scholarly journals Risk of fractures with inhaled corticosteroids in COPD: systematic review and meta-analysis of randomised controlled trials and observational studies

Thorax ◽  
2011 ◽  
Vol 66 (8) ◽  
pp. 699-708 ◽  
Author(s):  
Y. K. Loke ◽  
R. Cavallazzi ◽  
S. Singh
Keyword(s):  
Systematic Review ◽  
Observational Studies ◽  
Randomised Controlled Trials ◽  
Inhaled Corticosteroids ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomised Controlled

scholarly journals Tocilizumab and mortality in hospitalised patients with covid-19. A systematic review comparing randomised trials with observational studies

2021 ◽  
Author(s):  
Bélène Podmore ◽  
Nawab Qizilbash ◽  
Alessandra Lacetera ◽  
Itziar Ubillos ◽  
Kirsty Andresen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Hospital Mortality ◽  
Observational Studies ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Significant Heterogeneity ◽  
Moderate Risk ◽  
Randomised Controlled

Objective: To summarise and compare evidence from randomised controlled trials and observational studies of the effect of tocilizumab on in-hospital mortality in patients with covid-19. Design: Systematic review and meta-analysis. Data sources: Searches conducted in Embase and PubMed from July 2020 until 1 March 2021. Study Selection: Observational studies and randomised controlled trials (RCTs) assessing in-hospital mortality in patients receiving tocilizumab compared with standard care or placebo. Data extraction: The primary outcome was in-hospital mortality at 30 days. The risk of bias in observational studies was assessed using the ROBINS-I tool. A fixed effect meta-analysis was used to combine relative risks, with random effects and risk of bias as a sensitivity analysis. Results: Of 5,792 publications screened for inclusion, eight RCTs and 35 observational studies were identified. The RCTs showed an overall relative risk reduction in in-hospital mortality at 30 days of 0.86 (95% CI 0.78 to 0.96) with no statistically significant heterogeneity. 23 of the observational studies had a severe risk of bias, 10 of which did not adjust for potential confounders. The 10 observational studies with moderate risk of bias reported a larger reduction in mortality at 30-days (relative risk 0.72, 95% CI 0.64 to 0.81) but with significant heterogeneity (P<0.01). Conclusion: This meta-analysis provides strong evidence from RCTs that tocilizumab reduces the risk of mortality in hospitalised covid-19 patients. Observational studies with moderate risk of bias exaggerated the benefits on mortality two-fold and showed heterogeneity. Collectively observational studies provide a less reliable evidence base for evaluating treatments for covid-19.

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