Imperial College London
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Professor Anthony Gordon

Faculty of Medicine, Department of Surgery & Cancer

Chair in Anaesthesia and Critical Care
 
 
 
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Contact

 

anthony.gordon

 
 
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Location

 

ICUQueen Elizabeth the Queen Mother Wing (QEQM)St Mary's Campus

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Summary

 

Publications

Citation

BibTex format

@unpublished{The:2021:10.1101/2021.01.07.21249390,
author = {The, REMAP-CAP Investigators and Gordon, A and Mouncey, P and Al-Beidh, F and Rowan, K and Nichol, A and Arabi, Y and Annane, D and Beane, A and van, Bentum-Puijk W and Berry, L and Bhimani, Z and Bonten, MJM and Bradbury, C and Brunkhorst, F and Buzgau, A and Cheng, A and Detry, M and Duffy, E and Estcourt, L and Fitzgerald, M and Goossens, H and Haniffa, R and Higgins, A and Hills, T and Horvat, C and Lamontagne, F and Lawler, P and Leavis, H and Linstrum, K and Litton, E and Lorenzi, E and Marshall, J and Mayr, F and McAuley, D and McGlothlin, A and McGuinness, S and McVerry, B and Montgomery, S and Morpeth, S and Murthy, S and Orr, K and Parke, R and Parker, J and Patanwala, A and Pettilä, V and Rademaker, E and Santos, M and Saunders, C and Seymour, C and Shankar-Hari, M and Sligl, W and Turgeon, A and Turner, A and van, de Veerdonk F and Zarychanski, R and Green, C and Lewis, R and Angus, D and McArthur, C and Berry, S and Webb, S and Derde, LPG},
doi = {10.1101/2021.01.07.21249390},
publisher = {Cold Spring Harbor Laboratory},
title = {Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19 – Preliminary report},
url = {http://dx.doi.org/10.1101/2021.01.07.21249390},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - UNPB
AB  - Background The efficacy of interleukin-6 receptor antagonists in critically ill patients with coronavirus disease 2019 (Covid-19) is unclear.Methods We evaluated tocilizumab and sarilumab in an ongoing international, multifactorial, adaptive platform trial. Adult patients with Covid-19, within 24 hours of commencing organ support in an intensive care unit, were randomized to receive either tocilizumab (8mg/kg) or sarilumab (400mg) or standard care (control). The primary outcome was an ordinal scale combining in-hospital mortality (assigned −1) and days free of organ support to day 21. The trial uses a Bayesian statistical model with pre-defined triggers to declare superiority, efficacy, equivalence or futility.Results Tocilizumab and sarilumab both met the pre-defined triggers for efficacy. At the time of full analysis 353 patients had been assigned to tocilizumab, 48 to sarilumab and 402 to control. Median organ support-free days were 10 (interquartile range [IQR] −1, 16), 11 (IQR 0, 16) and 0 (IQR −1, 15) for tocilizumab, sarilumab and control, respectively. Relative to control, median adjusted odds ratios were 1.64 (95% credible intervals [CrI] 1.25, 2.14) for tocilizumab and 1.76 (95%CrI 1.17, 2.91) for sarilumab, yielding >99.9% and 99.5% posterior probabilities of superiority compared with control. Hospital mortality was 28.0% (98/350) for tocilizumab, 22.2% (10/45) for sarilumab and 35.8% (142/397) for control. All secondary outcomes and analyses supported efficacy of these IL-6 receptor antagonists.Conclusions In critically ill patients with Covid-19 receiving organ support in intensive care, treatment with the IL-6 receptor antagonists, tocilizumab and sarilumab, improved outcome, including survival. (ClinicalTrials.gov number: NCT02735707)Competing Interest StatementDr. Gordon reports grants from NIHR, grants from NIHR Research Professorship (RP-2015-06-18), non-financial support from NIHR Clinical Research Network, non-financial suppo
AU  - The,REMAP-CAP Investigators
AU  - Gordon,A
AU  - Mouncey,P
AU  - Al-Beidh,F
AU  - Rowan,K
AU  - Nichol,A
AU  - Arabi,Y
AU  - Annane,D
AU  - Beane,A
AU  - van,Bentum-Puijk W
AU  - Berry,L
AU  - Bhimani,Z
AU  - Bonten,MJM
AU  - Bradbury,C
AU  - Brunkhorst,F
AU  - Buzgau,A
AU  - Cheng,A
AU  - Detry,M
AU  - Duffy,E
AU  - Estcourt,L
AU  - Fitzgerald,M
AU  - Goossens,H
AU  - Haniffa,R
AU  - Higgins,A
AU  - Hills,T
AU  - Horvat,C
AU  - Lamontagne,F
AU  - Lawler,P
AU  - Leavis,H
AU  - Linstrum,K
AU  - Litton,E
AU  - Lorenzi,E
AU  - Marshall,J
AU  - Mayr,F
AU  - McAuley,D
AU  - McGlothlin,A
AU  - McGuinness,S
AU  - McVerry,B
AU  - Montgomery,S
AU  - Morpeth,S
AU  - Murthy,S
AU  - Orr,K
AU  - Parke,R
AU  - Parker,J
AU  - Patanwala,A
AU  - Pettilä,V
AU  - Rademaker,E
AU  - Santos,M
AU  - Saunders,C
AU  - Seymour,C
AU  - Shankar-Hari,M
AU  - Sligl,W
AU  - Turgeon,A
AU  - Turner,A
AU  - van,de Veerdonk F
AU  - Zarychanski,R
AU  - Green,C
AU  - Lewis,R
AU  - Angus,D
AU  - McArthur,C
AU  - Berry,S
AU  - Webb,S
AU  - Derde,LPG
DO  - 10.1101/2021.01.07.21249390
PB  - Cold Spring Harbor Laboratory
PY  - 2021///
TI  - Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19 – Preliminary report
UR  - http://dx.doi.org/10.1101/2021.01.07.21249390
UR  - https://www.medrxiv.org/content/10.1101/2021.01.07.21249390v2
UR  - http://hdl.handle.net/10044/1/90567
ER  -
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