Abstract
BackgroundThere 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...
Highlights
The novel SARS-CoV-2 was first identified in Wuhan, China, in December 2019.1 Since COVID-19 has been declared a global pandemic by the WHO and continues to spread at an exponential rate with over two million deaths reported worldwide.2 3The clinical manifestations of COVID-19 tend to be heterogenous ranging from asymptomatic infection to acute respiratory disease syndrome, multiorgan failure and death
Following removal of duplicates, screening and full-text review, 71 articles published worldwide were shortlisted for inclusion
All studies were performed in patients with COVID-19, with no suitable studies identified for SARS or Middle East respiratory syndrome (MERS)
Summary
The novel SARS-CoV-2 was first identified in Wuhan, China, in December 2019.1 Since COVID-19 has been declared a global pandemic by the WHO and continues to spread at an exponential rate with over two million deaths reported worldwide.2 3The clinical manifestations of COVID-19 tend to be heterogenous ranging from asymptomatic infection to acute respiratory disease syndrome, multiorgan failure and death. Severe disease are incompletely understood, but accumulating evidence points towards a dysregulated and excessive host immune response referred to as cytokine storm syndrome.. Severe disease are incompletely understood, but accumulating evidence points towards a dysregulated and excessive host immune response referred to as cytokine storm syndrome.4 During this state of immunological hyperactivation, increased circulating levels of proinflammatory cytokines including interleukin (IL)-1 and IL-6 have been demonstrated and are associated with adverse clinical outcomes.. Tocilizumab was associated with less severe outcomes on an Ordinal Scale (generalised OR 1.34, 95% CI 1.10 to 1.64, I2=98%) and adjusted mortality risk (HR 0.52, 95% CI 0.41 to 0.66, I2=76.6%). Conclusion Tocilizumab was associated with a lower relative risk of mortality in prospective studies, but effects were inconclusive for other outcomes.
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