ArticlePloS one2022
Association between tocilizumab, sarilumab and all-cause mortality at 28 days in hospitalised patients with COVID-19: A network meta-analysis.
Article in PloS one, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 2 of them syntheses that pooled it.
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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.
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.
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Who cites it
19 citing papers in PubMed, 2 syntheses or guidelines pooled it, 27 citations in OpenAlex.
- Estimating interactions and subgroup-specific treatment effects in meta-analysis without aggregation bias: A within-trial framework.Research synthesis methods · 2023Pooled it
- Efficacy of tocilizumab in the treatment of COVID-19: An umbrella review.Reviews in medical virology · 2022Pooled it
- Tocilizumab versus sarilumab among adults hospitalised with COVID-19: target trial emulation across England and Scotland.Nature communications · 2026Article
- IL-6 Receptor Antagonists and Severe Post-COVID-19 Outcomes: An Emulated Target Trial.medRxiv : the preprint server for health sciences · 2026Article
- Acute SARS-CoV-2 infection.Nature reviews. Disease primers · 2025Review
- Interleukin-6 drives endothelial glycocalyx damage in COVID-19 and bacterial sepsis.Angiogenesis · 2024Observational
- Effect of Anti-Interleukin-6 Agents on Psychopathology in a Sample of Patients with Post-COVID-19 Syndrome: An Observational Study.Brain sciences · 2024Article
- An exploratory analysis of associations of genetic variation with the efficacy of tocilizumab in severe COVID-19 patients. A pharmacogenetic study based on next-generation sequencing.Frontiers in pharmacology · 2024Article
- Tocilizumab in Severe and Critical COVID-19 Pneumonia: Streamlining the Mixed Signals.Acta medica Philippina · 2024Article
- Comparative effectiveness of tocilizumab vs standard care in patients with severe COVID-19-related pneumonia: a retrospective cohort study utilizing registry data as a synthetic control.BMC infectious diseases · 2023Article
- Efficacy and safety of interleukin-6 receptor antagonists in adult patients admitted to intensive care unit with COVID-19: A systematic review andPreventive medicine reports · 2023Review
- Prevalence and complication of COVID-19 in patients with ankylosing spondylitis (AS) and its relationship with TNF-a inhibitors.Immunity, inflammation and disease · 2023Article
- Could the fibromyalgia syndrome be triggered or enhanced by COVID-19?Inflammopharmacology · 2023Review
- Sarilumab plus standard of careEClinicalMedicine · 2023Article
- Review
- Enoxaparin Posology According to Prothrombotic Status and Bleeding Risk in Hospitalized Patients with SARS-CoV-2 Pneumonia.Journal of clinical medicine · 2023Article
- As the virus evolves, so too must we: a drug developer's perspective : We need a new paradigm in searching for next-generation countermeasures.Virology journal · 2022Review
- Review
- Perspective: repurposed drugs for COVID-19.Archives of medical science : AMS · 2022Article
Corrections and comments
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Authors and funding
13 authors at 9 institutions in 5 countries.
Funding
Abstract
backgroundA recent prospective meta-analysis demonstrated that interleukin-6 antagonists are associated with lower all-cause mortality in hospitalised patients with COVID-19, compared with usual care or placebo. However, emerging evidence suggests that clinicians are favouring the use of tocilizumab over sarilumab. A new randomised comparison of these agents from the REMAP-CAP trial shows similar effects on in-hospital mortality. Therefore, we initiated a network meta-analysis, to estimate pairwise associations between tocilizumab, sarilumab and usual care or placebo with 28-day mortality, in COVID-19 patients receiving concomitant corticosteroids and ventilation, based on all available direct and indirect evidence.
methodsEligible trials randomised hospitalised patients with COVID-19 that compared tocilizumab or sarilumab with usual care or placebo in the prospective meta-analysis or that directly compared tocilizumab with sarilumab. Data were restricted to patients receiving corticosteroids and either non-invasive or invasive ventilation at randomisation. Pairwise associations between tocilizumab, sarilumab and usual care or placebo for all-cause mortality 28 days after randomisation were estimated using a frequentist contrast-based network meta-analysis of odds ratios (ORs), implementing multivariate fixed-effects models that assume consistency between the direct and indirect evidence.
findingsOne trial (REMAP-CAP) was identified that directly compared tocilizumab with sarilumab and supplied results on all-cause mortality at 28-days. This network meta-analysis was based on 898 eligible patients (278 deaths) from REMAP-CAP and 3710 eligible patients from 18 trials (1278 deaths) from the prospective meta-analysis. Summary ORs were similar for tocilizumab [0·82 [0·71-0·95, p = 0·008]] and sarilumab [0·80 [0·61-1·04, p = 0·09]] compared with usual care or placebo. The summary OR for 28-day mortality comparing tocilizumab with sarilumab was 1·03 [95%CI 0·81-1·32, p = 0·80]. The p-value for the global test of inconsistency was 0·28.
conclusionsAdministration of either tocilizumab or sarilumab was associated with lower 28-day all-cause mortality compared with usual care or placebo. The association is not dependent on the choice of interleukin-6 receptor antagonist.
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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.