Division of Medicine, The Miriam Hospital, 164 Summit Ave, Providence, RI, 02906, USA.
Division of Medicine Aff2, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Lung. 2021 Jun;199(3):239-248. doi: 10.1007/s00408-021-00451-9. Epub 2021 May 29.
To date, only dexamethasone has been shown to reduce mortality in coronavirus disease-19 (COVID-19) patients. Tocilizumab has been recently added to the treatment guidelines for hospitalized COVID-19 patients, but data remain conflicting.
Electronic databases such as MEDLINE, EMBASE, and Cochrane central were searched from March 1, 2020, until March 10, 2021, for randomized controlled trials evaluating the efficacy of tocilizumab in hospitalized COVID-19 patients. The outcomes assessed were all-cause mortality, mechanical ventilation, and time to discharge.
Nine studies (with 6490 patients) were included in the analysis. In total, 3358 patients received tocilizumab, and 3132 received standard care/placebo. Pooled analysis showed a significantly decreased risk of all-cause mortality (RR 0.89, 95% CI 0.80-0.98, p = 0.02) and progression to mechanical ventilation (RR 0.80, 95% CI 0.71-0.89, p < 0.0001) in the tocilizumab arm compared to standard therapy or placebo. In addition, there was a trend towards improved median time to hospital discharge (RR 1.28, 95% CI 1.12-1.45, p = 0.0002).
Tocilizumab therapy improves outcomes of mortality and need for mechanical ventilation, in hospitalized patients with COVID-19 infection compared with standard therapy or placebo. Our findings suggest the efficacy of tocilizumab therapy in hospitalized COVID-19 patients and strengthen the concept that tocilizumab is a promising therapeutic intervention to improve mortality and morbidity in COVID-19 patients.
迄今为止，只有地塞米松被证明能降低 COVID-19 患者的死亡率。托珠单抗最近被添加到 COVID-19 住院患者的治疗指南中，但数据仍然存在争议。
从 2020 年 3 月 1 日至 2021 年 3 月 10 日，检索 MEDLINE、EMBASE 和 Cochrane 中心等电子数据库，以评估托珠单抗治疗住院 COVID-19 患者的疗效的随机对照试验。评估的结局包括全因死亡率、机械通气和出院时间。
共有 9 项研究（共 6490 例患者）纳入分析。共有 3358 例患者接受托珠单抗治疗，3132 例患者接受标准治疗/安慰剂治疗。汇总分析显示，托珠单抗组的全因死亡率（RR 0.89，95%CI 0.80-0.98，p=0.02）和进展为机械通气（RR 0.80，95%CI 0.71-0.89，p<0.0001）的风险显著降低。此外，托珠单抗组的中位住院出院时间有改善趋势（RR 1.28，95%CI 1.12-1.45，p=0.0002）。
与标准治疗或安慰剂相比，托珠单抗治疗可改善 COVID-19 感染住院患者的死亡率和机械通气需求。我们的研究结果表明托珠单抗治疗 COVID-19 住院患者的疗效，并强化了托珠单抗是改善 COVID-19 患者死亡率和发病率的有前途的治疗干预手段的概念。
