Clinical outcomes in COVID-19 patients treated with tocilizumab: An individual patient data systematic review.

摘要: BACKGROUND: Current evidence suggests an important role of the interleukin-6 (IL-6) pathway in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related cytokine release storm severely ill disease 2019 (COVID-19) patients. Inhibition IL-6 with tocilizumab has been employed successfully some these patients but data is mostly consistent case reports and series. METHODS: We performed a systematic search PubMed, Embase, Medline from 22nd April 2020 again on 27th using following terms alone or combination: "COVID-19," "coronavirus," "SARS-CoV-2," "COVID," "anti-interleukin-6 receptor antibodies," "anti-IL-6," "tocilizumab," "sarilumab," "siltuximab." included studies that reported individual patient data. extracted analyzed level baseline characteristics, laboratory findings, clinical outcomes. The primary endpoint was in-hospital mortality. Secondary endpoints complications, recovery rates, effect characteristics outcome changes levels inflammatory markers. RESULTS: Three hundred fifty-two records were identified through a systematic search, which 10 met inclusion criteria. A single study currently under review also added. Eleven observational encompassing 29 present review. There more males (24 [82.8%]), hypertension most common comorbidity (16 [48.3%]). Over average 5.4 hospital days, occurred 6 (20.7%) Among surviving patients, about 10% had worsened 17% recovered. complication distress (8 [27.6%]). significantly higher after initiation median (interquartile range) 376.6 (148-900.6) pg/mL compared to 71.1 (31.9-122.8) (P = .002). Mean (standard deviation) C-reactive protein (CRP) decreased treatment 24.6 (26.9) mg/L 140.4 (77) < .0001). Baseline demographics not different among survivors nonsurvivors by Fisher's exact test. CONCLUSION: In COVID-19 treated tocilizumab, are elevated, supportive storm. Following there elevation CRP dramatically decrease, suggesting improvement this hyperinflammatory state. Ongoing randomized control trials will allow for further evaluation promising therapy. IMPORTANCE: Recent indicate causes associated worse outcomes plays role. It suggestive anti-IL-6 results However, our knowledge, no summarize who received tocilizumab.