Introduction

As the pandemic progresses, the pathophysiology of COVID-19 is becoming more apparent, and the potential for tocilizumab is increasing. However, the clinical efficacy and safety of tocilizumab in the treatment of COVID-19 patients remain unclear.

Methods

To assess the efficacy and safety of tocilizumab treatment in COVID-19 patients, we performed a retrospective case-control study. The study was conducted, including 95 patients treated with tocilizumab plus standard treatment and matched controls with 95 patients treated with standard treatment therapy by propensity score from February to April 2020. We searched some databases using the search terms for studies published from January 1, 2020, to June 1, 2021.

Results

Our case-control study found a lower mortality rate in the tocilizumab treatment group than in the standard treatment group (9.47% versus 16.84%, P = 0.134), but the results were not statistically significant. We also found that the mortality rate in tocilizumab treatment groups was significantly lower than in the standard treatment group in the stratified ICU analysis (OR 0.52, 95% CI 0.44–0.61, P = 0.048 and OR 0.31, 95% CI 0.10–0.99, P = 0.044). We selected 49 studies (including 6568 cases and 11,660 controls) that met the inclusion criteria in the meta-analysis. In the overall analysis, we performed a meta-analysis that showed significantly decreased mortality after patients received tocilizumab (OR 0.81, 95% CI 0.69–0.95, P = 0.008). We also revealed significant associations within some subgroups. The sequential trial analysis showed a true-positive result. No significant associations were observed between tocilizumab and elevated secondary infection risk, discharge, adverse events, and mechanical ventilation in the overall analysis.

Conclusion

Tocilizumab significantly decreased mortality in COVID-19 patients with no increased discharge, secondary infection risk, adverse events, and mechanical ventilation in a meta-analysis. Our data suggest that clinicians should pay attention to tocilizumab therapy as an effective and safe treatment for COVID-19 patients.

中文翻译：

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托珠单抗治疗 COVID-19 患者的疗效和安全性：病例对照研究和荟萃分析

 介绍

随着大流行的进展，COVID-19 的病理生理学变得越来越明显，托珠单抗的潜力也在增加。然而，托珠单抗治疗COVID-19患者的临床疗效和安全性仍不清楚。

 方法

为了评估托珠单抗治疗 COVID-19 患者的疗效和安全性，我们进行了一项回顾性病例对照研究。该研究包括 2020 年 2 月至 4 月期间接受托珠单抗加标准治疗的 95 名患者，并根据倾向评分将对照组与接受标准治疗的 95 名患者进行匹配。我们使用 2020 年 1 月 1 日发表的研究搜索词搜索了一些数据库，至 2021 年 6 月 1 日。

 结果

我们的病例对照研究发现托珠单抗治疗组的死亡率低于标准治疗组（9.47% vs 16.84%， P = 0.134），但结果没有统计学意义。我们还发现，在分层 ICU 分析中，托珠单抗治疗组的死亡率显着低于标准治疗组（OR 0.52，95% CI 0.44–0.61， P = 0.048 和 OR 0.31，95% CI 0.10–0.99， P = 0.044）。我们选择了 49 项符合荟萃分析纳入标准的研究（包括 6568 例病例和 11,660 例对照）。在总体分析中，我们进行了一项荟萃分析，结果显示患者接受托珠单抗治疗后死亡率显着降低（OR 0.81，95% CI 0.69–0.95， P = 0.008）。我们还揭示了一些亚组内的显着关联。序贯试验分析显示出真阳性结果。在总体分析中，未观察到托珠单抗与继发感染风险升高、出院、不良事件和机械通气之间存在显着关联。

 结论

一项荟萃分析显示，托珠单抗显着降低了 COVID-19 患者的死亡率，且未增加出院率、继发感染风险、不良事件和机械通气。我们的数据表明，临床医生应重视托珠单抗治疗，将其作为治疗 COVID-19 患者的有效且安全的方法。