背景:迄今为止,只有糖皮质激素和白细胞介素-6(IL-6)抑制剂被证明可以降低COVID-19住院患者的死亡率.在这篇文献综述中,我们的目的是总结IL抑制剂的感染风险,无论是否使用皮质类固醇,用于治疗COVID-19住院患者。
方法:使用以下循证医学综述进行了文献检索:Cochrane中央对照试验注册;Cochrane系统综述数据库;Embase;OvidMedline和EpubAheadofPrint,在过程中,数据审查和其他非索引引文,每日和版本1946年至2021年4月28日。所有相关文章都是使用搜索词COVID-19或SARS-冠状病毒-2,感染,白细胞介素,住院病人,成年人,我相信。
结果:我们确定了36项研究,其中2项是荟萃分析,5个是随机对照试验,9是前瞻性研究,20项为回顾性研究.当阿纳金拉与对照相比时,2项研究报告感染风险增加,3项研究报告了相似或降低的感染发生率。在一项研究中,与安慰剂相比,Canakinumab的相关感染发生率较低。当sarilumab与安慰剂比较时,一项研究报告感染风险增加.九项比较托珠单抗与安慰剂的研究报告了感染风险降低或无差异(研究的比值比[OR]为0.39-1.21)。14项比较托珠单抗与安慰剂的研究报告了感染风险增加,范围为9.1%至63.0%(研究的OR范围为1.85-5.04)。感染最常表现为菌血症。在比较托珠单抗和皮质类固醇与安慰剂的6项研究中,4报告了与细菌感染相关的皮质类固醇的无显著增加(OR范围为2.76-3.8),2项研究报告未增加感染风险.
结论:我们的文献综述显示,IL-6抑制剂与COVID-19患者感染风险的相关性具有不同意义。
BACKGROUND: To date, only corticosteroids and interleukin-6 (IL-6) inhibitors have been shown to reduce mortality of hospitalized patients with COVID-19. In this literature review, we aimed to summarize infection risk of IL inhibitors, with or without the use of corticosteroids, used to treat hospitalized patients with COVID-19.
METHODS: A literature search was conducted using the following evidence-based medicine reviews: Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; Embase; Ovid Medline; and Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations, Daily and Versions 1946 to April 28, 2021. All relevant articles were identified using the search terms COVID-19 or SARS-coronavirus-2, infections, interleukins, inpatients, adults, and i ncidence.
RESULTS: We identified 36 studies of which 2 were meta-analyses, 5 were randomized controlled trials, 9 were prospective studies, and 20 were retrospective studies. When anakinra was compared with control, 2 studies reported an increased risk of infection, and 3 studies reported a similar or decreased incidence of infection. Canakinumab had a lower associated incidence of infection compared with placebo in one study. When sarilumab was compared with placebo, one study reported an increased risk of infection. Nine studies comparing tocilizumab with placebo reported decreased or no difference in infection risk (odds ratio [OR] for the studies ranged from 0.39-1.21). Fourteen studies comparing tocilizumab with placebo reported an increased risk of infection, ranging from 9.1% to 63.0% (OR for the studies ranged from 1.85-5.04). Infection most commonly presented as bacteremia. Of the 6 studies comparing tocilizumab and corticosteroid use with placebo, 4 reported a nonsignificant increase toward corticosteroids being associated with bacterial infections (OR ranged from 2.76-3.8), and 2 studies reported no increased association with a higher infection risk.
CONCLUSIONS: Our literature review showed mixed results with variable significance for the association of IL-6 inhibitors with risk of infections in patients with COVID-19.