Effect of tocilizumab, sarilumab, and baricitinib on mortality among patients hospitalized for COVID-19 treated with corticosteroids : a systematic review and meta-analysis
Copyright © 2022 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved..
BACKGROUND: Randomized controlled trials (RCT) established the mortality reduction by tocilizumab (Actemra), baricitinib (Olumiant), and sarilumab (Kevzara) in hospitalized COVID-19 patients. However, uncertainty remains about which treatment performs best in patients receiving corticosteroids.
OBJECTIVES: To estimate probabilities of noninferiority between baricitinib and sarilumab compared to tocilizumab in patients treated with corticosteroids.
DATA SOURCES: PubMed, Embase, Cochrane Library, and MedRxiv.
STUDY ELIGIBILITY CRITERIA: Eligible RCTs assigning hospitalized adults with COVID-19 treated with corticosteroids to tocilizumab or baricitinib or sarilumab versus standard of care or placebo (control).
METHODS: Reviewers independently abstracted published data and assessed study quality with the Risk of Bias 2 tool. Unpublished data, if required, were requested from authors of included studies. The outcome of interest was all-cause mortality at 28 days.
PARTICIPANTS: Twenty-seven RCTs with 13 549 patients were included. Overall, the risk of bias was low. Bayesian pairwise meta-analyses were used to aggregate results of each treatment versus control. The average odds ratio for mortality was 0.78 (95% credible interval [CrI]: 0.65, 0.94) for tocilizumab; 0.78 (95% CrI: 0.56, 1.03) for baricitinib; and 0.91 (95% CrI: 0.60, 1.40) for sarilumab. The certainty of evidence (GRADE) ranged from moderate to low. Bayesian meta-regressions with multiple priors were used to estimate probabilities of noninferiority (margin of 13% greater effect by tocilizumab). Compared to tocilizumab, there were ≤94% and 90% probabilities of noninferiority with baricitinib and sarilumab, respectively.
RESULTS: All but two studies included data with only indirect evidence for the comparison of interest.
CONCLUSIONS: Among hospitalized COVID-19 treated with corticosteroids, there are high probabilities that both baricitinib and sarilumab are associated with similar mortality reductions in comparison to tocilizumab.
| Errataetall: |
CommentIn: Clin Microbiol Infect. 2023 Jan;29(1):7-9. - PMID 36257548 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:29 |
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| Enthalten in: |
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases - 29(2023), 1 vom: 15. Jan., Seite 13-21 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Albuquerque, Arthur M [VerfasserIn] |
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| Links: |
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| Themen: |
Adrenal Cortex Hormones |
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| Anmerkungen: |
Date Completed 27.12.2022 Date Revised 03.04.2023 published: Print-Electronic CommentIn: Clin Microbiol Infect. 2023 Jan;29(1):7-9. - PMID 36257548 Citation Status MEDLINE |
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| doi: |
10.1016/j.cmi.2022.07.008 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 100 | 1 | |a Albuquerque, Arthur M |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Effect of tocilizumab, sarilumab, and baricitinib on mortality among patients hospitalized for COVID-19 treated with corticosteroids |b a systematic review and meta-analysis |
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| 500 | |a Date Completed 27.12.2022 | ||
| 500 | |a Date Revised 03.04.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Clin Microbiol Infect. 2023 Jan;29(1):7-9. - PMID 36257548 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2022 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved. | ||
| 520 | |a BACKGROUND: Randomized controlled trials (RCT) established the mortality reduction by tocilizumab (Actemra), baricitinib (Olumiant), and sarilumab (Kevzara) in hospitalized COVID-19 patients. However, uncertainty remains about which treatment performs best in patients receiving corticosteroids | ||
| 520 | |a OBJECTIVES: To estimate probabilities of noninferiority between baricitinib and sarilumab compared to tocilizumab in patients treated with corticosteroids | ||
| 520 | |a DATA SOURCES: PubMed, Embase, Cochrane Library, and MedRxiv | ||
| 520 | |a STUDY ELIGIBILITY CRITERIA: Eligible RCTs assigning hospitalized adults with COVID-19 treated with corticosteroids to tocilizumab or baricitinib or sarilumab versus standard of care or placebo (control) | ||
| 520 | |a METHODS: Reviewers independently abstracted published data and assessed study quality with the Risk of Bias 2 tool. Unpublished data, if required, were requested from authors of included studies. The outcome of interest was all-cause mortality at 28 days | ||
| 520 | |a PARTICIPANTS: Twenty-seven RCTs with 13 549 patients were included. Overall, the risk of bias was low. Bayesian pairwise meta-analyses were used to aggregate results of each treatment versus control. The average odds ratio for mortality was 0.78 (95% credible interval [CrI]: 0.65, 0.94) for tocilizumab; 0.78 (95% CrI: 0.56, 1.03) for baricitinib; and 0.91 (95% CrI: 0.60, 1.40) for sarilumab. The certainty of evidence (GRADE) ranged from moderate to low. Bayesian meta-regressions with multiple priors were used to estimate probabilities of noninferiority (margin of 13% greater effect by tocilizumab). Compared to tocilizumab, there were ≤94% and 90% probabilities of noninferiority with baricitinib and sarilumab, respectively | ||
| 520 | |a RESULTS: All but two studies included data with only indirect evidence for the comparison of interest | ||
| 520 | |a CONCLUSIONS: Among hospitalized COVID-19 treated with corticosteroids, there are high probabilities that both baricitinib and sarilumab are associated with similar mortality reductions in comparison to tocilizumab | ||
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Systematic Review | |
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a Baricitinib | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Corticosteroids | |
| 650 | 4 | |a Mortality | |
| 650 | 4 | |a Sarilumab | |
| 650 | 4 | |a Tocilizumab | |
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| 700 | 1 | |a McDonald, Emily G |e verfasserin |4 aut | |
| 700 | 1 | |a Brophy, James M |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Todd C |e verfasserin |4 aut | |
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