According to recent data, treatment with interleukin (IL)–6 receptor antagonists or antiplatelet agents improved survival and outcomes at 6 months in patients who were critically ill with COVID-19. Neither lopinavir-ritonavir nor convalescent plasma improved survival, and survival was worsened with hydroxychloroquine.
Researchers analyzed data for 4869 adult patients who were critically ill with COVID-19 between March 2020 and June 2021 at 197 sites in 14 countries. A 180-day follow-up was completed in March 2022. The patients were admitted to an intensive care unit and received respiratory or cardiovascular organ support. The researchers examined survival through day 180. Of the total patient population, 4107 had a known mortality status, and 2590 were alive at day 180. Patients who died by day 180 numbered 1517; 91 deaths (6%) occurred between hospital discharge and day 180. Overall, the use of IL-6 receptor antagonists (either sarilumab or tocilizumab) had a greater than 99.9% probability of improving 6-month survival compared with control therapies.
In contrast, long-term survival did not improve with convalescent plasma (54.7%) or lopinavir-ritonavir (31.9%). The probability of trial-defined statistical futility was high for convalescent plasma (99.2%) and lopinavir-ritonavir (96.6%). Long-term survival was worsened with hydroxychloroquine, with a posterior probability of harm of 96.9%. In addition, the combination of lopinavir-ritonavir and hydroxychloroquine had a 96.8% probability of harm.
In a subgroup analysis of 989 patients, health-related quality of life at day 180 was higher among those treated with IL-6 receptor antagonists and average quality-of-life score for the lopinavir-ritonavir group was lower than for control patients. Among 720 survivors, 273 patients (37.9%) had moderate, severe, or complete disability at day 180. IL-6 receptor antagonists had a 92.6% probability of reducing disability, and anakinra (an IL-1 receptor antagonist) had a 90.8% probability of reducing disability. However, lopinavir-ritonavir had a 91.7% probability of worsening disability.
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Cite this: Mary L. Windle. Rapid Rx Quiz: COVID-19 Treatment Updates - Medscape - Aug 22, 2023.