PDF(Pubmed)
Abstract：
Introduction: Tocilizumab and baricitinib are recommended treatment options for COVID-19 patients with hyperinflammatory response; however, there is a lack of systematic review directly evaluating their efficacy and safety. Objective: This review was conducted to evaluate the efficacy and safety of tocilizumab and baricitinib in the treatment of hospitalized patients with COVID-19. Methods: Relevant databases were searched for studies that compared the effect or safety of baricitinib or tocilizumab in hospitalized patients with COVID-19. The mortality was the main outcome. The hospital length of stay or adverse drug reactions were taken into consideration as secondary endpoints. The analyses were performed in Revman 5.3 or Stata 16.0. The protocol and analysis plan were pre-registered in PROSPERO, with the registration number CRD42023408219. Results: In total, 10 studies with 2,517 patients were included. The overall pooled data demonstrated that, there was no statistically significant difference in the 28-day mortality rate and the hospital length of stay between the tocilizumab and baricitinib (OR = 1.10, 95% CI = 0.80-1.51, p = 0.57; OR = -0.68, 95% CI = -2.24-0.87, p = 0.39). The adverse reactions including secondary infection rate, thrombotic and bleeding events, and acute liver injury of tocilizumab were significantly higher than that of baricitinib. (OR = 1.49, 95% CI = 1.18-1.88, p < 0.001,OR = 1.52, 95% CI = 1.11-2.08, p = 0.009; OR = 1.52, 95% CI = 1.11-2.08, p = 0.009; OR = 2.24, 95% CI = 1.49-3.35, p < 0.001). Conclusion: In patients hospitalized with COVID-19, no discernible difference in therapeutic efficacy was observed between tocilizumab and baricitinib; however, the group treated with baricitinib demonstrated a significantly lower incidence of adverse effects.
摘要：
简介：Tocilizumab和baricitinib是COVID-19高炎症反应患者的推荐治疗方案；然而，缺乏直接评价其疗效和安全性的系统评价.目的：评价托珠单抗和巴利替尼治疗COVID-19住院患者的疗效和安全性。方法：在相关数据库中搜索比较巴利替尼或托珠单抗在COVID-19住院患者中的效果或安全性的研究。死亡率是主要结果。将住院时间或药物不良反应作为次要终点。分析在Revman5.3或Stata16.0中进行。协议和分析计划在PROSPERO中预先注册，注册号为CRD42023408219。结果：总的来说，包括2,517名患者的10项研究。总体汇总数据表明，托珠单抗和巴利替尼的28日死亡率和住院时间无统计学差异(OR=1.10,95%CI=0.80~1.51,p=0.57;OR=-0.68,95%CI=-2.24~0.87,p=0.39).不良反应包括继发感染率、血栓和出血事件，托珠单抗的急性肝损伤明显高于巴利替尼。(OR=1.49,95%CI=1.18-1.88,p<0.001,OR=1.52,95%CI=1.11-2.08,p=0.009;OR=1.52,95%CI=1.11-2.08,p=0.009;OR=2.24,95%CI=1.49-3.35,p<0.001)。结论：在COVID-19住院患者中，托珠单抗和巴利替尼的治疗效果没有明显差异；然而，巴利替尼治疗组的不良反应发生率显著降低.
