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Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19

Gordon et al., New England Journal of Medicine, doi:10.1056/NEJMoa2100433, REMAP-CAP, NCT02735707
Apr 2021  
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Mortality, concurrent 26% Improvement Relative Risk Mortality, inc. non-concur.. 50% Sarilumab  REMAP-CAP  LATE TREATMENT  RCT Is late treatment with sarilumab beneficial for COVID-19? RCT 442 patients in multiple countries Lower mortality with sarilumab (not stat. sig., p=0.39) c19early.org Gordon et al., New England J. Medicine, Apr 2021 Favorssarilumab Favorscontrol 0 0.5 1 1.5 2+
RCT 803 critically ill COVID-19 patients showing improved outcomes with tocilizumab and sarilumab. There was only 48 sarilumab patients and the model used shrinks the posterior distribution for each intervention effect toward the overall estimate for the combined drugs. The concurrent event counts for sarilumab may be more accurate.
risk of death, 26.3% lower, RR 0.74, p = 0.39, treatment 10 of 45 (22.2%), control 19 of 63 (30.2%), NNT 13, concurrent control patients.
risk of death, 50.2% lower, HR 0.50, p = 0.048, treatment 45, control 397, inverted to make HR<1 favor treatment, including non-concurrent control patients.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Gordon et al., 22 Apr 2021, Randomized Controlled Trial, multiple countries, peer-reviewed, 62 authors, trial NCT02735707 (history) (REMAP-CAP).
This PaperSarilumabAll
Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19
A C Gordon, P R Mouncey, F Al-Beidh, K M Rowan, A D Nichol, Y M Arabi, D Annane, A Beane, W Van Bentum-Puijk, L R Berry, Z Bhimani, M J M Bonten, C A Bradbury, F M Brunkhorst, A Buzgau, A C Cheng, M A Detry, E J Duffy, L J Est- Court, M Fitzgerald, H Goossens, R Haniffa, A M Higgins, T E Hills, C M Horvat, F Lamontagne, P R Lawler, H L Leavis, K M Linstrum, E Litton, E Lo- Renzi, J C Marshall, F B Mayr, D F Mcauley, A Mcglothlin, S P Mcguin- Ness, B J Mcverry, S K Montgomery, S C Morpeth, S Murthy, K Orr, R L Parke, J C Parker, A E Patanwala, V Pet- Tilä, M.S E Rademaker, C T Santos, C W Saunders, M Seymour, W I Shankar-Hari, A F Sligl, A M Turgeon, F L Turner, R Van De Veerdonk, C Zarychanski, R J Green, D C Lewis, C J Angus, S Mc- Arthur, S A Berry, L P G Webb, Derde
New England Journal of Medicine, doi:10.1056/nejmoa2100433
19) is unclear.
Appendix The members of the writing committee are as follows: Prof.
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Late treatment
is less effective
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