Evidence map›Paper›PMID 36936570›Full record

ArticleBMJ medicine2022

Use of tocilizumab and sarilumab alone or in combination with corticosteroids for covid-19: systematic review and network meta-analysis.

Dena Zeraatkar, Ellen Cusano, Juan Pablo Díaz Martínez, Anila Qasim, Sophia Mangala, Elena Kum, Jessica Julia Bartoszko, Tahira Devji, Thomas Agoritsas, Gordon Guyatt and 7 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ medicine, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
28citing papers in PubMed, 3 pooled it
2.9field-weighted citation impact, top 7% 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

28 citing papers in PubMed, 3 syntheses or guidelines pooled it, 32 citations in OpenAlex.

  1. Effect of tocilizumab, sarilumab, and baricitinib on mortality among patients hospitalized for COVID-19 treated with corticosteroids: a systematic review and meta-analysis.Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases · 2023
    Pooled it
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  7. ARDS and corticosteroids: beyond COVID-19.Pneumonia (Nathan Qld.) · 2026
    Review
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  9. Article
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  11. Article
  12. Article
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  18. Review
  19. Sarilumab plus standard of careEClinicalMedicine · 2023
    Article
  20. Observational
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

17 authors at 10 institutions in 6 countries.

Dena ZeraatkarHealth Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.ORCID 0000-0003-4287-0541
Ellen CusanoInternal Medicine Residency Programme, University of Calgary Cumming School of Medicine, Calgary, AB, Canada.
Juan Pablo Díaz MartínezInstitute of Health Policy, Management and valuation, University of Toronto, Toronto, ON, Canada.
Anila QasimHealth Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Sophia MangalaMcMaster University, Hamilton, ON, Canada.
Elena KumHealth Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Jessica Julia BartoszkoHealth Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.ORCID 0000-0001-6743-3538
Tahira DevjiHealth Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.ORCID 0000-0001-8414-7410
Thomas AgoritsasDivision of General Internal Medicine & Division of Epidemiology, University Hospitals of Geneva, Geneva, Switzerland.
Gordon GuyattHealth Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Ariel IzcovichInternal Medicine, Hospital Alemán de Buenos Aires, Buenos Aires, Argentina.ORCID 0000-0001-9053-4396
Assem M KhamisWolfson Palliative Care Research Centre, Hull York Medical School, Hull, UK.ORCID 0000-0002-5567-7065
Francois LamontagneUniversity of Sherbrooke, Sherbrooke, QC, Canada.
Bram RochwergHealth Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Per VandvikDepartment of Medicine, Innlandet Hospital Trust-divisjon Gjøvik, Gjøvik, Norway.
Romina Brignardello-PetersenHealth Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Reed Alexander Cunningham SiemieniukHealth Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.ORCID 0000-0002-3725-3031
Impact · CAHarvard University · USHospital Alemán · ARHull York Medical School · GBInnlandet Hospital Trust · NOMcMaster University · CAUniversité de Sherbrooke · CAUniversity Hospital of Geneva · CHUniversity of Calgary · CAUniversity of Toronto · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Objective: To compare the effects of interleukin 6 receptor blockers, tocilizumab and sarilumab, with or without corticosteroids, on mortality in patients with covid-19. Design: Systematic review and network meta-analysis. Data sources: World Health Organization covid-19 database, a comprehensive multilingual source of global covid-19 literature, and two prospective meta-analyses (up to 9 June 2021). Review methods: Trials in which people with suspected, probable, or confirmed covid-19 were randomised to interleukin 6 receptor blockers (with or without corticosteroids), corticosteroids, placebo, or standard care. The analysis used a bayesian framework and assessed the certainty of evidence using the GRADE approach. Results from the fixed effect meta-analysis were used for the primary analysis. Results: Of 45 eligible trials (20 650 patients) identified, 36 (19 350 patients) could be included in the network meta-analysis. Of 36 trials, 27 were at high risk of bias, primarily due to lack of blinding. Tocilizumab, in combination with corticosteroids, suggested a reduction in the risk of death compared with corticosteroids alone (odds ratio 0.79, 95% credible interval 0.70 to 0.88; 35 fewer deaths per 1000 people, 95% credible interval 52 fewer to 18 fewer per 1000; moderate certainty of evidence), as did sarilumab in combination with corticosteroids, compared with corticosteroids alone (0.73, 0.58 to 0.92; 43 fewer per 1000, 73 fewer to 12 fewer; low certainty). Tocilizumab and sarilumab, each in combination with corticosteroids, appeared to have similar effects on mortality when compared with each other (1.07, 0.86 to 1.34; eight more per 1000, 20 fewer to 35 more; low certainty). The effects of tocilizumab (1.12, 0.91 to 1.38; 20 more per 1000, 16 fewer to 59 more; low certainty) and sarilumab (1.07, 0.81 to 1.40; 11 more per 1000, 38 fewer to 55 more; low certainty), when used alone, suggested an increase in the risk of death. Conclusion: These findings suggest that in patients with severe or critical covid-19, tocilizumab, in combination with corticosteroids, probably reduces mortality, and that sarilumab, in combination with corticosteroids, might also reduce mortality. Tocilizumab and sarilumab, in combination with corticosteroids, could have similar effectiveness. Tocilizumab and sarilumab, when used alone, might not be beneficial.

Indexed as

COVID-19critical care

Identifiers

PMID36936570
PMCPMC9978750
OpenAlexW4221137491

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.