The following is the summary of “Effect of tocilizumab, sarilumab, and baricitinib on mortality among patients hospitalized for COVID-19 treated with corticosteroids: a systematic review and meta-analysis” published in the January 2023 issue of Clinical microbiology and infections by Albuquerque, et al.
Tocilizumab (Actemra), baricitinib (Olumiant), and sarilumab (Kevzara) were shown to reduce mortality in hospitalized COVID-19 patients in randomized controlled trials (RCTs). However, there is still debate over which medication is most effective for corticosteroid-using patients. The goal of this study is to calculate the likelihood that baricitinib or sarilumab is noninferior to tocilizumab for patients on corticosteroids. Reference materials include the aforementioned databases as well as PubMed Central, EMBASE, the Cochrane Library, and MedRxiv. Tocilizumab, baricitinib, or sarilumab against standard of care or placebo in hospitalized people with COVID-19 treated with corticosteroids; randomized controlled trials (RCTs) considered (control).
Researchers independently extracted data from published sources and evaluated study quality using the Risk of Bias 2 instrument. To the extent possible, unpublished information was requested from the authors of the included research. All-cause mortality at 28 days was the primary endpoint. A total of 27 randomized controlled trials were considered, with a total of 13,549 participants. The potential for error was small overall. When comparing treatments and controls, investigators employed Bayesian pairwise meta-analyses to combine the data. Tocilizumab had an odds ratio of 0.78 (95% credible interval(CrI): 0.65, 0.94), baricitinib, 0.78 (95% CrI: 0.56, 1.03), and sarilumab, 0.91 (95% CrI: 0.60, 1.40) on average. Evidence GRADE was largely inconsistent, falling somewhere in the middle.
Multiple priors were employed in Bayesian meta-regressions to evaluate the likelihood of noninferiority (a margin of 13% larger effect by tocilizumab). Both baricitinib and sarilumab were shown to be noninferior to tocilizumab, with a 94% and 90% chance, respectively. With the exception of 2 research, all of the others relied on inferential or hypothetical comparisons to draw their conclusions. A high probability exists for baricitinib and sarilumab to be associated with similar mortality reductions compared to tocilizumab among hospitalized COVID-19 patients treated with corticosteroids.