Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19

Autor: Gordon, A.C., Mouncey, P.R., Al-Beidh, F., Rowan, K.M., Nichol, A.D., Arabi, Y.M., Annane, D., Beane, A., Bentum-Puijk, W. van, Berry, L.R., Bhimani, Z., Bonten, M.J.M., Bradbury, C.A., Brunkhorst, F.M., Buzgau, A., Cheng, A.C., Detry, M.A., Duffy, E.J., Estcourt, L.J., Fitzgerald, M., Goossens, H., Haniffa, R., Higgins, A.M., Hills, T.E., Horvat, C.M., Lamontagne, F., Lawler, P.R., Leavis, H.L., Linstrum, K.M., Litton, E., Lorenzi, E., Marshall, J.C., Mayr, F.B., McAuley, D.F., McGlothlin, A., McGuinness, S.P., McVerry, B.J., Montgomery, S.K., Morpeth, S.C., Murthy, S., Orr, K., Parke, R.L., Parker, J.C., Patanwala, A.E., Pettilä, V., Rademaker, E., Santos, M.S., Saunders, C.T., Seymour, C.W., Shankar-Hari, M., Sligl, W.I., Turgeon, A.F., Turner, A.M., Veerdonk, F.L. van de, Zarychanski, R., Green, C., Lewis, R.J., Angus, D.C., McArthur, C.J., Berry, S., Schouten, J.A., Pickkers, P., Webb, S.A., Derde, L.P.G.
Přispěvatelé: Université de Versailles Saint-Quentin-en-Yvelines - UFR Sciences de la santé Simone Veil (UVSQ Santé), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), REMAP-CAP Investigators, Pour la France: Bruno Megarbane, Inserm U1144, European Project: 602386,EC:FP7:HEALTH,FP7-HEALTH-2013-INNOVATION-1,CREDITS4HEALTH(2013), European Project: 602525,EC:FP7:HEALTH,FP7-HEALTH-2013-INNOVATION-1,PREPARE(2014), NIHR, National Institute for Health Research, Gordon, Anthony C [0000-0002-0419-547X], Mouncey, Paul R [0000-0002-8510-8517], Beane, Abi [0000-0001-7046-1580], Bradbury, Charlotte A [0000-0001-5248-8165], Detry, Michelle A [0000-0002-2794-1439], Duffy, Eamon J [0000-0002-4515-5116], Estcourt, Lise J [0000-0003-4309-9162], Haniffa, Rashan [0000-0002-8288-449X], Higgins, Alisa M [0000-0001-8295-7559], Hills, Thomas E [0000-0003-0322-5822], Horvat, Christopher M [0000-0002-1593-2252], Lawler, Patrick R [0000-0001-5155-5071], Litton, Edward [0000-0002-5125-6829], Mayr, Florian B [0000-0002-2298-9011], McVerry, Bryan J [0000-0002-1175-4874], Patanwala, Asad E [0000-0003-3999-4703], Saunders, Christina T [0000-0003-4325-9568], Shankar-Hari, Manu [0000-0002-5338-2538], Angus, Derek C [0000-0002-7026-5181], Derde, Lennie PG [0000-0002-3577-5629], Apollo - University of Cambridge Repository, Investigators, REMAP-CAP, HAL UVSQ, Équipe, Credits-based, people-centric approach for the adoption of healthy life-styles and balanced Mediterranean diet in the frame of social participation and innovation for health promotion. - CREDITS4HEALTH - - EC:FP7:HEALTH2013-09-01 - 2016-08-31 - 602386 - VALID, Platform foR European Preparedness Against (Re-)emerging Epidemics - PREPARE - - EC:FP7:HEALTH2014-02-01 - 2019-01-31 - 602525 - VALID
Rok vydání: 2021
Předmět:
Male
[SDV]Life Sciences [q-bio]
lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4]
030204 cardiovascular system & hematology
law.invention
chemistry.chemical_compound
0302 clinical medicine
Randomized controlled trial
law
Interquartile range
middle aged
Credible interval
Odds Ratio
odds ratio
030212 general & internal medicine
Hospital Mortality
humans
11 Medical and Health Sciences
adult
Hazard ratio
Covid19
General Medicine
Middle Aged
Intensive care unit
3. Good health
[SDV] Life Sciences [q-bio]
aged
Intensive Care Units
Antibodies
Monoclonal
Humanized/adverse effects
COVID-19/complications
Original Article
Female
Adult
medicine.medical_specialty
Critical Care
Critical Illness
Antibodies
Monoclonal
Humanized
03 medical and health sciences
Tocilizumab
male
Internal medicine
General & Internal Medicine
medicine
Humans
Aged
hospital mortality
business.industry
SARS-CoV-2
COVID-19
Odds ratio
Receptors
Interleukin-6
Respiration
Artificial
COVID-19 Drug Treatment
Coronavirus
Sarilumab
lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4]
chemistry
Receptors
Interleukin-6/antagonists & inhibitors
REMAP-CAP Investigators
interleukin-6 receptor antagonists
coronavirus disease
business
Zdroj: New England Journal of Medicine
New England Journal of Medicine, Massachusetts Medical Society, 2021, 384 (16), pp.1491-1502. ⟨10.1056/NEJMoa2100433⟩
McAuley, D & Writing Committee, REMAP-CAP 2021, ' Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19 ', New England Journal of Medicine . https://doi.org/10.1056/NEJMoa2100433
2021, ' Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19 ', New England Journal of Medicine, vol. 384, no. 16, pp. 1491-1502 . https://doi.org/10.1056/NEJMoa2100433
The New England Journal of Medicine, 384, 16, pp. 1491-1502
The New England Journal of Medicine, 384, 1491-1502
NEW ENGLAND JOURNAL OF MEDICINE
REMAP-CAP Investigators, Felton, T & Dark, P 2021, ' Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19 ', The New England Journal of Medicine, vol. 384, no. 16, pp. 1491-1502 . https://doi.org/10.1056/NEJMoa2100433
The New England Journal of Medicine
ISSN: 1533-4406
0028-4793
DOI: 10.1056/NEJMoa2100433⟩
Popis: BACKGROUNDThe efficacy of interleukin-6 receptor antagonists in critically ill patients with coronavirus disease 2019 (Covid-19) is unclear.METHODSWe evaluated tocilizumab and sarilumab in an ongoing international, multifactorial, adaptive platform trial. Adult patients with Covid-19, within 24 hours after starting organ support in the intensive care unit (ICU), were randomly assigned to receive tocilizumab (8 mg per kilogram of body weight), sarilumab (400 mg), or standard care (control). The primary outcome was respiratory and cardiovascular organ support–free days, on an ordinal scale combining in-hospital death (assigned a value of −1) and days free of organ support to day 21. The trial uses a Bayesian statistical model with predefined criteria for superiority, efficacy, equivalence, or futility. An odds ratio greater than 1 represented improved survival, more organ support–free days, or both.RESULTSBoth tocilizumab and sarilumab met the predefined criteria for efficacy. At that time, 353 patients had been assigned to tocilizumab, 48 to sarilumab, and 402 to control. The median number of organ support–free days was 10 (interquartile range, −1 to 16) in the tocilizumab group, 11 (interquartile range, 0 to 16) in the sarilumab group, and 0 (interquartile range, −1 to 15) in the control group. The median adjusted cumulative odds ratios were 1.64 (95% credible interval, 1.25 to 2.14) for tocilizumab and 1.76 (95% credible interval, 1.17 to 2.91) for sarilumab as compared with control, yielding posterior probabilities of superiority to control of more than 99.9% and of 99.5%, respectively. An analysis of 90-day survival showed improved survival in the pooled interleukin-6 receptor antagonist groups, yielding a hazard ratio for the comparison with the control group of 1.61 (95% credible interval, 1.25 to 2.08) and a posterior probability of superiority of more than 99.9%. All secondary analyses supported efficacy of these interleukin-6 receptor antagonists.CONCLUSIONSIn critically ill patients with Covid-19 receiving organ support in ICUs, treatment with the interleukin-6 receptor antagonists tocilizumab and sarilumab improved outcomes, including survival. (REMAP-CAP ClinicalTrials.gov number, NCT02735707. opens in new tab.)
Databáze: OpenAIRE
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