PDF(Pubmed)
Abstract：
UNASSIGNED: The COVID-19 pandemic caused by SARS-CoV-2 has been the major health concern in 2019 globally. Considering the severity and phase of the disease, various pharmacotherapy schedules were proposed. Here, we set out to provide close-up insights on the clinical utility of Tocilizumab (TCZ), a biologic monoclonal antibody in this regard.
UNASSIGNED: In this comprehensive review, various databases, including Scopus, PubMed Central, Medline, Embase, Google Scholar, and preprint publishers (med/bioRxiv) were searched until January 30, 2024, according to the keywords and search criteria.
UNASSIGNED: Besides the pros and cons, compelling evidence purported the safety and efficacy of TCZ and indicated that it exhibits great potential to reduce short-term and all-cause (28-30-day) mortality. TCZ significantly drops the adverse events if administered in the right time course (in the inflammatory phase) during critical/severe COVID-19 pneumonia. Despite contradictory results, the benefits of TCZ appear significant, especially in combination with add-on therapies, such as corticosteroids. Although the safety of TCZ is acceptable, solid data is lacking as to its benefits during pregnancy. There are limited data on TCZ combination therapies, such as hemoperfusion, intravenous immunoglobulin (IVIG), simple O2 therapy, vasopressor support, convalescent plasma therapy, and even in vaccinated patients and COVID-19 reinfection, especially in elderly persons. In addition, the impact of TCZ therapy on the long-lasting COVID-19 is unclear.
UNASSIGNED: Personalized medicine based on individual characteristics and pertinent clinical conditions must be considered in the clinicians\' decision-making policy. Finally, to mitigate the risk-to-benefit ratio of TCZ, a treatment algorithm, based on available literature and updated national institute of health (NIH) and Infectious Diseases Society of America (IDSA) guidelines, is also proposed.
UNASSIGNED: In this comprehensive review, various databases, including Scopus, PubMed Central, Medline, Embase, Google Scholar, and preprint publishers (med/bioRxiv) were searched until January 30, 2024, according to the keywords and search criteria.
UNASSIGNED: Besides the pros and cons, compelling evidence purported the safety and efficacy of TCZ and indicated that it exhibits great potential to reduce short-term and all-cause (28-30-day) mortality. TCZ significantly drops the adverse events if administered in the right time course (in the inflammatory phase) during critical/severe COVID-19 pneumonia. Despite contradictory results, the benefits of TCZ appear significant, especially in combination with add-on therapies, such as corticosteroids. Although the safety of TCZ is acceptable, solid data is lacking as to its benefits during pregnancy. There are limited data on TCZ combination therapies, such as hemoperfusion, intravenous immunoglobulin (IVIG), simple O2 therapy, vasopressor support, convalescent plasma therapy, and even in vaccinated patients and COVID-19 reinfection, especially in elderly persons. In addition, the impact of TCZ therapy on the long-lasting COVID-19 is unclear.
UNASSIGNED: Personalized medicine based on individual characteristics and pertinent clinical conditions must be considered in the clinicians\' decision-making policy. Finally, to mitigate the risk-to-benefit ratio of TCZ, a treatment algorithm, based on available literature and updated national institute of health (NIH) and Infectious Diseases Society of America (IDSA) guidelines, is also proposed.
摘要：
■由SARS-CoV-2引起的COVID-19大流行一直是2019年全球主要的健康问题。考虑到疾病的严重程度和阶段，提出了各种药物治疗时间表。这里,我们着手提供Tocilizumab（TCZ）临床应用的特写见解，这方面的生物单克隆抗体。
■在这次全面审查中，各种数据库，包括Scopus,PubMedCentral,Medline,Embase,谷歌学者，和预印本出版商（med/bioRxiv）根据关键字和搜索条件进行搜索，直到2024年1月30日。
■除了利弊，令人信服的证据表明TCZ的安全性和有效性，并表明它具有降低短期和全因（28-30天）死亡率的巨大潜力。如果在关键/严重COVID-19肺炎期间在正确的时间过程(在炎症阶段)给药，TCZ显著降低了不良事件。尽管结果矛盾，TCZ的好处似乎很大，特别是与附加疗法相结合，比如皮质类固醇。虽然TCZ的安全性是可以接受的，关于其在怀孕期间的益处，缺乏可靠的数据。关于TCZ联合疗法的数据有限，比如血液灌流,静脉注射免疫球蛋白（IVIG），简单的O2治疗，血管加压药支持,恢复期血浆疗法，甚至在接种疫苗和COVID-19再感染的患者中，尤其是老年人。此外,TCZ治疗对长期COVID-19的影响尚不清楚。
■在临床医生的决策政策中必须考虑基于个体特征和相关临床条件的个性化医疗。最后,为了降低TCZ的风险-收益比，一种治疗算法，根据现有文献和最新的美国国立卫生研究院（NIH）和传染病学会（IDSA）指南，也被提议。
■在这次全面审查中，各种数据库，包括Scopus,PubMedCentral,Medline,Embase,谷歌学者，和预印本出版商（med/bioRxiv）根据关键字和搜索条件进行搜索，直到2024年1月30日。
■除了利弊，令人信服的证据表明TCZ的安全性和有效性，并表明它具有降低短期和全因（28-30天）死亡率的巨大潜力。如果在关键/严重COVID-19肺炎期间在正确的时间过程(在炎症阶段)给药，TCZ显著降低了不良事件。尽管结果矛盾，TCZ的好处似乎很大，特别是与附加疗法相结合，比如皮质类固醇。虽然TCZ的安全性是可以接受的，关于其在怀孕期间的益处，缺乏可靠的数据。关于TCZ联合疗法的数据有限，比如血液灌流,静脉注射免疫球蛋白（IVIG），简单的O2治疗，血管加压药支持,恢复期血浆疗法，甚至在接种疫苗和COVID-19再感染的患者中，尤其是老年人。此外,TCZ治疗对长期COVID-19的影响尚不清楚。
■在临床医生的决策政策中必须考虑基于个体特征和相关临床条件的个性化医疗。最后,为了降低TCZ的风险-收益比，一种治疗算法，根据现有文献和最新的美国国立卫生研究院（NIH）和传染病学会（IDSA）指南，也被提议。
