scholarly journals Efficacy and safety of interleukin‐17 inhibitors in the treatment of chronic rheumatic diseases: A combined and updated meta‐analysis

2021 ◽  
Author(s):  
Chongru He ◽  
Chenchen Xue ◽  
Ge Zhu ◽  
Pengde Kang
Keyword(s):  
Rheumatic Diseases ◽  
Meta Analysis ◽  
Interleukin 17 ◽  
Efficacy And Safety ◽  
Chronic Rheumatic Diseases

scholarly journals AB0654 TOCILIZUMAB IS PROTECTIVE AGAINST SARS-COV2 INFECTION OR NOT?

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1359.2-1360
Author(s):  
F. Fayed ◽  
E. Abdelkarim
Keyword(s):  
Health Care Providers ◽  
Rheumatic Diseases ◽  
Clinical Presentation ◽  
Meta Analysis ◽  
Care Providers ◽  
Efficacy And Safety ◽  
Critical Patients ◽  
One Year ◽  
Protection Against Infection ◽  
Group 1

Background:SARS-COV2 (Covid19) pandemic has a scaring burden on hospitals and health care providers all over the world. Unfortunately, after one year of pandemic, millions of persons are infected either mild symptoms or critical ones and unexplained deaths. Till now, No effective treatment or vaccination. Researches showed that Covid 19 associated with elevated interleukin-6. Subsequently, Studies reported that tocilizumab (IL-6 antagonist) may be effective in critical patients even though other were shown that it is not associated with reduction in the mortality.(1,2) Therefore the question is that patients with rheumatic diseases who are already receiving tocilizumab having a primary protection against infection of Covid 19 in comparing to other receiving the other biologicals or conventional Therapy or not.Objectives:Our objective was to determine if tocolizumab had a primary protection against SARS-COV2 in comparing to patients were on other biologics.Methods:A Retrospective study was done among 100 patients with rheumatic diseases (Group 1: 10 on tocilizumab, Group2: 40 (30 on antiTNF and 10 on IL17 antagonist), Group3: on cDMARDs) from March to Dec 2020. Detailed history, clinical presentation, laboratory, computed tomography of chest and PCR for covid 19 if presented among infected patients.Results:Among 100 patients of median age 21, 19 patient (19%) had infected with Covid 19 (2 on tocilizumab, 6 on antiTNF, 1 on IL17 antagonist, 10 on cDMARDs). Symptoms were reported fever (89.4%), Fatigue (78.9%), myalgia (78.9%), Headache (73.7%), Dyspnea (52.6%), Cough (47.3%), chest pain (26.3%) and hypoxia (5%). CT findings were positive in 10 patients (52.63%) while PCR was done and positive in 15 out of 19 (78.94%). Nevertheless, there was no significant statistically difference between groups according to infection with SARS-COV2. (p=0.704)Conclusion:Tocilizumab is not shown to be protective against SARS-COV2 (COVID 19) infection compared to other biological or cDMARDs in patients with rheumatic diseases.References:[1]Tleyjeh IM, Kashour Z, Damlaj M, et al. Efficacy and safety of tocilizumab in COVID-19 patients: A living systematic review and meta-analysis. Clinical Microbiology and Infection. 2020 Nov 5.[2]Tsai, A., Diawara, O., Nahass, R.G. et al. Impact of tocilizumab administration on mortality in severe COVID-19. 2020;Sci Rep10:19131Disclosure of Interests:None declared.

Safety and efficacy of direct acting oral anticoagulants and vitamin K antagonists in nonvalvular atrial fibrillation – a network meta-analysis of real-world data

VASA ◽  
2019 ◽  
Vol 48 (2) ◽  
pp. 134-147 ◽  
Author(s):  
Mirko Hirschl ◽  
Michael Kundi
Keyword(s):  
Real World ◽  
Meta Analysis ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Efficacy And Safety ◽  
Nonvalvular Atrial Fibrillation ◽  
Real World Data ◽  
Hazard Ratios ◽  
Direct Acting ◽  
Event Rates

Abstract. Background: In randomized controlled trials (RCTs) direct acting oral anticoagulants (DOACs) showed a superior risk-benefit profile in comparison to vitamin K antagonists (VKAs) for patients with nonvalvular atrial fibrillation. Patients enrolled in such studies do not necessarily reflect the whole target population treated in real-world practice. Materials and methods: By a systematic literature search, 88 studies including 3,351,628 patients providing over 2.9 million patient-years of follow-up were identified. Hazard ratios and event-rates for the main efficacy and safety outcomes were extracted and the results for DOACs and VKAs combined by network meta-analysis. In addition, meta-regression was performed to identify factors responsible for heterogeneity across studies. Results: For stroke and systemic embolism as well as for major bleeding and intracranial bleeding real-world studies gave virtually the same result as RCTs with higher efficacy and lower major bleeding risk (for dabigatran and apixaban) and lower risk of intracranial bleeding (all DOACs) compared to VKAs. Results for gastrointestinal bleeding were consistently better for DOACs and hazard ratios of myocardial infarction were significantly lower in real-world for dabigatran and apixaban compared to RCTs. By a ranking analysis we found that apixaban is the safest anticoagulant drug, while rivaroxaban closely followed by dabigatran are the most efficacious. Risk of bias and heterogeneity was assessed and had little impact on the overall results. Analysis of effect modification could guide the clinical decision as no single DOAC was superior/inferior to the others under all conditions. Conclusions: DOACs were at least as efficacious as VKAs. In terms of safety endpoints, DOACs performed better under real-world conditions than in RCTs. The current real-world data showed that differences in efficacy and safety, despite generally low event rates, exist between DOACs. Knowledge about these differences in performance can contribute to a more personalized medicine.

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