Mary Wilson
Well-known member
This article is a preprint and has not been certified by peer review.
Posted February 11, 2021.
doi: https://doi.org/10.1101/2021.02.11.21249258
Peter W Horby, Mark Campbell, Natalie Staplin, Enti Spata, Jonathan R Emberson, Guilherme Pessoa-Amorim, Leon Peto, Christopher E Brightling, Rahuldeb Sarkar, Koshy Thomas, Vanda na Jeebun, Abdul Ashish, Redmond Tully, David Chad wick, Muhammad Sharafat, Richard Stewart, Banu Rud ran, J Kenneth Baillie, Maya H Buch, Lucy C Chappell, Jeremy N Day, Saul N Furst, Thomas Jaki, Katie Jeffery, Edmund Juszczak, Wei Shen Lim, Alan Montgomery, Andrew Mumford, Kathryn Rowan, Guy Thwaites, Marion Mafham, Richard Haynes, Martin J Landray
Abstract
Findings: Between 23 April 2020 and 25 January 2021, 4116 adults were included in the assessment of tocilizumab, including 562 (14%) patients receiving invasive mechanical ventilation, 1686 (41%) receiving non-invasive respiratory support, and. 1868 (45%) receiving no respiratory support other than oxygen. Median CRP was 143 [IQR 107-205] mg/L and 3385 (82%) patients were receiving systemic corticosteroids at randomisation. Overall, 596 (29%) of the 2022 patients allocated tocilizumab and 694 (33%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0.86; 95% confidence interval [CI] 0.77-0.96; p=0.007). Consistent results were seen in all pre-specified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital alive within 28 days (54% vs. 47%; rate ratio 1.23; 95% CI 1.12-1.34; p<0.0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (33% vs. 38%; risk ratio 0.85; 95% CI 0.78-0.93; p=0.0005). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes regardless of the level of respiratory support received and in addition to the use of systemic corticosteroids.
PDF Format:
https://www.medrxiv.org/content/10.1101/2021.02.11.21249258v1.full.pdf
Abstract:
https://www.medrxiv.org/content/10.1101/2021.02.11.21249258v1
Posted February 11, 2021.
doi: https://doi.org/10.1101/2021.02.11.21249258
Peter W Horby, Mark Campbell, Natalie Staplin, Enti Spata, Jonathan R Emberson, Guilherme Pessoa-Amorim, Leon Peto, Christopher E Brightling, Rahuldeb Sarkar, Koshy Thomas, Vanda na Jeebun, Abdul Ashish, Redmond Tully, David Chad wick, Muhammad Sharafat, Richard Stewart, Banu Rud ran, J Kenneth Baillie, Maya H Buch, Lucy C Chappell, Jeremy N Day, Saul N Furst, Thomas Jaki, Katie Jeffery, Edmund Juszczak, Wei Shen Lim, Alan Montgomery, Andrew Mumford, Kathryn Rowan, Guy Thwaites, Marion Mafham, Richard Haynes, Martin J Landray
Abstract
Findings: Between 23 April 2020 and 25 January 2021, 4116 adults were included in the assessment of tocilizumab, including 562 (14%) patients receiving invasive mechanical ventilation, 1686 (41%) receiving non-invasive respiratory support, and. 1868 (45%) receiving no respiratory support other than oxygen. Median CRP was 143 [IQR 107-205] mg/L and 3385 (82%) patients were receiving systemic corticosteroids at randomisation. Overall, 596 (29%) of the 2022 patients allocated tocilizumab and 694 (33%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0.86; 95% confidence interval [CI] 0.77-0.96; p=0.007). Consistent results were seen in all pre-specified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital alive within 28 days (54% vs. 47%; rate ratio 1.23; 95% CI 1.12-1.34; p<0.0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (33% vs. 38%; risk ratio 0.85; 95% CI 0.78-0.93; p=0.0005). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes regardless of the level of respiratory support received and in addition to the use of systemic corticosteroids.
PDF Format:
https://www.medrxiv.org/content/10.1101/2021.02.11.21249258v1.full.pdf
Abstract:
https://www.medrxiv.org/content/10.1101/2021.02.11.21249258v1