Lopinavir-ritonavir and hydroxychloroquine for critically ill patients with COVID-19: REMAP-CAP randomized controlled trial.
Lopinavir-ritonavir and hydroxychloroquine for critically ill patients with COVID-19: REMAP-CAP randomized controlled trial.
复制标题
DOI：
10.1007/s00134-021-06448-5
复制
发表时间：
2021-08
影响因子：
38.9
通讯作者：
REMAP-CAP Investigators
中科院分区：
文献类型：
--
作者：
Arabi YM;Gordon AC;Derde LPG;Nichol AD;Murthy S;Beidh FA;Annane D;Swaidan LA;Beane A;Beasley R;Berry LR;Bhimani Z;Bonten MJM;Bradbury CA;Brunkhorst FM;Buxton M;Buzgau A;Cheng A;De Jong M;Detry MA;Duffy EJ;Estcourt LJ;Fitzgerald M;Fowler R;Girard TD;Goligher EC;Goossens H;Haniffa R;Higgins AM;Hills TE;Horvat CM;Huang DT;King AJ;Lamontagne F;Lawler PR;Lewis R;Linstrum K;Litton E;Lorenzi E;Malakouti S;McAuley DF;McGlothlin A;Mcguinness S;McVerry BJ;Montgomery SK;Morpeth SC;Mouncey PR;Orr K;Parke R;Parker JC;Patanwala AE;Rowan KM;Santos MS;Saunders CT;Seymour CW;Shankar-Hari M;Tong SYC;Turgeon AF;Turner AM;Van de Veerdonk FL;Zarychanski R;Green C;Berry S;Marshall JC;McArthur C;Angus DC;Webb SA;REMAP-CAP Investigators
研究洛匹那韦-利托那韦和羟氯喹在2019冠状病毒病（COVID-19）重症患者中的疗效。患有COVID-19的重症成人被随机分配接受洛匹那韦-利托那韦、羟氯喹、洛匹那韦-利托那韦和羟氯喹的联合治疗或不接受抗病毒治疗（对照）。主要终点是无器官支持天数的顺序量表。分析使用贝叶斯累积逻辑模型，并将治疗效果表示为调整的比值比（OR），其中OR > 1是有利的。我们将694例患者随机分为接受洛匹那韦-利托那韦（n = 255），羟氯喹（n = 50），联合治疗（n = 27）或对照组（n = 362）。洛匹那韦-利托那韦、羟氯喹和联合治疗组患者的中位无器官支持天数为4（-1至15），0（-1到9）和-1（-1至7），分别与6（-1至16）例，住院死亡率分别为88/249（35%）、17/49（35%）、13/26（50%），而对照组为106/353（30%）。与对照组相比，三种干预措施减少了无器官支持的天数（OR [95%可信区间]：0.73 [0.55，0.99]，0.57 [0.35，0.83] 0.41 [0.24，0.72]），产生达到无效阈值的后验概率（≥ 99.0%）和高伤害概率（分别为98.0%、99.9%和> 99.9%）。与对照组相比，三种干预措施降低了住院生存率（OR [95% CrI]：0.65 [0.45，0.95]，0.56 [0.30，0.89]和0.36 [0.17，0.73]），产生了高伤害概率（分别为98.5%，99.4%和99.8%）。在患有COVID-19的重症患者中，与未接受抗病毒治疗相比，洛匹那韦-利托那韦、羟氯喹或联合治疗使结局恶化。在线版本包含补充材料，可通过10.1007/s 00134 -021-06448-5获得。
To study the efficacy of lopinavir-ritonavir and hydroxychloroquine in critically ill patients with coronavirus disease 2019 (COVID-19). 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. 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). Among critically ill patients with COVID-19, lopinavir-ritonavir, hydroxychloroquine, or combination therapy worsened outcomes compared to no antiviral therapy. The online version contains supplementary material available at 10.1007/s00134-021-06448-5.
登录
查看更多内容
DOI：
10.1056/nejmoa2022926
发表时间：
2020-11-19
期刊：
The New England journal of medicine
影响因子：
--
作者：
RECOVERY Collaborative Group;Horby P;Mafham M;Linsell L;Bell JL;Staplin N;Emberson JR;Wiselka M;Ustianowski A;Elmahi E;Prudon B;Whitehouse T;Felton T;Williams J;Faccenda J;Underwood J;Baillie JK;Chappell LC;Faust SN;Jaki T;Jeffery K;Lim WS;Montgomery A;Rowan K;Tarning J;Watson JA;White NJ;Juszczak E;Haynes R;Landray MJ
通讯作者：
Landray MJ
DOI：
10.1097/qai.0b013e318232b057
发表时间：
2011-12-01
影响因子：
3.6
作者：
Best, Brookie M.;Capparelli, Edmund V.;Rakhmanina, Natella
通讯作者：
Rakhmanina, Natella
影响因子：
4.9
作者：
Marzolini, Catia;Stader, Felix;Sendi, Parham
通讯作者：
Sendi, Parham
影响因子：
7.6
作者：
Choy, Ka-Tim;Wong, Alvina Yin-Lam;Yen, Hui-Ling
通讯作者：
Yen, Hui-Ling
影响因子：
6.4
作者：
Park, Su-Jin;Yu, Kwang-Min;Choi, Young Ki
通讯作者：
Choi, Young Ki