Petrelli Fausto, Cherri Sara, Ghidini Michele, Perego Gianluca, Ghidini Antonio, Zaniboni Alberto
Oncology Unit, Asst Bergamo Ovest, Milano 20124, Italy.
Department of Clinical Oncology, Fondazione Poliambulanza, Brescia 25124, Italy.
World J Methodol. 2021 May 20;11(3):95-109. doi: 10.5662/wjm.v11.i3.95.
The majority of patients with coronavirus disease 2019 (COVID-19) have good prognoses, but some develop a critical illness that can lead to death. Evidence shows severe acute respiratory syndrome is closely related to the induced cytokine storm. Interleukin-6 is a key player; its role in systemic inflammation is well known.
To evaluate the effect of tocilizumab (TCZ), an interleukin-6 receptor antagonist, on the outcomes for patients with COVID-19 pneumonia.
PubMed, EMBASE, SCOPUS, Web of Science, MedRxiv, Science Direct, and the Cochrane Library were searched from inception to 9 June 2020 for observational or prospective studies reporting results of hospitalized adult patients with COVID-19 infection treated with TCZ. Effect sizes were reported as odds ratios (ORs) with 95% confidence intervals (CIs), and an OR less than 1 was associated with a better outcome in those treated with TCZ.
Overall 13476 patients (33 studies; = 3264 received TCZ) with COVID-19 pneumonia and various degree of severity were included. Outcome was improved with TCZ. In the primary analysis ( = 19 studies reporting data), mortality was reduced in patients treated with TCZ (OR = 0.64, 95%CI: 0.47-0.87; < 0.01). In 9 studies where risk of death with TCZ use was controlled for other variables mortality was reduced by 57% (OR = 0.43, 95%CI: 0.27-0.7; < 0.01). Intensive care need (mechanical ventilation) was also reduced (OR = 0.36, 95%CI: 0.14-0.89; = 0.02).
In COVID-19-infected patients treated with TCZ, outcome may be improved compared to those not treated with TCZ.
大多数2019冠状病毒病（COVID-19）患者预后良好，但部分患者会发展为危重症甚至死亡。有证据表明，严重急性呼吸综合征与诱导的细胞因子风暴密切相关。白细胞介素-6是关键因素，其在全身炎症中的作用众所周知。
评估白细胞介素-6受体拮抗剂托珠单抗（TCZ）对COVID-19肺炎患者预后的影响。
检索了PubMed、EMBASE、SCOPUS、Web of Science、MedRxiv、Science Direct和Cochrane图书馆，时间范围从数据库创建至2020年6月9日，查找报告接受TCZ治疗的COVID-19感染住院成年患者结果的观察性或前瞻性研究。效应量以比值比（OR）及95%置信区间（CI）表示，OR小于1表明接受TCZ治疗的患者预后更好。
共纳入13476例患有不同严重程度COVID-19肺炎的患者（33项研究；n = 3264例接受TCZ治疗）。TCZ治疗改善了预后。在初步分析中（19项报告数据的研究），接受TCZ治疗的患者死亡率降低（OR = 0.64，95%CI：0.47 - 0.87；P < 0.01）。在9项对使用TCZ时的死亡风险进行其他变量控制的研究中，死亡率降低了57%（OR = 0.43，95%CI：0.27 - 0.7；P < 0.01）。重症监护需求（机械通气）也有所减少（OR = 0.36，95%CI：0.14 - 0.89；P = 0.02）。
与未接受TCZ治疗的COVID-19感染患者相比，接受TCZ治疗的患者预后可能得到改善。
