{"id":23287,"date":"2023-01-24T04:03:00","date_gmt":"2023-01-23T20:03:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=23287"},"modified":"2023-01-24T06:27:22","modified_gmt":"2023-01-23T22:27:22","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9aremap-cap%e9%9a%8f%e6%9c%ba%e4%b8%b4%e5%ba%8a%e8%af%95%e9%aa%8c%e4%b8%ad%e6%96%b0%e5%86%a0%e8%82%ba%e7%82%8e%e5%8d%b1%e9%87%8d%e7%97%85%e6%82%a3","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=23287","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1aREMAP-CAP\u968f\u673a\u4e34\u5e8a\u8bd5\u9a8c\u4e2d\u65b0\u51a0\u80ba\u708e\u5371\u91cd\u75c5\u60a3\u8005\u7684\u957f\u671f\uff08180\u5929\uff09\u9884\u540e"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Caring for the Critically Ill Patient<\/p>\n\n\n\n

December 16, 2022<\/p>\n\n\n\n

Long-term (180-Day) Outcomes in Critically Ill Patients With COVID-19 in the REMAP-CAP Randomized Clinical Trial<\/h1>\n\n\n\n

Writing Committee for the REMAP-CAP Investigators<\/h3>\n\n\n\n

JAMA.\u00a0<\/em>Published online December 16, 2022. doi:10.1001\/jama.2022.23257<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  What is the effect of treatment for critically ill patients with COVID-19 on longer-term mortality, disability, and health-related quality of life?<\/p>\n\n\n\n

Findings<\/strong>  In this bayesian adaptive randomized clinical platform trial that included 4869 critically ill patients with COVID-19, the probability was high that IL-6 receptor antagonists and antiplatelet agents improved survival at 6 months (posterior probabilities of superiority of >99.9% and 95.0%, respectively). Long-term outcomes were not improved with therapeutic anticoagulation (11.5%), convalescent plasma (54.7%), or lopinavir-ritonavir (31.9%) and were worsened with hydroxychloroquine (posterior probability of harm, 96.8%). Corticosteroids did not improve long-term outcomes, although enrollment had been terminated early in response to external evidence.<\/p>\n\n\n\n

Meaning<\/strong>  Among critically ill patients with COVID-19 randomized to receive 1 or more therapeutic interventions, there was a high likelihood of improved 180-day mortality among patients treated with IL-6 receptor antagonists and antiplatelet agents.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  The longer-term effects of therapies for the treatment of critically ill patients with COVID-19 are unknown.<\/p>\n\n\n\n

Objective<\/strong>  To determine the effect of multiple interventions for critically ill adults with COVID-19 on longer-term outcomes.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  Prespecified secondary analysis of an ongoing adaptive platform trial (REMAP-CAP) testing interventions within multiple therapeutic domains in which 4869 critically ill adult patients with COVID-19 were enrolled between March 9, 2020, and June 22, 2021, from 197 sites in 14 countries. The final 180-day follow-up was completed on March 2, 2022.<\/p>\n\n\n\n

Interventions<\/strong>  Patients were randomized to receive 1 or more interventions within 6 treatment domains: immune modulators (n\u2009=\u20092274), convalescent plasma (n\u2009=\u20092011), antiplatelet therapy (n\u2009=\u20091557), anticoagulation (n\u2009=\u20091033), antivirals (n\u2009=\u2009726), and corticosteroids (n\u2009=\u2009401).<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  The main outcome was survival through day 180, analyzed using a bayesian piecewise exponential model. A hazard ratio (HR) less than 1 represented improved survival (superiority), while an HR greater than 1 represented worsened survival (harm); futility was represented by a relative improvement less than 20% in outcome, shown by an HR greater than 0.83.<\/p>\n\n\n\n

Results<\/strong>  Among 4869 randomized patients (mean age, 59.3 years; 1537 [32.1%] women), 4107 (84.3%) had known vital status and 2590 (63.1%) were alive at day 180. IL-6 receptor antagonists had a greater than 99.9% probability of improving 6-month survival (adjusted HR, 0.74 [95% credible interval {CrI}, 0.61-0.90]) and antiplatelet agents had a 95% probability of improving 6-month survival (adjusted HR, 0.85 [95% CrI, 0.71-1.03]) compared with the control, while the probability of trial-defined statistical futility (HR >0.83) was high for therapeutic anticoagulation (99.9%; HR, 1.13 [95% CrI, 0.93-1.42]), convalescent plasma (99.2%; HR, 0.99 [95% CrI, 0.86-1.14]), and lopinavir-ritonavir (96.6%; HR, 1.06 [95% CrI, 0.82-1.38]) and the probabilities of harm from hydroxychloroquine (96.9%; HR, 1.51 [95% CrI, 0.98-2.29]) and the combination of lopinavir-ritonavir and hydroxychloroquine (96.8%; HR, 1.61 [95% CrI, 0.97-2.67]) were high. The corticosteroid domain was stopped early prior to reaching a predefined statistical trigger; there was a 57.1% to 61.6% probability of improving 6-month survival across varying hydrocortisone dosing strategies.<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  Among critically ill patients with COVID-19 randomized to receive 1 or more therapeutic interventions, treatment with an IL-6 receptor antagonist had a greater than 99.9% probability of improved 180-day mortality compared with patients randomized to the control, and treatment with an antiplatelet had a 95.0% probability of improved 180-day mortality compared with patients randomized to the control. Overall, 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.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Caring for the Critically […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/23287"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=23287"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/23287\/revisions"}],"predecessor-version":[{"id":23288,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/23287\/revisions\/23288"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=23287"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=23287"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=23287"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}