100,101]. COVACTA, a phase 3, multicenter RCT, failed to show the benefits of 28-day mortality reduction or clinical improvement over that of placebo [102].…”

Section: Interleukin 6 Inhibitor: Tocilizumabmentioning

confidence: 99%

Therapeutic Approaches in Modulating the Inflammatory and Immunological Response in Patients With Sepsis, Acute Respiratory Distress Syndrome, and Pancreatitis: An Expert Opinion Review

Mehta¹,

Dixit²,

Zirpe³

et al. 2021

Cureus

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Immunomodulation has long been an adjunct approach in treating critically ill patients with sepsis, acute respiratory distress syndrome (ARDS), and acute pancreatitis (AP). Hyperactive immune response with immunopathogenesis leads to organ dysfunction and alters the clinical outcomes in critically ill. Though the immune response in the critically ill might have been overlooked, it has gathered greater attention during this novel coronavirus disease 2019 (COVID-19) pandemic. Modulating hyperactive immune response, the cytokine storm, especially with steroids, has shown to improve the outcomes in COVID-19 patients. In this review, we find that immune response pathogenesis in critically ill patients with sepsis, ARDS, and AP is nearly similar. The use of immunomodulators such as steroids, broad-spectrum serine protease inhibitors such as ulinastatin, thymosin alpha, intravenous immunoglobulins, and therapies such as CytoSorb and therapeutic plasma exchange may help in improving the clinical outcomes in these conditions. As the experience of the majority of physicians in using such therapeutics may be limited, we provide our expert comments regarding immunomodulation to optimize outcomes in patients with sepsis/septic shock, ARDS, and AP.

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Improved Survival Outcome in Patients With Sars-Cov-2 (Covid-19) Ards With Tocilizumab Administration

Cited by 6 publications

References 0 publications

Effect of Tocilizumab in Reducing the Mortality Rate in COVID-19 Patients: A Systematic Review with Meta-Analysis

Effect of Tocilizumab in Reducing the Mortality Rate in COVID-19 Patients: A Systematic Review with Meta-Analysis

Tocilizumab in critically ill COVID-19 patients: An observational study

Therapeutic Approaches in Modulating the Inflammatory and Immunological Response in Patients With Sepsis, Acute Respiratory Distress Syndrome, and Pancreatitis: An Expert Opinion Review

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