治疗COVID-19的互白素-6阻断剂:一个活生生的系统性审查
Lina Ghosn1,2,3, Rouba Assi1,2,3, Theodoros Evrenoglou3
1Cochrane France, Paris, France.
The Cochrane database of systematic reviews
|June 1, 2023
概括
像托西利祖马布 (tocilizumab) 这样的插白素6 (IL-6) 阻断剂在住院COVID-19患者的死亡率降低方面显示出短期的好处. 然而,它们在临床改善和对其他IL-6药物的安全性方面的有效性仍然不确定.
科学领域:
- 免疫学 免疫学 免疫学
- 病毒学 病毒学
- 临床医学 临床医学
背景情况:
- 患有针对I型干扰素的自身抗体的COVID-19患者可能会经历细胞因子风暴,导致严重的呼吸系统问题.
- 干白素6 (IL-6) 是这种炎症过程中的关键细胞因子,促使IL-6阻断剂在严重的COVID-19中使用.
研究的目的:
- 在COVID-19患者中,与标准护理或安慰剂相比,评估IL-6阻断剂的有效性和安全性.
- 更新关于IL-6抑制剂治疗COVID-19在不同疾病严重程度的现有证据.
主要方法:
- 从主要临床试验注册表中确定的随机对照试验 (RCT) 的系统审查和元分析.
- 纳入标准侧重于RCT,将IL-6阻断剂与COVID-19的标准护理或安慰剂进行比较.
- 数据提取和偏差风险评估由研究人员独立进行,证据确定性使用GRADE方法进行分级.
主要成果:
- 在住院COVID-19患者中,托西利祖马布在28天内显示出降低全因死亡率的高确定性证据.
- 托西利祖马布和沙利祖马布在28天后显示出中度确定性证据,表明临床改善的增加很小或没有.
- 关于沙利卢马布和其他IL-6阻断剂 (克拉扎基祖马布,奥洛基祖马布,西尔图西马布,莱维利马布) 对临床结果和安全性的影响的证据仍然不确定或非常不确定.
结论:
- 托西利祖马布为住院COVID-19患者提供了短期生存益处,可能在不良事件中没有显著差异.
- 托西利祖马布和沙利祖马布的临床改善和长期结果仍然不确定,其他IL-6阻断剂的疗效也是如此.
- 审查结束后,由于尚未完成的研究数量有限,没有计划进一步更新.
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