ABSTRACT
Background and objectives A flare-up in coronavirus disease 2019 (COVID-19) cases threatens the health of people, and though there is no proven pharmacological treatment, many analytical studies have suggested that interleukin-6 (IL-6) levels are elevated in cases of severe COVID-19 and that the anti-IL-6 biologic agent tocilizumab may be beneficial. This is a critical review of studies aiming to assess the safety and efficacy of tocilizumab as compared to the standard regimen in patients with COVID-19. Materials and methods Online databases (PubMed and Cochrane) were searched until June 29, 2020, for original articles investigating the immunological response in COVID-19 and its treatment with tocilizumab. Data on multiple baseline characteristics and pre-specified endpoints were extracted and pooled using a random effect model. We used Review Manager version 5.3 (The Nordic Cochrane Centre, The Cochrane Collaboration, 2014, Denmark) and Stata 11.0 (Stata Corporation LP, College Station, TX) for all analyses. Risk ratios (RR) and the weighted mean difference (WMD) with the corresponding 95% confidence interval (CI) were calculated. Results From a total of 1,246 identified articles, 13 studies were included after duplicate removal and narrowing based on title and abstract. Of the 13 included studies, seven case-control studies were shortlisted for meta-analysis (quantitative) and six-single arm studies were used in the discussion (qualitative). These studies had 766 patients (351 in the tocilizumab arm and 414 in the control arm). Their pooled analysis demonstrated that mortality was significantly lower in the tocilizumab group (RR=0.56 [0.34, 0.92]; p=0.02; I2=76%), as was the need for artificial invasive ventilation (RR=0.34 [0.12, 0.99]; p=0.05; I2=0%) as compared to the control group. No significant differences were observed between tocilizumab and control group in intensive care unit admissions (RR=0.73 [0.15, 3.59]; p=0.70; I2=60%) and risks of post-drug infection (RR=1.29 [0.41, 4.04]; p=0.66; I2=88%). In terms of efficacy outcome, improved oxygen saturation (RR=1.13 [1.04, 1.65]; p=0.02; I2=0%) was reported to be markedly significant in tocilizumab patients when compared with the standard care group. Conclusions Our results based on pooled studies show tocilizumab to be safe and efficacious in reducing mortality among critically ill COVID-19 patients. However, due to the limited number of observational studies, the positive findings should be viewed cautiously and warrant further investigation.
ABSTRACT
Background Obesity is a major public health concern and is associated with incident cardiovascular diseases. A very few studies around the globe have assessed how type 2 diabetic (T2D) patients comprehend obesity. Our study aims to evaluate the concerns and behaviors of T2D patients regarding obesity in a developing country like Pakistan. Methods A cross-sectional study was conducted in Karachi during the period of December to February 2020 in which T2D patients were assessed for their comprehension of how obesity affects their disease and concerns, as well as their practices such as weight loss activities and dietary habits. Data analysis was performed using Statistical Package for the Social Sciences Version 24 (IBM Corp., Armonk, NY, USA). Results Of 417 T2D patients inducted in our study, 265 (63.5%) knew their ideal body weight, whereas only 221 (52.9%) knew how to measure it. Among those who were willing to lose weight, this was mostly due to a wish to avoid further complications of obesity (N=155 [73.1%]) and also peer/family pressures (N=124 [58.5%]) among other reasons. More obese (N=68 [43.6%]) than non-obese participants (N=87 [33.3%]) were willing to consult a doctor to help them reduce weight. Participants had adopted various strategies to reduce weight, of which increasing exercise (N=242 [85.8%]) and healthy eating (N=162 [57.4%]) were most popular. Conclusions There is a need to address barriers to weight loss among T2D patients in Pakistan and to provide patients with pragmatic guidelines on how to make sustainable lifestyle changes to help reduce and maintain their body weight.
ABSTRACT
PURPOSE: To conduct a meta-analysis to evaluate the effect of ertugliflozin on long-term hemoglobin A1c (HbA1c), body weight and blood pressure (BP). METHODS: Online databases available were searched from their inception to February 2020. Randomized controlled trials (RCTs) comparing ertugliflozin to either placebo or an active control drug were included. Data on four efficacy outcomes were extracted, namely: HbA1c, systolic blood pressure (SBP), diastolic blood pressure (DBP) and body weight. Continuous outcomes were pooled using a random-effects model and presented as weighted mean differences (WMDs) and corresponding 95% CIs. Additionally, a subgroup analysis was done to compare two doses of ertugliflozin (5 mg and 15 mg). A sensitivity analysis was also performed by eliminating studies using active drugs as controls. RESULTS: From a total of 123 search results, eight studies were included. Compared to the control group, ertugliflozin was associated with a significant decrease in SBP (WMD: -3.64 mmHg, 95% CI [-4.39,-2.90]; p < 0.001; I2 = 0%) and DBP (WMD: -1.13 mmHg, 95% CI [-1.67,-0.60], p < 0.001; I2 = 0%). Similarly, significant reductions in body weight (WMD: -2.35 kg, 95% CI [-2.94,-1.77]; p < 0.001; I2 = 0%) as well as HbA1c (WMD: -0.41%, 95% CI [-0.62,-0.20]; p < 0.001; I2 = 0%) were seen with ertugliflozin. Subgroup analysis demonstrated no significant difference in efficacy between the two doses in any of the four outcomes. CONCLUSION: Ertugliflozin results in significant reductions in HbA1c, body weight, SBP and DBP, when compared to control. Subgroup analyses suggest that these effects are not dose-dependent.
