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https://hdl.handle.net/2440/135310
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dc.contributor.author | Arabi, Y.M. | - |
dc.contributor.author | Gordon, A.C. | - |
dc.contributor.author | Derde, L.P.G. | - |
dc.contributor.author | Nichol, A.D. | - |
dc.contributor.author | Murthy, S. | - |
dc.contributor.author | Beidh, F.A. | - |
dc.contributor.author | Annane, D. | - |
dc.contributor.author | Swaidan, L.A. | - |
dc.contributor.author | Beane, A. | - |
dc.contributor.author | Beasley, R. | - |
dc.contributor.author | Berry, L.R. | - |
dc.contributor.author | Bhimani, Z. | - |
dc.contributor.author | Bonten, M.J.M. | - |
dc.contributor.author | Bradbury, C.A. | - |
dc.contributor.author | Brunkhorst, F.M. | - |
dc.contributor.author | Buxton, M. | - |
dc.contributor.author | Buzgau, A. | - |
dc.contributor.author | Cheng, A. | - |
dc.contributor.author | De Jong, M. | - |
dc.contributor.author | Detry, M.A. | - |
dc.contributor.author | et al. | - |
dc.date.issued | 2021 | - |
dc.identifier.citation | Intensive Care Medicine, 2021; 47(8):867-886 | - |
dc.identifier.issn | 0342-4642 | - |
dc.identifier.issn | 1432-1238 | - |
dc.identifier.uri | https://hdl.handle.net/2440/135310 | - |
dc.description.abstract | Purpose: To study the efficacy of lopinavir-ritonavir and hydroxychloroquine in critically ill patients with coronavirus disease 2019 (COVID-19). Methods: 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. Results: 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 supportfree 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). Conclusion: Among critically ill patients with COVID-19, lopinavir-ritonavir, hydroxychloroquine, or combination therapy worsened outcomes compared to no antiviral therapy. | - |
dc.description.statementofresponsibility | Yaseen M. Arabi ... et al. on behalf of the REMAP-CAP Investigators: Farah Al-Beidh ... Vishwanath Biradar ... Sandra Peake ... Patricia Williams ... Samuel Gluck ... Stephanie O’Connor ... Marianne Chapman ... et al. | - |
dc.language.iso | en | - |
dc.publisher | Springer-Verlag | - |
dc.rights | © 2021 Springer-Verlag GmbH Germany, part of Springer Nature | - |
dc.source.uri | http://dx.doi.org/10.1007/s00134-021-06448-5 | - |
dc.subject | Adaptive platform trial; Intensive care; Pneumonia; Pandemic; COVID-19; Lopinavir-ritonavir; Hydroxychloroquine | - |
dc.subject.mesh | Humans | - |
dc.subject.mesh | Critical Illness | - |
dc.subject.mesh | Ritonavir | - |
dc.subject.mesh | Hydroxychloroquine | - |
dc.subject.mesh | Drug Combinations | - |
dc.subject.mesh | Antiviral Agents | - |
dc.subject.mesh | Bayes Theorem | - |
dc.subject.mesh | Adult | - |
dc.subject.mesh | Lopinavir | - |
dc.subject.mesh | COVID-19 | - |
dc.subject.mesh | SARS-CoV-2 | - |
dc.title | Lopinavir-ritonavir and hydroxychloroquine for critically ill patients with COVID-19: REMAP-CAP randomized controlled trial | - |
dc.type | Journal article | - |
dc.identifier.doi | 10.1007/s00134-021-06448-5 | - |
dc.relation.grant | http://purl.org/au-research/grants/nhmrc/1101719 | - |
dc.relation.grant | http://purl.org/au-research/grants/nhmrc/1116530 | - |
pubs.publication-status | Published | - |
dc.identifier.orcid | Peake, S. [0000-0001-6682-7973] | - |
Appears in Collections: | Anaesthesia and Intensive Care publications |
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