Longer-term Outcomes in Critically Ill Patients with COVID-19 in the REMAP-CAP Trial

Clinical question: What is the longer-term (180-day) mortality effect of common therapies on critically ill patients with COVID-19? Background: Most randomized clinical trials for patients with COVID-19 focus on short-term outcomes such as 28-day mortality or organ failure. Trials evaluating longer-term outcomes of therapeutic interventions are needed. Study design: Randomized adaptive-platform trial Setting: International multicenter trial (197 sites in 14 countries) Synopsis: 4,869 critically ill patients were enrolled from March 2020 through June 2021. Patients were randomized to one of six treatment arms (immune modulation, convalescent plasma, antiplatelet [subdivided into aspirin, P2Y12 inhibitor, or no antiplatelet], therapeutic anticoagulation, antivirals, and corticosteroids). The primary outcome was 180-day mortality calculated with adjusted hazard ratios (aHR). Futility was defined as the probability there was not more than 20% relative improvement in outcome. Harm was defined as the probability that the adjusted HR was >1. Secondary analyses included 90-day mortality, health-related quality of life, and disability at 180 days. Criteria for high probability of benefit were met by IL-6 receptor antagonists (>99.9% probability) and antiplatelet treatment (95% probability). Futility criteria were met by therapeutic anticoagulation, convalescent plasma, and lopinavir-ritonavir while hydroxychloroquine had a high probability of harm (96.6% probability). Results of...
Source: The Hospitalist - Category: Hospital Management Authors: Tags: COVID-19 In the Literature Source Type: research