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http://hdl.handle.net/11054/1837
Title: | Lopinavir-ritonavir and hydroxychloroquine for critically ill patients with COVID-19: REMAP-CAP randomized controlled trial. |
Author: | Arabi, Y. Gordon, A. Derde, L. Nichol, A. Murthy, S. Beidh, F. Annane, D. Swaidan, L. Beane, A. Beasley, R. Berry, L. Bhimani, Z. Bonten, M. Bradbury, C. Brunkhorst, F. Buxton, M. Buzgau, A. Cheng, A. De Jong, M. Detry, M. Duffy, E. Estcourt, L. Fitzgerald, M. Fowler, R. Girard, T. Goligher, E. Goossens, H. Haniffa, R. Higgins, A. Hills, T. Horvat, C. Huang, D. King, A. Lamontagne, F. Lawler, P. Lewis, R. Linstrum, K. Litton, E. Lorenzi, E. Malakouti, S. McAuley, D. McGlothlin, A. Mcguinness, S. McVerry, B. Montgomery, S. Morpeth, S. Mouncy, P. Orr, K. Parke, R. Parker, J. Patanwala, A. Rowan, K. Santos, M. Saunders, C. Seymour, C. Shankar-Hari, M. Tong, S. Turgeon, A. Turner, A. Van de Veerdonk, F. Zarychanski, R. Green, C. Berry, S. Marshall, J. McArthur, C. Angus, D. Webb, S. |
Institutional Author: | REMAP-CAP Investigators |
Issue Date: | 2021 |
Publication Title: | Intensive Care Medicine |
Volume: | 47 |
Issue: | 8 |
Start Page: | 867 |
End Page: | 886 |
Abstract: | Purpose To study the efficacy of lopinavir-ritonavir and hydroxychloroquine in critically ill patients with coronavirus disease 2019 (COVID-19). Methods Critically ill adults with COVID-19 were randomized to receive lopinavir-ritonavir, hydroxychloroquine, combination therapy of lopinavir-ritonavir and hydroxychloroquine or no antiviral therapy (control). The primary endpoint was an ordinal scale of organ support-free days. Analyses used a Bayesian cumulative logistic model and expressed treatment effects as an adjusted odds ratio (OR) where an OR > 1 is favorable. Results We randomized 694 patients to receive lopinavir-ritonavir (n = 255), hydroxychloroquine (n = 50), combination therapy (n = 27) or control (n = 362). The median organ support-free days among patients in lopinavir-ritonavir, hydroxychloroquine, and combination therapy groups was 4 (– 1 to 15), 0 (– 1 to 9) and—1 (– 1 to 7), respectively, compared to 6 (– 1 to 16) in the control group with in-hospital mortality of 88/249 (35%), 17/49 (35%), 13/26 (50%), respectively, compared to 106/353 (30%) in the control group. The three interventions decreased organ support-free days compared to control (OR [95% credible interval]: 0.73 [0.55, 0.99], 0.57 [0.35, 0.83] 0.41 [0.24, 0.72]), yielding posterior probabilities that reached the threshold futility (≥ 99.0%), and high probabilities of harm (98.0%, 99.9% and > 99.9%, respectively). The three interventions reduced hospital survival compared with control (OR [95% CrI]: 0.65 [0.45, 0.95], 0.56 [0.30, 0.89], and 0.36 [0.17, 0.73]), yielding high probabilities of harm (98.5% and 99.4% and 99.8%, respectively). Conclusion Among critically ill patients with COVID-19, lopinavir-ritonavir, hydroxychloroquine, or combination therapy worsened outcomes compared to no antiviral therapy. |
Description: | Includes data from BHS |
URI: | http://hdl.handle.net/11054/1837 |
DOI: | https://doi: 10.1007/s00134-021-06448-5 |
Internal ID Number: | 01775 |
Health Subject: | ADAPTIVE PLATFORM TRIAL COVID-19 HYDROXYCHLOROQUINE INTENSIVE CARE LOPINAVIR-RITONAVIR PANDEMIC PNEUMONIA |
Type: | Journal Article Article |
Appears in Collections: | Research Output |
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