What’s the longer-term effect of treatment for critically ill patients with COVID-19?
Researchers of a new study published in JAMA found that among critically ill patients with COVID-19, there was a high likelihood of improved 180-day mortality among patients treated with IL-6 receptor antagonists and antiplatelet agents.
Researchers used data from the ongoing REMAP-CAP (Randomized Embedded Multifactorial Adaptive Platform for Community Acquired Pneumonia) trial to gauge the longer-term effectiveness of 6 categories of treatment used among critically ill COVID-19 patients: immune modulators, convalescent plasma, antiplatelet therapy, anticoagulation, antivirals, and corticosteroids. For the study, patients were randomized to receive one or more of these treatment interventions.
“When considered with previously reported short-term results, the findings indicate that initial in-hospital treatment effects were consistent for most therapies through 6 months,” concluded the study authors.
Specifically, they were looking at longer-term mortality, disability, and health-related quality of life.
The REMAP-CAP trial included critically ill adult patients with COVID-19 enrolled between March 9, 2020, and June 24, 2021. Patients came from 14 countries.
The primary outcome was survival through day 180. Of the 4,869 randomized patients, 84.3% had known vital status and 63.1% were alive at 180 days.
According to the study, the pooled IL-6 receptor antagonists and antiplatelet treatment groups each had a high probability of benefit compared with the control groups. The probability of benefit for fixed-dose corticosteroids and shock-dependent corticosteroids compared with no corticosteroids was 61.6% and 57.1% respectively. However, the corticosteroid domain was stopped early on the basis of external evidence.
In contrast, the likelihood of trial-defined statistical futility was high for therapeutic anticoagulation in critically ill patients, convalescent plasma, and lopinavir-ritonavir. In addition, there was a high likelihood of harm for hydroxychloroquine and its combination with lopinavir-ritonavir.