Laboratory of Rheumatology and Institute of TCM Clinical Basic Medicine, College of Basic Medical Science, Zhejiang Chinese Medical University, Binwen Road 548, Hangzhou, 310053, Zhejiang, China.
First People's Hospital of Taizhou, Taizhou, 318020, Zhejiang, China.
Inflammopharmacology. 2023 Feb;31(1):275-285. doi: 10.1007/s10787-022-01105-9. Epub 2022 Nov 29.
This study aims to determine the efficacy and safety of granulocyte-macrophage colony-stimulating factor (GM-CSF) antibodies in COVID-19 patients.
We searched Cochrane Library, PubMed, Embase, and ClinicalTrials.gov databases until July 27, 2022. Both randomized control trials (RCTs) and cohort studies were included and analyzed separately. The outcomes included mortality, incidence of invasive mechanical ventilation (IMV), ventilation improvement rate (need oxygen therapy to without oxygen therapy), secondary infection, and adverse events (AEs). The odds ratio (OR) with a 95% confidence interval (CI) was calculated by a random-effects meta-analysis model.
Five RCTs and 2 cohort studies with 1726 COVID-19 patients were recruited (n = 866 in the GM-CSF antibody group and n = 891 in the control group). GM-CSF antibodies treatment reduced the incidence of IMV, which was supported by two cohort studies (OR 0.16; 95% CI 0.03, 0.74) and three RCTs (OR 0.62; 95% CI 0.41, 0.94). GM-CSF antibodies resulted in slight but not significant reductions in mortality (based on two cohort studies and five RCTs) and ventilation improvement (based on one cohort study and two RCTs). The sensitive analysis further showed the results of mortality and ventilation improvement rate became statistically significant when one included study was removed. Besides, GM-CSF antibodies did not increase the risks of the second infection (based on one cohort study and five RCTs) and AEs (based on five RCTs).
GM-CSF antibody treatments may be an efficacious and well-tolerant way for the treatment of COVID-19. Further clinical evidence is still warranted.
本研究旨在确定粒细胞-巨噬细胞集落刺激因子（GM-CSF）抗体在 COVID-19 患者中的疗效和安全性。
我们检索了 Cochrane 图书馆、PubMed、Embase 和 ClinicalTrials.gov 数据库，截至 2022 年 7 月 27 日。同时纳入随机对照试验（RCT）和队列研究，并分别进行分析。结局指标包括死亡率、有创机械通气（IMV）发生率、通气改善率（需氧治疗至无需氧治疗）、继发感染和不良事件（AE）。采用随机效应荟萃分析模型计算比值比（OR）及其 95%置信区间（CI）。
共纳入 5 项 RCT 和 2 项队列研究，共计 1726 例 COVID-19 患者（GM-CSF 抗体组 n=866，对照组 n=891）。GM-CSF 抗体治疗降低了 IMV 的发生率，这一结果得到了 2 项队列研究（OR 0.16；95%CI 0.03，0.74）和 3 项 RCT（OR 0.62；95%CI 0.41，0.94）的支持。GM-CSF 抗体治疗对死亡率（基于 2 项队列研究和 5 项 RCT）和通气改善率（基于 1 项队列研究和 2 项 RCT）的影响虽小，但无统计学意义。敏感性分析进一步表明，当排除一项纳入研究时，死亡率和通气改善率的结果具有统计学意义。此外，GM-CSF 抗体并未增加继发感染（基于 1 项队列研究和 5 项 RCT）和 AE（基于 5 项 RCT）的风险。
GM-CSF 抗体治疗可能是 COVID-19 治疗的一种有效且耐受良好的方法，但仍需要更多的临床证据支持。
