TY - JOUR
T1 - Immunomodulators for immunocompromised patients hospitalized for COVID-19: a meta-analysis of randomized controlled trials
AU - Siempos, Ilias I.
AU - Kalil, Andre C.
AU - Belhadi, Drifa
AU - Veiga, Viviane Cordeiro
AU - Cavalcanti, Alexandre Biasi
AU - Branch-Elliman, Westyn
AU - Papoutsi, Eleni
AU - Gkirgkiris, Konstantinos
AU - Xixi, Nikoleta A.
AU - Kotanidou, Anastasia
AU - Hermine, Olivier
AU - Porcher, Raphaël
AU - Mariette, Xavier
AU - CORIMUNO-19 Collaborative Group
AU - DisCoVeRy Study Group
AU - ACTT-2 Study Group
AU - ACTT-3 Study Group
A2 - Nielsen, Henrik
N1 - © 2024 The Authors.
PY - 2024/3
Y1 - 2024/3
N2 - BACKGROUND: Although immunomodulators have established benefit against the new coronavirus disease (COVID-19) in general, it is uncertain whether such agents improve outcomes without increasing the risk of secondary infections in the specific subgroup of previously immunocompromised patients. We assessed the effect of immunomodulators on outcomes of immunocompromised patients hospitalized for COVID-19.METHODS: The protocol was prospectively registered with PROSPERO (CRD42022335397). MEDLINE, Cochrane Central Register of Controlled Trials and references of relevant articles were searched up to 01-06-2022. Authors of potentially eligible randomized controlled trials were contacted to provide data on immunocompromised patients randomized to immunomodulators vs control (i.e., placebo or standard-of-care).FINDINGS: Eleven randomized controlled trials involving 397 immunocompromised patients hospitalized for COVID-19 were included. Ten trials had low risk of bias. There was no difference between immunocompromised patients randomized to immunomodulators vs control regarding mortality [30/182 (16.5%) vs 41/215 (19.1%); RR 0.93, 95% CI 0.61-1.41; p = 0.74], secondary infections (RR 1.00, 95% CI 0.64-1.58; p = 0.99) and change in World Health Organization ordinal scale from baseline to day 15 (weighed mean difference 0.27, 95% CI -0.09-0.63; p = 0.15). In subgroup analyses including only patients with hematologic malignancy, only trials with low risk of bias, only trials administering IL-6 inhibitors, or only trials administering immunosuppressants, there was no difference between comparators regarding mortality.INTERPRETATION: Immunomodulators, compared to control, were not associated with harmful or beneficial outcomes, including mortality, secondary infections, and change in ordinal scale, when administered to immunocompromised patients hospitalized for COVID-19.FUNDING: Hellenic Foundation for Research and Innovation.
AB - BACKGROUND: Although immunomodulators have established benefit against the new coronavirus disease (COVID-19) in general, it is uncertain whether such agents improve outcomes without increasing the risk of secondary infections in the specific subgroup of previously immunocompromised patients. We assessed the effect of immunomodulators on outcomes of immunocompromised patients hospitalized for COVID-19.METHODS: The protocol was prospectively registered with PROSPERO (CRD42022335397). MEDLINE, Cochrane Central Register of Controlled Trials and references of relevant articles were searched up to 01-06-2022. Authors of potentially eligible randomized controlled trials were contacted to provide data on immunocompromised patients randomized to immunomodulators vs control (i.e., placebo or standard-of-care).FINDINGS: Eleven randomized controlled trials involving 397 immunocompromised patients hospitalized for COVID-19 were included. Ten trials had low risk of bias. There was no difference between immunocompromised patients randomized to immunomodulators vs control regarding mortality [30/182 (16.5%) vs 41/215 (19.1%); RR 0.93, 95% CI 0.61-1.41; p = 0.74], secondary infections (RR 1.00, 95% CI 0.64-1.58; p = 0.99) and change in World Health Organization ordinal scale from baseline to day 15 (weighed mean difference 0.27, 95% CI -0.09-0.63; p = 0.15). In subgroup analyses including only patients with hematologic malignancy, only trials with low risk of bias, only trials administering IL-6 inhibitors, or only trials administering immunosuppressants, there was no difference between comparators regarding mortality.INTERPRETATION: Immunomodulators, compared to control, were not associated with harmful or beneficial outcomes, including mortality, secondary infections, and change in ordinal scale, when administered to immunocompromised patients hospitalized for COVID-19.FUNDING: Hellenic Foundation for Research and Innovation.
KW - Acute hypoxemic respiratory failure
KW - Acute respiratory distress syndrome
KW - Cancer
KW - Critically ill
KW - Pneumonia
UR - http://www.scopus.com/inward/record.url?scp=85184888058&partnerID=8YFLogxK
U2 - 10.1016/j.eclinm.2024.102472
DO - 10.1016/j.eclinm.2024.102472
M3 - Review article
C2 - 38361992
SN - 2589-5370
VL - 69
JO - EClinicalMedicine
JF - EClinicalMedicine
M1 - 102472
ER -