Evidence map›Paper›PMID 33161150›Full record

SynthesisClinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases2021

Efficacy and safety of tocilizumab in COVID-19 patients: a living systematic review and meta-analysis.

Imad M Tleyjeh, Zakariya Kashour, Moussab Damlaj, Muhammad Riaz, Haytham Tlayjeh, Mustafa Altannir, Youssef Altannir, Mohamad Al-Tannir, Rana Tleyjeh, Leslie Hassett and 1 more

Registry-linked trialOpen access · bronzeAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05218369 (Effects of Immunomodulation With Interleukin-6 Antagonists on the Coagulation System in Critically-ill Covid-19 Patients), which is not on this map. Cited by 123 papers, 15 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
123citing papers in PubMed, 15 pooled it
5.0field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05218369 unknown statusnot on this mapstarted 2022, after this paper: background citation

Effects of Immunomodulation With Interleukin-6 Antagonists on the Coagulation System in Critically-ill Covid-19 Patients

TypeobservationalSponsorUniversity of PecsRan2022 to 2024Enrolled30ConditionsCOVID-19, Critical IllnessArmsIL6 Antagonist
3 · Its place in the literature

Who cites it

123 citing papers in PubMed, 15 syntheses or guidelines pooled it, 212 citations in OpenAlex.

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  9. Tocilizumab and Systemic Corticosteroids in the Management of Patients with COVID-19: A Systematic Review and Meta-Analysis.International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases · 2021
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  10. Efficacy and safety of tocilizumab in COVID-19 patients: a living systematic review and meta-analysis, first update.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2021
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  16. Early administration of tocilizumab in hospitalized COVID-19 patients with elevated inflammatory markers; COVIDSTORM-a prospective, randomized, single-centre, open-label study.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2022
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63 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 6 institutions in 4 countries.

Imad M TleyjehInfectious Diseases Section, Department of Medical Specialties King Fahad Medical City, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia; Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN, USA; Division of Epidemiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA. Electronic address: Tleyjeh.Imad@mayo.edu.
Zakariya KashourDepartment of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Moussab DamlajDivision of Hematology and HSCT, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
Muhammad RiazDepartment of Public Health, College of Health Sciences, Qatar University, Doha, Qatar.
Haytham TlayjehKing Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Intensive Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
Mustafa AltannirCollege of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Youssef AltannirCollege of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Mohamad Al-TannirResearch Center, King Fahad Medical City, Riyadh, Saudi Arabia.
Rana TleyjehCollege of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
Leslie HassettMayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA.
Tarek KashourDepartment of Cardiac Sciences, King Fahad Cardiac Center, King Saud University Medical City, Riyadh, Saudi Arabia.
Alfaisal University · SAKing Saud bin Abdulaziz University for Health Sciences · SAMayo Clinic · USKing Saud Medical City · SAQatar University · QAUniversity of Alberta · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesCytokine release syndrome with elevated interleukin-6 (IL-6) levels is associated with multiorgan damage and death in severe coronavirus disease 2019 (COVID-19). Our objective was to perform a living systematic review of the literature concerning the efficacy and toxicity of the IL-6 receptor antagonist tocilizumab in COVID-19 patients.

methodsData sources were Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, Web of Science, Scopus up, preprint servers and Google up to October 8, 2020. Study eligibility criteria were randomized controlled trials (RCTs) and observational studies at low or moderate risk of bias. Participants were hospitalized COVID-19 patients. Interventions included tocilizumab versus placebo or standard of care. We pooled crude risk ratios (RRs) of RCTs and adjusted RRs from cohorts, separately. We evaluated inconsistency between studies with I

resultsOf 1156 citations, 24 studies were eligible (five RCTs and 19 cohorts). Five RCTs at low risk of bias, with 1325 patients, examined the effect of tocilizumab on short-term mortality; pooled RR was 1.09 (95%CI 0.80-1.49, I

conclusionsCumulative moderate-certainty evidence shows that tocilizumab reduces the risk of mechanical ventilation in hospitalized COVID-19 patients. While RCTs showed that tocilizumab did not reduce short-term mortality, low-certainty evidence from cohort studies suggests an association between tocilizumab and lower mortality. We did not observe a higher risk of infections or adverse events with tocilizumab use. This review will continuously evaluate the role of tocilizumab in COVID-19 treatment.

Indexed as

COVID-19 Drug TreatmentAntibodies, Monoclonal, HumanizedCOVID-19Cytokine Release SyndromeHumansObservational Studies as TopicOdds RatioRandomized Controlled Trials as TopicReceptors, Interleukin-6Respiration, ArtificialSafetySARS-CoV-2Antibodies, Monoclonal, HumanizedReceptors, Interleukin-6tocilizumabCOVID-19Meta-analysisMortalityTocilizumabToxicity

Identifiers

PMID33161150
PMCPMC7644182
OpenAlexW3096119943

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.