Immunomodulators for immunocompromised patients hospitalized for COVID-19 : a meta-analysis of randomized controlled trials
© 2024 The Authors..
Background: Although immunomodulators have established benefit against the new coronavirus disease (COVID-19) in general, it is uncertain whether such agents improve outcomes without increasing the risk of secondary infections in the specific subgroup of previously immunocompromised patients. We assessed the effect of immunomodulators on outcomes of immunocompromised patients hospitalized for COVID-19.
Methods: The protocol was prospectively registered with PROSPERO (CRD42022335397). MEDLINE, Cochrane Central Register of Controlled Trials and references of relevant articles were searched up to 01-06-2022. Authors of potentially eligible randomized controlled trials were contacted to provide data on immunocompromised patients randomized to immunomodulators vs control (i.e., placebo or standard-of-care).
Findings: Eleven randomized controlled trials involving 397 immunocompromised patients hospitalized for COVID-19 were included. Ten trials had low risk of bias. There was no difference between immunocompromised patients randomized to immunomodulators vs control regarding mortality [30/182 (16.5%) vs 41/215 (19.1%); RR 0.93, 95% CI 0.61-1.41; p = 0.74], secondary infections (RR 1.00, 95% CI 0.64-1.58; p = 0.99) and change in World Health Organization ordinal scale from baseline to day 15 (weighed mean difference 0.27, 95% CI -0.09-0.63; p = 0.15). In subgroup analyses including only patients with hematologic malignancy, only trials with low risk of bias, only trials administering IL-6 inhibitors, or only trials administering immunosuppressants, there was no difference between comparators regarding mortality.
Interpretation: Immunomodulators, compared to control, were not associated with harmful or beneficial outcomes, including mortality, secondary infections, and change in ordinal scale, when administered to immunocompromised patients hospitalized for COVID-19.
Funding: Hellenic Foundation for Research and Innovation.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2024 |
|---|---|
| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:69 |
|---|---|
| Enthalten in: |
EClinicalMedicine - 69(2024) vom: 19. Feb., Seite 102472 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Siempos, Ilias I [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Acute hypoxemic respiratory failure |
|---|
| Anmerkungen: |
Date Revised 17.02.2024 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
|---|
| doi: |
10.1016/j.eclinm.2024.102472 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM368520870 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM368520870 | ||
| 003 | DE-627 | ||
| 005 | 20240217232418.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 240216s2024 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1016/j.eclinm.2024.102472 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1297.xml |
| 035 | |a (DE-627)NLM368520870 | ||
| 035 | |a (NLM)38361992 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Siempos, Ilias I |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Immunomodulators for immunocompromised patients hospitalized for COVID-19 |b a meta-analysis of randomized controlled trials |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Revised 17.02.2024 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2024 The Authors. | ||
| 520 | |a Background: Although immunomodulators have established benefit against the new coronavirus disease (COVID-19) in general, it is uncertain whether such agents improve outcomes without increasing the risk of secondary infections in the specific subgroup of previously immunocompromised patients. We assessed the effect of immunomodulators on outcomes of immunocompromised patients hospitalized for COVID-19 | ||
| 520 | |a Methods: The protocol was prospectively registered with PROSPERO (CRD42022335397). MEDLINE, Cochrane Central Register of Controlled Trials and references of relevant articles were searched up to 01-06-2022. Authors of potentially eligible randomized controlled trials were contacted to provide data on immunocompromised patients randomized to immunomodulators vs control (i.e., placebo or standard-of-care) | ||
| 520 | |a Findings: Eleven randomized controlled trials involving 397 immunocompromised patients hospitalized for COVID-19 were included. Ten trials had low risk of bias. There was no difference between immunocompromised patients randomized to immunomodulators vs control regarding mortality [30/182 (16.5%) vs 41/215 (19.1%); RR 0.93, 95% CI 0.61-1.41; p = 0.74], secondary infections (RR 1.00, 95% CI 0.64-1.58; p = 0.99) and change in World Health Organization ordinal scale from baseline to day 15 (weighed mean difference 0.27, 95% CI -0.09-0.63; p = 0.15). In subgroup analyses including only patients with hematologic malignancy, only trials with low risk of bias, only trials administering IL-6 inhibitors, or only trials administering immunosuppressants, there was no difference between comparators regarding mortality | ||
| 520 | |a Interpretation: Immunomodulators, compared to control, were not associated with harmful or beneficial outcomes, including mortality, secondary infections, and change in ordinal scale, when administered to immunocompromised patients hospitalized for COVID-19 | ||
| 520 | |a Funding: Hellenic Foundation for Research and Innovation | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Acute hypoxemic respiratory failure | |
| 650 | 4 | |a Acute respiratory distress syndrome | |
| 650 | 4 | |a Cancer | |
| 650 | 4 | |a Critically ill | |
| 650 | 4 | |a Pneumonia | |
| 700 | 1 | |a Kalil, Andre C |e verfasserin |4 aut | |
| 700 | 1 | |a Belhadi, Drifa |e verfasserin |4 aut | |
| 700 | 1 | |a Veiga, Viviane Cordeiro |e verfasserin |4 aut | |
| 700 | 1 | |a Cavalcanti, Alexandre Biasi |e verfasserin |4 aut | |
| 700 | 1 | |a Branch-Elliman, Westyn |e verfasserin |4 aut | |
| 700 | 1 | |a Papoutsi, Eleni |e verfasserin |4 aut | |
| 700 | 1 | |a Gkirgkiris, Konstantinos |e verfasserin |4 aut | |
| 700 | 1 | |a Xixi, Nikoleta A |e verfasserin |4 aut | |
| 700 | 1 | |a Kotanidou, Anastasia |e verfasserin |4 aut | |
| 700 | 1 | |a Hermine, Olivier |e verfasserin |4 aut | |
| 700 | 1 | |a Porcher, Raphaël |e verfasserin |4 aut | |
| 700 | 1 | |a Mariette, Xavier |e verfasserin |4 aut | |
| 700 | 0 | |a CORIMUNO-19 Collaborative Group |e verfasserin |4 aut | |
| 700 | 0 | |a DisCoVeRy Study Group |e verfasserin |4 aut | |
| 700 | 0 | |a ACTT-2 Study Group |e verfasserin |4 aut | |
| 700 | 0 | |a ACTT-3 Study Group |e verfasserin |4 aut | |
| 700 | 1 | |a Hermine, Olivier |e investigator |4 oth | |
| 700 | 1 | |a Mariette, Xavier |e investigator |4 oth | |
| 700 | 1 | |a Ravaud, Philippe |e investigator |4 oth | |
| 700 | 1 | |a Bureau, Serge |e investigator |4 oth | |
| 700 | 1 | |a Dougados, Maxime |e investigator |4 oth | |
| 700 | 1 | |a Resche-Rigon, Matthieu |e investigator |4 oth | |
| 700 | 1 | |a Tharaux, Pierre-Louis |e investigator |4 oth | |
| 700 | 1 | |a Tibi, Annick |e investigator |4 oth | |
| 700 | 1 | |a Hermine, Olivier |e investigator |4 oth | |
| 700 | 1 | |a Azoulay, Elie |e investigator |4 oth | |
| 700 | 1 | |a Bureau, Serge |e investigator |4 oth | |
| 700 | 1 | |a Cadranel, Jacques |e investigator |4 oth | |
| 700 | 1 | |a Dougados, Maxime |e investigator |4 oth | |
| 700 | 1 | |a Emmerich, Joseph |e investigator |4 oth | |
| 700 | 1 | |a Fartoukh, Muriel |e investigator |4 oth | |
| 700 | 1 | |a Guidet, Bertrand |e investigator |4 oth | |
| 700 | 1 | |a Humbert, Marc |e investigator |4 oth | |
| 700 | 1 | |a Lacombe, Karine |e investigator |4 oth | |
| 700 | 1 | |a Mahevas, Matthieu |e investigator |4 oth | |
| 700 | 1 | |a Mariette, Xavier |e investigator |4 oth | |
| 700 | 1 | |a Pene, Frédéric |e investigator |4 oth | |
| 700 | 1 | |a Porcher, Raphaël |e investigator |4 oth | |
| 700 | 1 | |a Pourchet-Martinez, Valerie |e investigator |4 oth | |
| 700 | 1 | |a Ravaud, Philippe |e investigator |4 oth | |
| 700 | 1 | |a Resche-Rigon, Matthieu |e investigator |4 oth | |
| 700 | 1 | |a Schlemmer, Frédéric |e investigator |4 oth | |
| 700 | 1 | |a Tharaux, Pierre-Louis |e investigator |4 oth | |
| 700 | 1 | |a Tibi, Annick |e investigator |4 oth | |
| 700 | 1 | |a Yazdanpanah, Yazdan |e investigator |4 oth | |
| 700 | 1 | |a Ravaud, Philippe |e investigator |4 oth | |
| 700 | 1 | |a Porcher, Raphaël |e investigator |4 oth | |
| 700 | 1 | |a Baron, Gabriel |e investigator |4 oth | |
| 700 | 1 | |a Perrodeau, Elodie |e investigator |4 oth | |
| 700 | 1 | |a Bureau, Serge |e investigator |4 oth | |
| 700 | 1 | |a Vanhoye, Damien |e investigator |4 oth | |
| 700 | 1 | |a Kedzia, Cécile |e investigator |4 oth | |
| 700 | 1 | |a Demerville, Lauren |e investigator |4 oth | |
| 700 | 1 | |a Gysembergh-Houal, Anne |e investigator |4 oth | |
| 700 | 1 | |a Bourgoin, Alexandre |e investigator |4 oth | |
| 700 | 1 | |a Resche-Rigon, Matthieu |e investigator |4 oth | |
| 700 | 1 | |a Raked, Nabil |e investigator |4 oth | |
| 700 | 1 | |a Mameri, Lakhdar |e investigator |4 oth | |
| 700 | 1 | |a Montlahuc, Claire |e investigator |4 oth | |
| 700 | 1 | |a Biard, Lucie |e investigator |4 oth | |
| 700 | 1 | |a Alary, St Phanie |e investigator |4 oth | |
| 700 | 1 | |a Hamiria, Samir |e investigator |4 oth | |
| 700 | 1 | |a Bariz, Thinhinane |e investigator |4 oth | |
| 700 | 1 | |a Semri, Hala |e investigator |4 oth | |
| 700 | 1 | |a Hai, Dhiaa Meriem |e investigator |4 oth | |
| 700 | 1 | |a Benafla, Moustafa |e investigator |4 oth | |
| 700 | 1 | |a Belloul, Mohamed |e investigator |4 oth | |
| 700 | 1 | |a Vauboin, Pernelle |e investigator |4 oth | |
| 700 | 1 | |a Flamand, Saskia |e investigator |4 oth | |
| 700 | 1 | |a Pacheco, Claire |e investigator |4 oth | |
| 700 | 1 | |a Walter-Petrich, Anouk |e investigator |4 oth | |
| 700 | 1 | |a Stan, Emilia |e investigator |4 oth | |
| 700 | 1 | |a Benarab, Souad |e investigator |4 oth | |
| 700 | 1 | |a Nyanou, Corine |e investigator |4 oth | |
| 700 | 1 | |a Dougados, Maxime |e investigator |4 oth | |
| 700 | 1 | |a Tibi, Annick |e investigator |4 oth | |
| 700 | 1 | |a Charreteur, Robin |e investigator |4 oth | |
| 700 | 1 | |a Dupre, Céline |e investigator |4 oth | |
| 700 | 1 | |a Cardet, Kévin |e investigator |4 oth | |
| 700 | 1 | |a Lehmann, Blandine |e investigator |4 oth | |
| 700 | 1 | |a Baghli, Kamyl |e investigator |4 oth | |
| 700 | 1 | |a Yazdanpanah, Yazdan |e investigator |4 oth | |
| 700 | 1 | |a Madelaine, Claire |e investigator |4 oth | |
| 700 | 1 | |a D'Ortenzio, Eric |e investigator |4 oth | |
| 700 | 1 | |a Puéchal, Oriane |e investigator |4 oth | |
| 700 | 1 | |a Semaille, Caroline |e investigator |4 oth | |
| 700 | 1 | |a Mariette, Xavier |e investigator |4 oth | |
| 700 | 1 | |a Savale, Laurent |e investigator |4 oth | |
| 700 | 1 | |a Harrois, Anatole |e investigator |4 oth | |
| 700 | 1 | |a Figueiredo, Samy |e investigator |4 oth | |
| 700 | 1 | |a Duranteau, Jacques |e investigator |4 oth | |
| 700 | 1 | |a Anguel, Nadia |e investigator |4 oth | |
| 700 | 1 | |a Pavot, Arthur |e investigator |4 oth | |
| 700 | 1 | |a Monnet, Xavier |e investigator |4 oth | |
| 700 | 1 | |a Richard, Christian |e investigator |4 oth | |
| 700 | 1 | |a Teboul, Jean-Louis |e investigator |4 oth | |
| 700 | 1 | |a Durand, Philippe |e investigator |4 oth | |
| 700 | 1 | |a Tissieres, Pierre |e investigator |4 oth | |
| 700 | 1 | |a Jevnikar, Mitja |e investigator |4 oth | |
| 700 | 1 | |a Humbert, Marc |e investigator |4 oth | |
| 700 | 1 | |a Montani, David |e investigator |4 oth | |
| 700 | 1 | |a Pavy, Stephan |e investigator |4 oth | |
| 700 | 1 | |a Nocturne, Gaétane |e investigator |4 oth | |
| 700 | 1 | |a Bitoun, Samuel |e investigator |4 oth | |
| 700 | 1 | |a Noel, Nicolas |e investigator |4 oth | |
| 700 | 1 | |a Lambotte, Olivier |e investigator |4 oth | |
| 700 | 1 | |a Escaut, Lelia |e investigator |4 oth | |
| 700 | 1 | |a Jauréguiberry, Stephane |e investigator |4 oth | |
| 700 | 1 | |a Baudry, Elodie |e investigator |4 oth | |
| 700 | 1 | |a Verny, Christiane |e investigator |4 oth | |
| 700 | 1 | |a Lefevre, Edouard |e investigator |4 oth | |
| 700 | 1 | |a Zaidan, Mohamad |e investigator |4 oth | |
| 700 | 1 | |a Molinari, Domitille |e investigator |4 oth | |
| 700 | 1 | |a Leprun, Gaël |e investigator |4 oth | |
| 700 | 1 | |a Fourreau, Alain |e investigator |4 oth | |
| 700 | 1 | |a Cylly, Laurent |e investigator |4 oth | |
| 773 | 0 | 8 | |i Enthalten in |t EClinicalMedicine |d 2018 |g 69(2024) vom: 19. Feb., Seite 102472 |w (DE-627)NLM289300495 |x 2589-5370 |7 nnns |
| 773 | 1 | 8 | |g volume:69 |g year:2024 |g day:19 |g month:02 |g pages:102472 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1016/j.eclinm.2024.102472 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 69 |j 2024 |b 19 |c 02 |h 102472 | ||