Lopinavir-ritonavir and hydroxychloroquine for critically ill patients with COVID-19: REMAP-CAP randomized controlled trial.
dc.contributor.author | Arabi, YM | |
dc.contributor.author | Gordon, AC | |
dc.contributor.author | Derde, LPG | |
dc.contributor.author | Nichol, AD | |
dc.contributor.author | Murthy, S | |
dc.contributor.author | Beidh, FA | |
dc.contributor.author | Annane, D | |
dc.contributor.author | Swaidan, LA | |
dc.contributor.author | Beane, A | |
dc.contributor.author | Beasley, R | |
dc.contributor.author | Berry, LR | |
dc.contributor.author | Bhimani, Z | |
dc.contributor.author | Bonten, MJM | |
dc.contributor.author | Bradbury, CA | |
dc.contributor.author | Brunkhorst, FM | |
dc.contributor.author | Buxton, M | |
dc.contributor.author | Buzgau, A | |
dc.contributor.author | Cheng, A | |
dc.contributor.author | De Jong, M | |
dc.contributor.author | Detry, MA | |
dc.contributor.author | Duffy, EJ | |
dc.contributor.author | Estcourt, LJ | |
dc.contributor.author | Fitzgerald, M | |
dc.contributor.author | Fowler, R | |
dc.contributor.author | Girard, TD | |
dc.contributor.author | Goligher, EC | |
dc.contributor.author | Goossens, H | |
dc.contributor.author | Haniffa, R | |
dc.contributor.author | Higgins, AM | |
dc.contributor.author | Hills, TE | |
dc.contributor.author | Horvat, CM | |
dc.contributor.author | Huang, DT | |
dc.contributor.author | King, AJ | |
dc.contributor.author | Lamontagne, F | |
dc.contributor.author | Lawler, PR | |
dc.contributor.author | Lewis, R | |
dc.contributor.author | Linstrum, K | |
dc.contributor.author | Litton, E | |
dc.contributor.author | Lorenzi, E | |
dc.contributor.author | Malakouti, S | |
dc.contributor.author | McAuley, DF | |
dc.contributor.author | McGlothlin, A | |
dc.contributor.author | Mcguinness, S | |
dc.contributor.author | McVerry, BJ | |
dc.contributor.author | Montgomery, SK | |
dc.contributor.author | Morpeth, SC | |
dc.contributor.author | Mouncey, PR | |
dc.contributor.author | Orr, K | |
dc.contributor.author | Parke, R | |
dc.contributor.author | Parker, JC | |
dc.contributor.author | Patanwala, AE | |
dc.contributor.author | Rowan, KM | |
dc.contributor.author | Santos, MS | |
dc.contributor.author | Saunders, CT | |
dc.contributor.author | Seymour, CW | |
dc.contributor.author | Shankar-Hari, M | |
dc.contributor.author | Tong, SYC | |
dc.contributor.author | Turgeon, AF | |
dc.contributor.author | Turner, AM | |
dc.contributor.author | Van de Veerdonk, FL | |
dc.contributor.author | Zarychanski, R | |
dc.contributor.author | Green, C | |
dc.contributor.author | Berry, S | |
dc.contributor.author | Marshall, JC | |
dc.contributor.author | McArthur, C | |
dc.contributor.author | Angus, DC | |
dc.contributor.author | Webb, SA | |
dc.contributor.author | REMAP-CAP Investigators | |
dc.date.accessioned | 2021-08-27T14:12:16Z | |
dc.date.available | 2021-05-27 | |
dc.date.available | 2021-08-27T14:12:16Z | |
dc.date.issued | 2021-07-12 | |
dc.identifier.citation | Arabi, Y.M., Gordon, A.C., Derde, L.P.G. et al. Lopinavir-ritonavir and hydroxychloroquine for critically ill patients with COVID-19: REMAP-CAP randomized controlled trial. Intensive Care Med 47, 867–886 (2021). https://doi.org/10.1007/s00134-021-06448-5 | en_US |
dc.identifier.uri | https://qmro.qmul.ac.uk/xmlui/handle/123456789/73807 | |
dc.description.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. | en_US |
dc.format.extent | 867 - 886 | |
dc.language | eng | |
dc.language.iso | en | en_US |
dc.relation.ispartof | Intensive Care Medicine | |
dc.subject | Adaptive platform trial | en_US |
dc.subject | COVID-19 | en_US |
dc.subject | Hydroxychloroquine | en_US |
dc.subject | Intensive care | en_US |
dc.subject | Lopinavir-ritonavir | en_US |
dc.subject | Pandemic | en_US |
dc.subject | Pneumonia | en_US |
dc.subject | Adult | en_US |
dc.subject | Antiviral Agents | en_US |
dc.subject | Bayes Theorem | en_US |
dc.subject | COVID-19 | en_US |
dc.subject | Critical Illness | en_US |
dc.subject | Drug Combinations | en_US |
dc.subject | Humans | en_US |
dc.subject | Hydroxychloroquine | en_US |
dc.subject | Lopinavir | en_US |
dc.subject | Ritonavir | en_US |
dc.subject | SARS-CoV-2 | en_US |
dc.title | Lopinavir-ritonavir and hydroxychloroquine for critically ill patients with COVID-19: REMAP-CAP randomized controlled trial. | en_US |
dc.type | Article | en_US |
dc.identifier.doi | 10.1007/s00134-021-06448-5 | |
pubs.author-url | https://www.ncbi.nlm.nih.gov/pubmed/34251506 | en_US |
pubs.issue | 8 | en_US |
pubs.notes | Not known | en_US |
pubs.publication-status | Published | en_US |
pubs.volume | 47 | en_US |
dcterms.dateAccepted | 2021-05-27 | |
rioxxterms.funder | Default funder | en_US |
rioxxterms.identifier.project | Default project | en_US |