在REMAP-CAP随机临床试验中,重症患者的长期 (180天) 结果
, Alisa M Higgins1, Lindsay R Berry2
1Monash University, Melbourne, Victoria, Australia.
JAMA
|December 16, 2022
概括
互白素-6 (IL-6) 受体对抗剂显著改善了重症COVID-19患者的6个月生存期. 抗血小板药物也显示出生存益处,而其他治疗方法如康复性血和某些抗病毒药物被发现是无效的或可能有害的.
科学领域:
- 危急护理医学
- 传染性疾病
- 药理学
背景情况:
- 用于重症COVID-19患者的各种治疗方法的长期影响在很大程度上是未知的.
- 了解干预的持续影响对于优化治疗策略至关重要.
研究的目的:
- 评估COVID-19严重病情的成年患者多种治疗干预的长期 (180天) 结果.
- 为了确定治疗的有效性和安全性,
主要方法:
- 涉及4869名重症COVID-19患者的REMAP-CAP适应性平台试验的预先规定的二次分析.
- 患者被随机分配到各种治疗领域,包括免疫调节剂,康复性血,抗血小板治疗,抗凝血,抗病毒药物和皮质类固醇.
- 主要结果是使用贝叶斯统计模型分析的180天生存期.
主要成果:
- 介素-6 (IL-6) 受体对抗剂显示改善6个月生存率的概率高于99. 9% (调整后HR为0. 74).
- 抗血小板药物改善6个月生存率的概率为95% (调整后HR为0. 85).
- 治疗抗凝剂,康复期血和洛皮纳维尔- 里托纳维尔具有很高的无效率,而氧化及其与洛皮纳维尔- 里托纳维尔的组合则具有很高的有害性.
结论:
- 使用IL-6受体对抗剂的治疗显著改善了COVID-19重症患者的180天死亡率.
- 抗血小板治疗也可以改善存活率.
- 大多数治疗的初始住院治疗效果在6个月内保持一致,这突显了特定干预的持续益处.
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