We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Lopinavir-ritonavir and hydroxychloroquine for critically ill patients with COVID-19: REMAP-CAP randomized controlled trial.
- Authors
Arabi, Yaseen M.; Gordon, Anthony C.; Derde, Lennie P. G.; Nichol, Alistair D.; Murthy, Srinivas; Beidh, Farah Al; Annane, Djillali; Swaidan, Lolowa Al; Beane, Abi; Beasley, Richard; Berry, Lindsay R.; Bhimani, Zahra; Bonten, Marc J. M.; Bradbury, Charlotte A.; Brunkhorst, Frank M.; Buxton, Meredith; Buzgau, Adrian; Cheng, Allen; De Jong, Menno; Detry, Michelle A.
- Abstract
<bold>Purpose: </bold>To study the efficacy of lopinavir-ritonavir and hydroxychloroquine in critically ill patients with coronavirus disease 2019 (COVID-19).<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusion: </bold>Among critically ill patients with COVID-19, lopinavir-ritonavir, hydroxychloroquine, or combination therapy worsened outcomes compared to no antiviral therapy.
- Subjects
COVID-19; LOPINAVIR-ritonavir; CRITICALLY ill; HYDROXYCHLOROQUINE; ADULTS
- Publication
Intensive Care Medicine, 2021, Vol 47, Issue 8, p867
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s00134-021-06448-5