School of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Department of Nutrition, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil.
Clin Microbiol Infect. 2023 Jan;29(1):13-21. doi: 10.1016/j.cmi.2022.07.008. Epub 2022 Jul 19.
Randomized controlled trials (RCT) established the mortality reduction by tocilizumab (Actemra), baricitinib (Olumiant), and sarilumab (Kevzara) in hospitalized COVID-19 patients. However, uncertainty remains about which treatment performs best in patients receiving corticosteroids.
To estimate probabilities of noninferiority between baricitinib and sarilumab compared to tocilizumab in patients treated with corticosteroids.
PubMed, Embase, Cochrane Library, and MedRxiv.
Eligible RCTs assigning hospitalized adults with COVID-19 treated with corticosteroids to tocilizumab or baricitinib or sarilumab versus standard of care or placebo (control).
Reviewers independently abstracted published data and assessed study quality with the Risk of Bias 2 tool. Unpublished data, if required, were requested from authors of included studies. The outcome of interest was all-cause mortality at 28 days.
Twenty-seven RCTs with 13 549 patients were included. Overall, the risk of bias was low. Bayesian pairwise meta-analyses were used to aggregate results of each treatment versus control. The average odds ratio for mortality was 0.78 (95% credible interval [CrI]: 0.65, 0.94) for tocilizumab; 0.78 (95% CrI: 0.56, 1.03) for baricitinib; and 0.91 (95% CrI: 0.60, 1.40) for sarilumab. The certainty of evidence (GRADE) ranged from moderate to low. Bayesian meta-regressions with multiple priors were used to estimate probabilities of noninferiority (margin of 13% greater effect by tocilizumab). Compared to tocilizumab, there were ≤94% and 90% probabilities of noninferiority with baricitinib and sarilumab, respectively.
All but two studies included data with only indirect evidence for the comparison of interest.
Among hospitalized COVID-19 treated with corticosteroids, there are high probabilities that both baricitinib and sarilumab are associated with similar mortality reductions in comparison to tocilizumab.
随机对照试验（RCT）证实了托珠单抗（Actemra）、巴瑞替尼（Olumiant）和司鲁利单抗（Kevzara）可降低住院 COVID-19 患者的死亡率。然而，在接受皮质类固醇治疗的患者中，哪种治疗效果最好仍存在不确定性。
估计巴瑞替尼和司鲁利单抗与托珠单抗相比在接受皮质类固醇治疗的患者中的非劣效性概率。
PubMed、Embase、Cochrane 图书馆和 MedRxiv。
将 COVID-19 住院成人患者随机分配至托珠单抗或巴瑞替尼或司鲁利单抗与标准治疗或安慰剂（对照）组的 RCT。
审查员独立提取已发表的数据，并使用风险偏倚 2 工具评估研究质量。如果需要，向纳入研究的作者请求未发表的数据。主要结局为 28 天全因死亡率。
共纳入 27 项 RCT，共 13549 名患者。总体而言，风险偏倚较低。贝叶斯成对荟萃分析用于汇总每种治疗与对照的结果。托珠单抗死亡率的平均比值比（OR）为 0.78（95%可信区间[CrI]：0.65，0.94）；巴瑞替尼为 0.78（95% CrI：0.56，1.03）；司鲁利单抗为 0.91（95% CrI：0.60，1.40）。证据确定性（GRADE）范围为中等到低。使用多个先验的贝叶斯荟萃回归来估计非劣效性概率（托珠单抗效应增加 13%的边缘）。与托珠单抗相比，巴瑞替尼和司鲁利单抗的非劣效性概率分别≤94%和 90%。
除两项研究外，所有研究均包含仅间接证据支持的比较数据。
在接受皮质类固醇治疗的住院 COVID-19 患者中，巴瑞替尼和司鲁利单抗与托珠单抗相比，死亡率降低的可能性非常高。
Zotero 插件
