تقرير
Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19 – Preliminary report
| العنوان: | Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19 – Preliminary report |
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| المؤلفون: | The REMAP-CAP Investigators, Gordon, A, Mouncey, P, Al-Beidh, F, Rowan, K, Nichol, A, Arabi, Y, Annane, D, Beane, A, Van Bentum-Puijk, W, Berry, L, Bhimani, Z, Bonten, MJM, Bradbury, C, Brunkhorst, F, Buzgau, A, Cheng, A, Detry, M, Duffy, E, Estcourt, L, Fitzgerald, M, Goossens, H, Haniffa, R, Higgins, A, Hills, T, Horvat, C, Lamontagne, F, Lawler, P, Leavis, H, Linstrum, K, Litton, E, Lorenzi, E, Marshall, J, Mayr, F, McAuley, D, McGlothlin, A, McGuinness, S, McVerry, B, Montgomery, S, Morpeth, S, Murthy, S, Orr, K, Parke, R, Parker, J, Patanwala, A, Pettilä, V, Rademaker, E, Santos, M, Saunders, C, Seymour, C, Shankar-Hari, M, Sligl, W, Turgeon, A, Turner, A, Van de Veerdonk, F, Zarychanski, R, Green, C, Lewis, R, Angus, D, McArthur, C, Berry, S, Webb, S, Derde, LPG |
| بيانات النشر: | Cold Spring Harbor Laboratory |
| سنة النشر: | 2021 |
| المجموعة: | Imperial College London: Spiral |
| مصطلحات موضوعية: | The REMAP-CAP Investigators |
| الوصف: | Background The efficacy of interleukin-6 receptor antagonists in critically ill patients with coronavirus disease 2019 (Covid-19) is unclear. Methods We evaluated tocilizumab and sarilumab in an ongoing international, multifactorial, adaptive platform trial. Adult patients with Covid-19, within 24 hours of commencing organ support in an intensive care unit, were randomized to receive either tocilizumab (8mg/kg) or sarilumab (400mg) or standard care (control). The primary outcome was an ordinal scale combining in-hospital mortality (assigned −1) and days free of organ support to day 21. The trial uses a Bayesian statistical model with pre-defined triggers to declare superiority, efficacy, equivalence or futility. Results Tocilizumab and sarilumab both met the pre-defined triggers for efficacy. At the time of full analysis 353 patients had been assigned to tocilizumab, 48 to sarilumab and 402 to control. Median organ support-free days were 10 (interquartile range [IQR] −1, 16), 11 (IQR 0, 16) and 0 (IQR −1, 15) for tocilizumab, sarilumab and control, respectively. Relative to control, median adjusted odds ratios were 1.64 (95% credible intervals [CrI] 1.25, 2.14) for tocilizumab and 1.76 (95%CrI 1.17, 2.91) for sarilumab, yielding >99.9% and 99.5% posterior probabilities of superiority compared with control. Hospital mortality was 28.0% (98/350) for tocilizumab, 22.2% (10/45) for sarilumab and 35.8% (142/397) for control. All secondary outcomes and analyses supported efficacy of these IL-6 receptor antagonists. Conclusions In critically ill patients with Covid-19 receiving organ support in intensive care, treatment with the IL-6 receptor antagonists, tocilizumab and sarilumab, improved outcome, including survival. (ClinicalTrials.gov number: NCT02735707) Competing Interest Statement Dr. Gordon reports grants from NIHR, grants from NIHR Research Professorship (RP-2015-06-18), non-financial support from NIHR Clinical Research Network, non-financial support from Roche Products Ltd, non-financial support from ... |
| نوع الوثيقة: | report |
| اللغة: | unknown |
| العلاقة: | http://hdl.handle.net/10044/1/90567Test |
| DOI: | 10.1101/2021.01.07.21249390 |
| الإتاحة: | https://doi.org/10.1101/2021.01.07.21249390Test http://hdl.handle.net/10044/1/90567Test |
| حقوق: | © 2021 The Author(s). It is made available under a CC-BY-NC-ND 4.0 International license . ; http://creativecommons.org/licenses/by-nc-nd/4.0Test/ |
| رقم الانضمام: | edsbas.DA75D4C9 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1101/2021.01.07.21249390 |
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