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10.1136/thoraxjnl-2020-215266

http://scihub22266oqcxt.onion/10.1136/thoraxjnl-2020-215266
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33579777!ä!33579777

suck abstract from ncbi


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pmid33579777      Thorax 2021 ; 76 (9): 907-919
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  • Systematic review and meta-analysis of anakinra, sarilumab, siltuximab and tocilizumab for COVID-19 #MMPMID33579777
  • Khan FA; Stewart I; Fabbri L; Moss S; Robinson K; Smyth AR; Jenkins G
  • Thorax 2021[Sep]; 76 (9): 907-919 PMID33579777show ga
  • BACKGROUND: There is accumulating evidence for an overly activated immune response in severe COVID-19, with several studies exploring the therapeutic role of immunomodulation. Through systematic review and meta-analysis, we assess the effectiveness of specific interleukin inhibitors for the treatment of COVID-19. METHODS: Electronic databases were searched on 7 January 2021 to identify studies of immunomodulatory agents (anakinra, sarilumab, siltuximab and tocilizumab) for the treatment of COVID-19. The primary outcomes were severity on an Ordinal Scale measured at day 15 from intervention and days to hospital discharge. Key secondary endpoints included overall mortality. RESULTS: 71 studies totalling 22 058 patients were included, 6 were randomised trials. Most studies explored outcomes in patients who received tocilizumab (60/71). In prospective studies, tocilizumab was associated with improved unadjusted survival (risk ratio 0.83, 95% CI 0.72 to 0.96, I(2)=0.0%), but conclusive benefit was not demonstrated for other outcomes. In retrospective studies, tocilizumab was associated with less severe outcomes on an Ordinal Scale (generalised OR 1.34, 95% CI 1.10 to 1.64, I(2)=98%) and adjusted mortality risk (HR 0.52, 95% CI 0.41 to 0.66, I(2)=76.6%). The mean difference in duration of hospitalisation was 0.36 days (95% CI -0.07 to 0.80, I(2)=93.8%). There was substantial heterogeneity in retrospective studies, and estimates should be interpreted cautiously. Other immunomodulatory agents showed similar effects to tocilizumab, but insufficient data precluded meta-analysis by agent. CONCLUSION: Tocilizumab was associated with a lower relative risk of mortality in prospective studies, but effects were inconclusive for other outcomes. Current evidence for the efficacy of anakinra, siltuximab or sarilumab in COVID-19 is insufficient, with further studies urgently needed for conclusive findings. PROSPERO REGISTRATION NUMBER: CRD42020176375.
  • |*COVID-19 Drug Treatment[MESH]
  • |Antibodies, Monoclonal, Humanized/*therapeutic use[MESH]
  • |Antibodies, Monoclonal/*therapeutic use[MESH]
  • |Antineoplastic Agents/therapeutic use[MESH]
  • |Antirheumatic Agents/therapeutic use[MESH]
  • |COVID-19/*mortality[MESH]
  • |Humans[MESH]
  • |Interleukin 1 Receptor Antagonist Protein/*therapeutic use[MESH]
  • |SARS-CoV-2[MESH]


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