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10.1056/NEJMoa2100433 http://scihub22266oqcxt.onion/10.1056/NEJMoa2100433 33631065!7953461!33631065     free     free     free Deprecated: Implicit conversion from float 235.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 235.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Deprecated: Implicit conversion from float 235.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534       N+Engl+J+Med 2021 ; 384 (16): 1491-1502 Nephropedia Template TP {{tp|p=33631065|t=2021. Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19 |pdf=|usr=}}{{33631065}} gab.com Text Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19 JO: N Engl J Med http://www.kidney.de/pget.php?&tw=1&pmid=33631065 #FOAvip BACKGROUND: The efficacy of interleukin-6 receptor antagonists in critically ill patients with coronavirus disease 2019 (Covid-19) is unclear. METHODS: We evaluated tocilizumab and sarilumab in an ongoing international, multifactorial, adaptive platform trial. Adult patients with Covid-19, within 24 hours after starting organ support in the intensive care unit (ICU), were randomly assigned to receive tocilizumab (8 mg per kilogram of body weight), sarilumab (400 mg), or standard care (control). The primary outcome was respiratory and cardiovascular organ support-free days, on an ordinal scale combining in-hospital death (assigned a value of -1) and days free of organ support to day 21. The trial uses a Bayesian statistical model with predefined criteria for superiority, efficacy, equivalence, or futility. An odds ratio greater than 1 represented improved survival, more organ support-free days, or both. RESULTS: Both tocilizumab and sarilumab met the predefined criteria for efficacy. At that time, 353 patients had been assigned to tocilizumab, 48 to sarilumab, and 402 to control. The median number of organ support-free days was 10 (interquartile range, -1 to 16) in the tocilizumab group, 11 (interquartile range, 0 to 16) in the sarilumab group, and 0 (interquartile range, -1 to 15) in the control group. The median adjusted cumulative odds ratios were 1.64 (95% credible interval, 1.25 to 2.14) for tocilizumab and 1.76 (95% credible interval, 1.17 to 2.91) for sarilumab as compared with control, yielding posterior probabilities of superiority to control of more than 99.9% and of 99.5%, respectively. An analysis of 90-day survival showed improved survival in the pooled interleukin-6 receptor antagonist groups, yielding a hazard ratio for the comparison with the control group of 1.61 (95% credible interval, 1.25 to 2.08) and a posterior probability of superiority of more than 99.9%. All secondary analyses supported efficacy of these interleukin-6 receptor antagonists. CONCLUSIONS: In critically ill patients with Covid-19 receiving organ support in ICUs, treatment with the interleukin-6 receptor antagonists tocilizumab and sarilumab improved outcomes, including survival. (REMAP-CAP ClinicalTrials.gov number, NCT02735707.). Twit Text FOAVip Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19 ????N Engl J Med http://www.kidney.de/pget.php?&tw=1&pmid=33631065 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=33631065 #FOAvip English Wikipedia <ref>{{Cite pmid|33631065}}</ref> Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19 #MMPMID33631065 Gordon AC; Mouncey PR; Al-Beidh F; Rowan KM; Nichol AD; Arabi YM; Annane D; Beane A; van Bentum-Puijk W; Berry LR; Bhimani Z; Bonten MJM; Bradbury CA; Brunkhorst FM; Buzgau A; Cheng AC; Detry MA; Duffy EJ; Estcourt LJ; Fitzgerald M; Goossens H; Haniffa R; Higgins AM; Hills TE; Horvat CM; Lamontagne F; Lawler PR; Leavis HL; Linstrum KM; Litton E; Lorenzi E; Marshall JC; Mayr FB; McAuley DF; McGlothlin A; McGuinness SP; McVerry BJ; Montgomery SK; Morpeth SC; Murthy S; Orr K; Parke RL; Parker JC; Patanwala AE; Pettila V; Rademaker E; Santos MS; Saunders CT; Seymour CW; Shankar-Hari M; Sligl WI; Turgeon AF; Turner AM; van de Veerdonk FL; Zarychanski R; Green C; Lewis RJ; Angus DC; McArthur CJ; Berry S; Webb SA; Derde LPG N Engl J Med 2021[Apr]; 384 (16): 1491-1502 PMID33631065show ga BACKGROUND: The efficacy of interleukin-6 receptor antagonists in critically ill patients with coronavirus disease 2019 (Covid-19) is unclear. METHODS: We evaluated tocilizumab and sarilumab in an ongoing international, multifactorial, adaptive platform trial. Adult patients with Covid-19, within 24 hours after starting organ support in the intensive care unit (ICU), were randomly assigned to receive tocilizumab (8 mg per kilogram of body weight), sarilumab (400 mg), or standard care (control). The primary outcome was respiratory and cardiovascular organ support-free days, on an ordinal scale combining in-hospital death (assigned a value of -1) and days free of organ support to day 21. The trial uses a Bayesian statistical model with predefined criteria for superiority, efficacy, equivalence, or futility. An odds ratio greater than 1 represented improved survival, more organ support-free days, or both. RESULTS: Both tocilizumab and sarilumab met the predefined criteria for efficacy. At that time, 353 patients had been assigned to tocilizumab, 48 to sarilumab, and 402 to control. The median number of organ support-free days was 10 (interquartile range, -1 to 16) in the tocilizumab group, 11 (interquartile range, 0 to 16) in the sarilumab group, and 0 (interquartile range, -1 to 15) in the control group. The median adjusted cumulative odds ratios were 1.64 (95% credible interval, 1.25 to 2.14) for tocilizumab and 1.76 (95% credible interval, 1.17 to 2.91) for sarilumab as compared with control, yielding posterior probabilities of superiority to control of more than 99.9% and of 99.5%, respectively. An analysis of 90-day survival showed improved survival in the pooled interleukin-6 receptor antagonist groups, yielding a hazard ratio for the comparison with the control group of 1.61 (95% credible interval, 1.25 to 2.08) and a posterior probability of superiority of more than 99.9%. All secondary analyses supported efficacy of these interleukin-6 receptor antagonists. CONCLUSIONS: In critically ill patients with Covid-19 receiving organ support in ICUs, treatment with the interleukin-6 receptor antagonists tocilizumab and sarilumab improved outcomes, including survival. (REMAP-CAP ClinicalTrials.gov number, NCT02735707.). |*COVID-19 Drug Treatment[MESH] |Adult[MESH] |Aged[MESH] |Antibodies, Monoclonal, Humanized/adverse effects/*therapeutic use[MESH] |COVID-19/complications/mortality/therapy[MESH] |Critical Illness[MESH] |Female[MESH] |Hospital Mortality[MESH] |Humans[MESH] |Intensive Care Units[MESH] |Male[MESH] |Middle Aged[MESH] |Odds Ratio[MESH] |Receptors, Interleukin-6/*antagonists & inhibitors[MESH]Interleukin-6 Receptor Antagonists in Critically Ill Patients with Cov(epmc).pdf DeepDyve Pubget Overpricing