Published today in The Journal of the American Medical Association ( JAMA ), the study is part of the ongoing Randomized Embedded Multifactorial Adaptive Platform for Community Acquired Pneumonia (REMAP-CAP) trial and was led by Monash University’s Dr Lisa Higgins from the School of Public Health and Preventive Medicine.
The study found that among critically ill patients with COVID-19 randomised to receive one or more therapeutic interventions, treatment with an IL-6 receptor antagonist (tocilizumab or sarilumab), led to a greater than 99.9% probability of improved 6-month mortality, whilst antiplatelet agents had a 95% probability of improving 6-month survival.
Moreover, the study also showed that treatments which improve survival, such as interleukin-6 receptor antagonists, do not come at the expense of survival with increased disability or poorer health-related quality of life.
In contrast, longer-term outcomes were not improved with therapeutic anticoagulation, convalescent plasma, or lopinavir-ritonavir, and were worsened with hydroxychloroquine alone or in combination with lopinavir-ritonavir. Corticosteroids did not confer a high probability of improved longer-term survival, although enrolment into this domain was closed early in response to external evidence.
"While we have been treating critically ill patients with COVID-19 for nearly 3 years, we are still very much in the early stages of understanding the long-term survival, health-related quality of life, and disability among patients with critical illness due to COVID-19," said Dr Higgins.
"These findings have important clinical and research implications in COVID-19, and in critical care more generally, because they provide evidence that short-term within-hospital treatment effects are sustained longer-term."
The 4869 critically ill adult patients with COVID-19 were enrolled into the trial 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.
As an adaptive platform trial, REMAP CAP continues to evaluate new interventions for the treatment of both COVID-19 and other non-COVID 19 respiratory tract infections.
REMAP-CAP is an Australian-led global adaptive trial investigating multiple treatments for COVID-19 among patients in Intensive Care Units (ICUs). Run by Monash University’s Australian and New Zealand Intensive Care Research Centre , the trial mobilised to evaluate specific treatments for COVID-19 patients in ICUs in early March 2020.
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