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Immunomodulators for immunocompromised patients hospitalized for COVID-19: a meta-analysis of randomized controlled trials

Publication ,  Journal Article
Siempos, II; Kalil, AC; Belhadi, D; Veiga, VC; Cavalcanti, AB; Branch-Elliman, W; Papoutsi, E; Gkirgkiris, K; Xixi, NA; Kotanidou, A; Ravaud, P ...
Published in: eClinicalMedicine
March 1, 2024

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.

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Published In

eClinicalMedicine

DOI

EISSN

2589-5370

Publication Date

March 1, 2024

Volume

69

Related Subject Headings

  • 4206 Public health
  • 4203 Health services and systems
  • 3202 Clinical sciences
 

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Siempos, I. I., Kalil, A. C., Belhadi, D., Veiga, V. C., Cavalcanti, A. B., Branch-Elliman, W., … Boudali, Y. (2024). Immunomodulators for immunocompromised patients hospitalized for COVID-19: a meta-analysis of randomized controlled trials. EClinicalMedicine, 69. https://doi.org/10.1016/j.eclinm.2024.102472
Siempos, I. I., A. C. Kalil, D. Belhadi, V. C. Veiga, A. B. Cavalcanti, W. Branch-Elliman, E. Papoutsi, et al. “Immunomodulators for immunocompromised patients hospitalized for COVID-19: a meta-analysis of randomized controlled trials.” EClinicalMedicine 69 (March 1, 2024). https://doi.org/10.1016/j.eclinm.2024.102472.
Siempos II, Kalil AC, Belhadi D, Veiga VC, Cavalcanti AB, Branch-Elliman W, et al. Immunomodulators for immunocompromised patients hospitalized for COVID-19: a meta-analysis of randomized controlled trials. eClinicalMedicine. 2024 Mar 1;69.
Siempos, I. I., et al. “Immunomodulators for immunocompromised patients hospitalized for COVID-19: a meta-analysis of randomized controlled trials.” EClinicalMedicine, vol. 69, Mar. 2024. Scopus, doi:10.1016/j.eclinm.2024.102472.
Siempos II, Kalil AC, Belhadi D, Veiga VC, Cavalcanti AB, Branch-Elliman W, Papoutsi E, Gkirgkiris K, Xixi NA, Kotanidou A, Hermine O, Porcher R, Mariette X, Ravaud P, Bureau S, Dougados M, Resche-Rigon M, Tharaux PL, Tibi A, Azoulay E, Cadranel J, Emmerich J, Fartoukh M, Guidet B, Humbert M, Lacombe K, Mahevas M, Pene F, Pourchet-Martinez V, Schlemmer F, Yazdanpanah Y, Baron G, Perrodeau E, Vanhoye D, Kedzia C, Demerville L, Gysembergh-Houal A, Bourgoin A, Raked N, Mameri L, Montlahuc C, Biard L, Alary SP, Hamiria S, Bariz T, Semri H, Hai DM, Benafla M, Belloul M, Vauboin P, Flamand S, Pacheco C, Walter-Petrich A, Stan E, Benarab S, Nyanou C, Charreteur R, Dupre C, Cardet K, Lehmann B, Baghli K, Madelaine C, D’Ortenzio E, Puéchal O, Semaille C, Savale L, Harrois A, Figueiredo S, Duranteau J, Anguel N, Pavot A, Monnet X, Richard C, Teboul JL, Durand P, Tissieres P, Jevnikar M, Montani D, Pavy S, Nocturne G, Bitoun S, Noel N, Lambotte O, Escaut L, Jauréguiberry S, Baudry E, Verny C, Lefevre E, Zaidan M, Molinari D, Leprun G, Fourreau A, Cylly L, Grimaldi L, Virlouvet M, Meftali R, Fabre S, Licois M, Mamoune A, Boudali Y. Immunomodulators for immunocompromised patients hospitalized for COVID-19: a meta-analysis of randomized controlled trials. eClinicalMedicine. 2024 Mar 1;69.
Journal cover image

Published In

eClinicalMedicine

DOI

EISSN

2589-5370

Publication Date

March 1, 2024

Volume

69

Related Subject Headings

  • 4206 Public health
  • 4203 Health services and systems
  • 3202 Clinical sciences