By: Yaseen M.
Arabi, Anthony C.
Gordon, the REMAP-CAP
Investigators
Intensive
Care Medicine volume 47, pages867–886 Published: 12 July 2021
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.
No comments:
Post a Comment