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Combination therapy of tocilizumab and steroid for COVID-19 patients: A meta-analysis
Mahmood Moosazadeh1, Tahoora Mousavi2,3
1Epidemiology, Gastrointestinal Cancer Research Center, Non-communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
Insights
Combination therapy with tocilizumab and steroids significantly reduced mortality in COVID-19 patients. This treatment approach offers a better survival outcome compared to tocilizumab alone or control groups for severe coronavirus disease.
Area of Science:
- Immunology
- Pharmacology
- Critical Care Medicine
Background:
- Pro-inflammatory cytokines, coagulation markers, and lymphopenia are linked to COVID-19 severity.
- Anti-inflammatory agents like corticosteroids (CS) and tocilizumab (TCZ) are considered for advanced COVID-19 to reduce ventilator use and mortality.
Purpose of the Study:
- To evaluate the efficacy of combination therapy with tocilizumab and steroids in reducing mortality among COVID-19 patients through a meta-analysis.
Main Methods:
- A meta-analysis was conducted on five relevant studies identified through international databases.
- Study quality was assessed using a checklist, and heterogeneity was evaluated using Cochran's Q-test and I2 index.
- Statistical analysis was performed using Stata software, with publication bias assessed by Egger's test.
Main Results:
- The risk of death for COVID-19 patients treated with corticosteroids and tocilizumab was lower compared to tocilizumab alone (0.74) and control groups (0.48).
- Specifically, the combination therapy demonstrated a 26% reduction in mortality risk compared to tocilizumab alone and a 52% reduction compared to the control group.
Conclusions:
- Combination therapy of corticosteroids and tocilizumab is associated with a significant reduction in mortality for patients with severe COVID-19.
- This therapeutic strategy appears more effective than tocilizumab monotherapy or standard care in improving survival outcomes for coronavirus disease.
Abstract:
The coagulation markers, pro-inflammatory cytokines (such as IL-2R, IL-6, IL-10, and TNF-a) and lymphopenia are associated with the severity of coronavirus disease 2019 (COVID-19) disease. The use of anti-inflammatory agents, such as corticosteroids (CS) or tosilizumab (TCZ), has been suggested for the treatment of advanced stage of COVID-19 and the reduction of mechanical ventilators and mortality. The aim of this meta-analysis is to determine the role of combination therapy with tocilizumab and steroids in COVID-19 patients. Relevant studies were found using online international databases, and suitable studies were selected and assessed by two independent researchers. The quality of all papers was determined by a checklist. Heterogeneity assay among the primary studies was evaluated by Cochran's Q-test and I2 index. The statistical analyses were done using the Stata ver. 14 package (StataCorp) software. Publication bias was estimated through Egger's test, and the impact of each study on the overall estimate was assessed by sensitivity analysis. Five studies were entered into this meta-analysis. The results of these studies showed that the risk of death for COVID-19 patients treated with the combination of corticosteroids and tocilizumab compared to tocilizumab and the control group was 0.74 (95% confidence interval [CI]: 0.36-1.50) and 0.48 (95% CI: 0.31-0.74), respectively. This meta-analysis showed that the risk of death in COVID-19 patients who were treated with corticosteroids and tocilizumab was lower than the tocilizumab alone and control groups (26% and 52%, respectively).
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