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Can medicines that block interleukin-6 (a protein involved in immune responses) treat COVID-19?

čet, 03/18/2021 - 09:52

This recently published Cochrane review examines the effects of a class of treatments on people with COVID-19. 

Treating COVID-19 with tocilizumab (a medicine that blocks interleukin-6) reduces the numbers of people who die within 28 days of treatment, and probably results in fewer serious unwanted effects than placebo treatment.

Studies of other medicines that block interleukin-6 to treat COVID-19 are under way. The authors of this review will update this review when results from them become available.

COVID-19

COVID-19 is an infectious respiratory disease caused by a type of virus called a coronavirus. If the infection becomes severe, people may need intensive care and support in hospital, including machines to help them breathe (mechanical ventilation). Medicines that are currently used to treat other diseases are being tested in the search to find effective treatments for COVID-19.

Blocking interleukin 6

An immune response is how the body recognises and defends itself against harmful substances, such as viruses. COVID-19 can disrupt the immune system, causing it to over-react and produce dangerously high levels of inflammation. Interleukin-6 (IL-6) is a protein involved in triggering inflammation. Blocking the production of interleukin-6 could reduce inflammation and help the immune system to fight COVID-19.

Why did the authors do this Cochrane Review?

Tocilizumab and sarilumab are two medicines that block interleukin-6. They are used to treat other conditions that involve an "over-reactive" immune system, such as rheumatoid arthritis. We wanted to find out if medicines that block interleukin-6 can be used to treat COVID-19, and whether they might cause any unwanted effects.

What did the authors do?

They searched for studies that tested if medicines that block interleukin-6 could treat COVID-19.

They looked for randomised controlled studies, in which the treatments people received were decided by chance. This type of study usually gives the most reliable evidence about the effects of a treatment.

Search date: The authors searched for trials up to 26 February 2021.

What they found

The author team found 10 studies in 6896 people with COVID-19. The average age of people in the studies was 56 to 65 years, and 66% of the people enrolled were men. The studies took place in Brazil, China, France, Italy, the UK and the USA; four studies took place in more than one country. Three studies were funded by pharmaceutical companies.

The medicines tested were tocilizumab and sarilumab. Both medicines were compared against a placebo (a dummy treatment that appears identical to the medicine being tested but without any active medicine) or standard care. The results were measured 28 days after treatment and after 60 days or more.

The authors also found 41 more studies of medicines blocking interleukin-6 to treat COVID-19 that had not yet published any results. These included 20 studies of tocilizumab, 11 studies of sarilumab and 10 studies of other medicines. Some of those studies are still ongoing and we will update this review to include their results when published.

What are the main results of this review?

Compared with placebo treatment or standard treatment, treatment with tocilizumab:

  • reduces the number of people who died, of any cause, after 28 days (evidence from 6363 people in 8 studies); on average, 32 fewer people per 1000 died when treated with tocilizumab plus standard care, compared with standard care alone or placebo;
  • probably makes little or no difference to clinical improvement (which is leaving hospital or improvement in COVID-19 symptoms) at 28 days (evidence from 5585 people in 7 studies); and
  • probably reduces slightly the number of serious unwanted effects, such as life-threatening conditions or death (evidence from 2312 people in 8 studies).

The authors are uncertain about the effects of tocilizumab treatment on:

  • severity of COVID-19; that is, how many patients died of COVID-19 or needed a ventilator or additional organ support at 28 days (evidence from 712 people in 3 studies); or 
  • how many patients died, of any cause, after 60 days or more (evidence from 519 people in 2 studies).

No results were reported for tocilizumab after 60 days or more for improvement, or severity at 28 days of COVID-19.

The author team are uncertain about how sarilumab treatment affected the: 

  • numbers of people who died (of any cause) at 28 days (evidence from 880 people in 2 studies) and after 60 days (evidence from 420 people in 1 study); or
  • the numbers of serious unwanted effects, such as life-threatening conditions or death (evidence from 880 people in 2 studies). 
  • Sarilumab probably does not cause more unwanted effects (of any type) than placebo treatment (evidence from 420 people in 1 study). No other results for sarilumab treatment were reported.

The authors were not able to explore which COVID-19 patients are more likely to benefit from this treatment.

Confidence in the results

The authors are confident that tocilizumab reduced the number of deaths (from any cause) at 28 days. Their confidence in the other results for tocilizumab is moderate to low; further evidence may change these results. Their confidence in the results for sarilumab is low; further evidence is likely to change these results. The authors' confidence was lowered because some of the studies did not report all their results.

Lead author Professor Isabelle Boutron explains, “In the rush to find effective treatments, good quality evidence is critical for health workers treating COVID-19 patients. We looked at this treatment because immunosuppressive effect of Interleukin 6 blocking agents might be valuable in patients with COVID-19 and found that it is a fast moving field. Some treatments, such as tocilizumab, seem beneficial on mortality at day 28 although more data are needed to identify which patients are more likely to benefit from the treatment. New data are available regularly  therefore we plan to update this review when results become available."

Thursday, March 18, 2021

Cochrane signs WHO’s Vaccine Equity Declaration

sri, 03/17/2021 - 15:25

Cochrane has signed a World Health Organization (WHO) Declaration that calls for a more equitable rollout of COVID-19 vaccines.

While several countries currently have vaccination programmes up and running, the global distribution of vaccines has so far been unequal. Many low- and middle-income countries are yet to receive any doses and face uncertainties about access.

The WHO Declaration highlights that quick and equitable rollout of vaccines will be key to avoiding future variants, saving lives, and ultimately ending the pandemic. It therefore calls on global, national and local leaders to reject vaccine nationalism and to prioritise the equitable distribution of vaccines in every country – focusing first on health workers and those at highest risk.



Cochrane firmly believes in the principle of equity and is proud to support this global initiative.

Read the full declaration here

Wednesday, March 17, 2021

Cochrane seeks Statistical Editor

sri, 03/17/2021 - 11:39

Specifications: Part time 22.5 hours (Fixed term/Secondment/Consultancy role)
Salary: between £35,000 to £40,000 per annum full time equivalent
Location: Flexible
Application Closing Date:  5 April 2021

The Cochrane Methods Support Unit was created in 2019 to support the eight Cochrane Review Group (CRG) Networks in the efficient and timely production of high quality, high priority Cochrane systematic reviews. The MSU provides hands on statistical and methods support to Cochrane systematic reviews methods input on request by CRG Network editorial teams. The unit comprises two part-time Statistical Editors and one full time Systematic Review Methodology Editor.  

As Statistical Editor, you will provide advanced research methods support and advice as requested by Network Editorial Teams (Network Senior Editor, Associate Editor or Network Support Fellow) or field queries from the Community Support Team as needed. The post holder will also provide independent methods review of high-profile reviews, including those intended for press release.  In addition to this he or she will support the implementation of established and more complex methods in Cochrane reviews and work on monitoring the quality of statistical methods and analysis in Cochrane reviews to inform priorities for training and guidance. The role will require a formal qualification in epidemiology or biomedical statistics, and a good understanding of methods used in meta-analysis.

Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information. An understanding of Cochrane’s work and health research more generally is an advantage, but not essential.

The majority of Cochrane Central Executive staff are located in London, UK, however flexible location or a part-time appointment are possible for the right candidate.

How to apply

  • For further information on the role and how to apply, please click here
  • The deadline to receive your application is by 5 April 2021.
  • The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples. Note that we will assess applications as they are received, and therefore may fill the post before the deadline.
  • Interviews to be held on: w/c 26 April 2021

Wednesday, March 17, 2021 Category: Jobs

Featured Review: Does cleaning venous leg ulcers help them to heal?

pon, 03/15/2021 - 14:12
Monday, March 15, 2021

Special Collection: Brain tumour diagnosis and management

pet, 03/12/2021 - 20:17

Cochrane Library Special Collections provide a round-up of up-to-date Cochrane evidence on a specific topic. This Special Collection provides evidence in several key clinical priority areas for brain tumour research. The reviews in this Collection provide evidence towards clinical priority areas for research, and their funding, and therefore, are important for consumers, clinicians, healthcare providers and funders.

Topic include:

  • Diagnosing brain tumours quickly, safely, and accurately
  • Risk-sharing in decision making for brain tumours
  • Best treatment when decisions are difficult

 When asked about the new Special Collection, Helen Bulbeck, Director of policy and services at brainstrust said, "We’re excited by the launch of this neuro-oncology collection. It reflects true collaboration between the Cochrane Organisation, the James Lind Alliance, the National Institute of Health Research, the National Cancer Research Institute and, most importantly, people who are living with brain cancer. This is transforming the neuro-oncology clinical research landscape."

A patient with glioblastoma at recurrence commented, "When you’re living with a brain tumour, there’s never a right and wrong decision. So these reviews are vital for people living with a brain tumour. I know, on my own brain tumour pathway, that there have been times when I have been so conflicted about which decision to make. I feel well; should I or shouldn’t I have a scan? Should I delay or start treatment? Should I just get on with living my life? So evidence around risk taking that helps you make the choice that is right for you, which you can share with your clinical team, is a gift. I wish more people knew about these reviews. I will talk about them with my doctors."

A caregiver of an elderly parent with a glioblastoma noted, "I think using patient advocacy resources has become more important since lockdown because MDTs and other cancer centre resources are so stretched. Sometimes you need to get all you can without the help of the medical community who are dealing as best they can with more urgent cases and themselves often in the front line of coronavirus! Finding these brain tumour Cochrane evidence reviews has helped my family and plugged a gap."

Wednesday, March 17, 2021

Jimmy Volmink recognized for his “exceptional lifelong contribution to medical research and public health"

pet, 03/12/2021 - 20:08

Professor James "Jimmy" Volmink, the founding Director of the South African Cochrane Centre, was recognized for his exceptional lifelong contributions to medical research and public health with the Presidential Award from The South African Medical Research Council (SAMRC).

SAMRCed host its 7th SAMRC Scientific Merit Awards with a ceremony of a small outdoor gathering of attendees following COVID-19 protocols at the organisation’s Head Office in Cape Town and an online audience. You can watch the awards ceremony and Jimmy's acceptance speech in this video:

Jimmy reflects on reflects his personal and professional journey in this 'Recommended Dose' podcast. His current role at Stellenbosch - one of South Africa’s most pre-eminent universities - is itself a striking testament to the kind of change he has witnessed, worked towards and continues to advocate for. When he applied to study at Stellenbosch back in the 1980s, Jimmy was turned down because he was black. Almost four decades later, he holds the prestigious position of Dean of Medicine and Health Sciences at that very same university. Here, Jimmy shares with Ray how this and many other formative experiences have led to his lifelong, unwavering commitment to support and mentor new generations of students in South Africa and to keep on 'banging the drum about inequality' to affect real change.

Please join us in offering Professor Volmink congratulations on this honour and best wishes for the future.

Friday, March 12, 2021

Cochrane seeks Managing Editor

čet, 03/11/2021 - 11:28

Specifications: Full Time (Fixed Term/Consultancy role)
Salary: circa £40,000 per annum
Location: Flexible
Application Closing Date:  24 March 2021


Cochrane has established a centrally-resourced Editorial Service to support the efficient and timely publication of high-quality systematic reviews in the Cochrane Library. The reviews that are published through the Central Editorial Service address some of the research questions considered to be the most important to decision makers.

The Central Editorial Service will also be instrumental in running a pilot of approaches to increase editorial efficiency and integrity within Cochrane. The Managing Editor role will play a key role in operationalising this pilot.

Reporting to the Executive Editor of the Central Editorial Service, the Managing Editor will manage the editorial process of protocols and reviews submitted to the Central Editorial Service. The role-holder should be alert to the demands of delivering high-quality review content for publication in a timely fashion, and work to ensure that deadlines can be met.   

Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information. An understanding of Cochrane’s work and health research more generally is an advantage, but not essential.

The majority of Cochrane Central Executive staff are located in London, UK, however flexible location or a part-time appointment are possible for the right candidate.

How to apply

  • For further information on the role and how to apply, please click here
  • The deadline to receive your application is by 24 March 2021
  • The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples. Note that we will assess applications as they are received, and therefore may fill the post before the deadline
  • Interviews to be held on: 8 and 9 April 2021
Thursday, March 11, 2021 Category: Jobs

Visual Abstract: Ivabradine as adjuvant treatment for chronic heart failure

čet, 03/11/2021 - 10:27
Thursday, March 11, 2021

Cochrane in 2021: an opportunity to reunite with colleagues

uto, 03/09/2021 - 20:21

​It is with pleasure that we invite our global community of staff, members and supporters to join us for a virtual meeting on Monday 22 March 2021. Register for this event

This is a free online event open to everyone in Cochrane that will give our members the opportunity to hear updates and about key organizational priorities for 2021 and beyond.

 The session will be presented live twice 09:00-11:00 (check in your local time) and 17:00-19:00 GMT (check your local time) via Cochrane’s virtual events online platform, Hopin. Short presentations from Cochrane’s leadership will be pre-recorded and made available via email and our Community website during the week commencing 15th March. Alongside the pre-recorded material, you will be given the opportunity to submit any questions that you have in advance so that they can be addressed on the day.

A virtual meeting of the Governing Board and Senior Management Team. We look forward to meeting with you March 22!

The two-hour format will include a live question and answer session with the majority of time dedicated to smaller, interactive groups allowing our Cochrane colleagues and friends to connect and reunite, and share their work and experiences from the last 12 months. There will be no formal live presentations. 

Free registration is now open via Hopin – register today! Please note that you will need to sign up to Hopin before you can register for the event. In the meantime, should you have any questions, please contact support@cochrane.org

This special event will not replace Cochrane’s virtual Governance meetings; we now plan to hold these online on Monday 17th - Wednesday 19th May 2021, inclusive.

We know that COVID-19 continues to have a significant impact on all of us in 2021 with so many disruptions to our home and work lives. We hope you, your families and colleagues are well and safe and we look forward to seeing many of you again, albeit virtually, on March 22. 

With our best wishes, 

Catherine Marshall and Tracey Howe
Co-chairs of the Governing Board                   

Mark Wilson
Chief Executive Officer                          

Karla Soares-Weiser
Editor-in-Chief

Tuesday, March 9, 2021

Cochrane Library Editorial - Contested effects and chaotic policies: the 2020 story of (hydroxy) chloroquine for treating COVID-19

uto, 03/09/2021 - 19:48

During the past 12 months chloroquine and hydroxychloroquine have been touted as cures for COVID-19 and introduced into Covid-19 treatment protocols. This has led to increases in demand, leaving some rheumatoid arthritis and lupus patients deprived of effective treatments.

A newly published Cochrane Library Editorial explores the story of the assessment of chloroquine and hydroxychloroquine efficacy and the lessons learnt. 

This Editorial publishes alongside the recently published review published in the Cochrane Library  that concludes that hydroxychloroquine  has no clinical benefit in treating COVID-19 in hospitalised patients.

View larger sized visual abstract

Thursday, March 25, 2021

Special Collection - Best of the Cochrane Library: 2020 in review

uto, 03/09/2021 - 15:41

The annual 'Best of the Cochrane Library' Special Collection showcases Cochrane content published in various formats.

What were the most accessed Cochrane Reviews of 2020? The most accessed Cochrane Editorials or Podcasts?  Find out in a Special Collection, now available on the Cochrane Library website.

 

Wednesday, March 10, 2021

Featured Review: Stopping smoking is linked to improved mental health

uto, 03/09/2021 - 09:08

Evidence published in the Cochrane Library today will reassure people who want to stop smoking that quitting for at least 6 weeks may improve their mental wellbeing, by reducing anxiety, depression, and stress. People’s social relationships are unlikely to suffer if they stop smoking. 

Smoking is the world's leading cause of preventable illness and death. One in every two people who smoke will die of a smoking-related disease unless they quit. Some people believe that smoking helps reduce stress and other mental health symptoms, and that quitting smoking might make their mental health problems worse. People who smoke may also worry that stopping smoking will have a negative impact on their social lives and friendships.

The review found that people who stopped smoking for at least 6 weeks experienced less depression, anxiety, and stress than people who continued to smoke. People who quit also experienced more positive feelings and better psychological wellbeing.  Giving up smoking did not have an impact on the quality of people’s social relationships and it is possible that stopping smoking may be associated with a small improvement in social wellbeing.

The review summarises evidence from 102 observational studies involving over 169,500 people. The review authors combined the results from 63 of these studies that measured changes in mental health symptoms in people who stopped smoking with changes occurring in people who continued to smoke. They also combined results from 10 studies that measured how many people developed a mental health disorder during the study. The studies involved a wide range of people, including people with mental health conditions and people with long-term physical illnesses. The length of time the studies followed people varied, with the shortest being 6 weeks, but some studies followed people for up to 6 years. The certainty of the evidence ranged from very low to moderate.

The lead author of this Cochrane Review, Dr Gemma Taylor from the Addiction & Mental Health Group at the University of Bath, said, “We found stopping smoking was associated with small to moderate improvements in mood. The benefits of smoking cessation on mood seem to be similar in a range of people, and most crucially, there is no reason to fear that people with mental health conditions will experience a worsening of their health if they stop smoking. Our confidence in the precise size of the benefit is limited due to the way the studies were designed and future studies that can overcome those challenges will greatly strengthen the evidence about the impacts of smoking cessation on mental health.”

Dr Gemma Taylor continued, “Many people who smoke are concerned that quitting could disrupt their social networks, and lead to feelings of loneliness. People can be reassured that stopping smoking does not seem to have a negative impact on social quality of life. People may also be concerned that quitting is stressful. The evidence shows that stress is reduced in people who stop smoking and that there are likely longer-term benefits for peoples’ mental health.”

A team of researchers from the Universities of Bath, Birmingham, Oxford, and New York University  worked together to produce this review.

Tuesday, March 9, 2021

Cochrane seeks Contracts Officer (maternity cover)

čet, 03/04/2021 - 15:54

Specifications: Full Time fixed term contract
Salary: up to £35,000
Location: London with flexibility to work from home up to 3 days a week
Application Closing Date: 15 March 2021

We are looking for a self-motivated and highly organised individual who is able to work effectively and collaboratively with a diverse range of contacts across the world.  This role is an exciting opportunity to use your experience as a legal administrator to make a difference in the field of health care research.  

The successful candidate will support the Senior Contracts Specialist in delivering an effective contracts management service to the Central Executive Team, by:

  • Managing and maintaining a contracts database
  • Proof-reading final drafts of agreements
  • Executing contracts
  • Populating templates
  • Drafting (with support).
  • Legal research.

The successful candidate will have:

Essential

  • Degree in law or significant experience in contracts management
  • Previous experience of providing administrative support to a solicitor/contracts team
  • Excellent written and verbal communication skills
  • Experience of, or an interest in, learning about contracts drafting and negotiation in the research/healthcare sector
  • Experience of skim-reading contracts/reports
  • Previous demonstrable experience of database management
  • Ability to work methodically and accurately
  • Ability to work independently and use initiative/self-starter
  • A pro-active approach to problem-solving
  • Awareness of handling confidential and sensitive information
  • Intermediate level IT skills, including Word, Excel and PowerPoint. Be confident in assimilating new computer programmes and systems.
  • Strong organization and prioritization skills - a flexible approach with the ability to respond quickly to issues as they arise
  • Excellent interpersonal skills and ability to maintain a diplomatic, measured approach at all times.

Cochrane is a global, independent network of health practitioners, researchers, patient advocates and others, responding to the challenge of making vast amounts of research evidence useful for informing decisions about health. We do this by synthesizing research findings to produce the best available evidence on what can work, what might harm and where more research is needed. Our work is recognised as the international gold standard for high quality, trusted information.

How to apply
For further information on the role and how to apply, please click here.  The deadline to receive your application is by 15 March 2021.  The supporting statement should indicate why you are applying for the post, and how far you meet the requirements, using specific examples. Note that we will assess applications as they are received, and therefore may fill the post before the deadline.

  • Deadline for applications: 15 March 2021 (12 midnight GMT)
  • Interviews to be held on: w/c 22 March 2021 (TBC)
Thursday, March 4, 2021 Category: Jobs

Cochrane International Mobility - Carolina Severiche Mena

sri, 03/03/2021 - 12:22

Cochrane is made up of 11,000 members and over 67,000 supporters come from more than 130 countries, worldwide. Our volunteers and contributors are researchers, health professionals, patients, carers, people passionate about improving health outcomes for everyone, everywhere.

Getting involved in Cochrane’s work means becoming part of a global community. The Cochrane International Mobility programme connects successful applicants with a placement in a host Cochrane Group, learning more about the production, use, and knowledge translation of Cochrane reviews. The prgramme offers opportunities for learning and training not only for participants but also for host staff.

In this series, we profile those that have participated in the Cochrane International Mobility Program and learn more about their experiences.

Name: Carolina Severiche Mena
Location:
USA/Colombia
Cochrane
International Mobility location: Cochrane Croatia

How did you first learn about Cochrane?
I have been a Cochrane member since 2019. I became interested in Cochrane because I was impressed by its commitment to making high-quality medical information accessible to people worldwide. That motivated me to volunteer my time and support its mission.

What was your experience with Cochrane International Mobility?
Participating in CIM has been very rewarding. It has helped me develop professional skills and increase my knowledge of research methodologies. I also had the opportunity to complete Cochrane Interactive Training. All these tasks have been carried out remotely, given COVID-19.

What are you doing now in relation to your Cochrane International Mobility experience?
Currently, I am preparing my first systemic review about peripheral artery disease and patient-centered outcomes. In the future, I plan to continue collaborating with Cochrane on cardiovascular disease and patient-centered care initiatives. Meanwhile, I am attending online webinars hosted by Cochrane to refine my technical knowledge.

Do you have any words of advice to anyone conserving a Cochrane International Mobility experience?
I highly recommend this experience to medical professionals or students who want to increase their research methodology skills and systematic review knowledge.

Wednesday, March 3, 2021

Special Collection - Chronic suppurative otitis media: effectiveness of non-surgical treatments

uto, 03/02/2021 - 20:26

Supported by Cochrane Ear ,Nose and Throat a new Cochrane Library Special Collection curates the latest Cochrane evidence on non-surgical treatments for chronic suppurative otitis media (CSOM). 

CSOM is estimated to have a global incidence of 31 million episodes per year, disproportionately affecting people at socio-economic disadvantage. Many people who are affected by CSOM do not have good access to modern primary healthcare, let alone specialised ear, nose and throat care. Given this evidence need, Cochrane ENT have prioritized the production of systematic reviews on non-surgical treatments for CSOM. This up-to-date evidence is in this Cochrane Library Special Collection.

 

 

Friday, March 5, 2021

Stranice