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Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.
JAMA. 2020 10 06; 324(13):1317-1329.JAMA

Abstract

Importance

Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited.

Objective

To determine whether hydrocortisone improves outcome for patients with severe COVID-19.

Design, Setting, and Participants

An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020.

Interventions

The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108).

Main Outcomes and Measures

The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%).

Results

After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively.

Conclusions and Relevance

Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions.

Trial Registration

ClinicalTrials.gov Identifier: NCT02735707.

Authors+Show Affiliations

The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania.Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. Intensive Care Center, University Medical Center Utrecht, Utrecht, the Netherlands.Division of Anaesthetics, Pain Medicine and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom.Intensive Care Unit, Raymond Poincaré Hospital (AP-HP), Paris, France. Simone Veil School of Medicine, University of Versailles, Versailles, France. University Paris Saclay, Garches, France.Intensive Care Department, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia.Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom.Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.Berry Consultants LLC, Austin, Texas.Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands. Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands.Bristol Royal Informatory, Bristol, United Kingdom. University of Bristol, Bristol, United Kingdom.Center for Clinical Studies and Center for Sepsis Control and Care (CSCC), Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.Global Coalition for Adaptive Research, San Francisco, California.Helix, Monash University, Melbourne, Victoria, Australia.Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Victoria, Australia. Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.Department of Medical Microbiology, Amsterdam University Medical Center, University of Amsterdam, the Netherlands.Berry Consultants LLC, Austin, Texas.NHS Blood and Transplant, Bristol, United Kingdom. Transfusion Medicine, Medical Sciences Division, University of Oxford, Oxford, United Kingdom.Berry Consultants LLC, Austin, Texas.Department of Microbiology, Antwerp University Hospital, Antwerp, Belgium.Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka. Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania.Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia.Université de Sherbrooke, Sherbrooke, Quebec, Canada.Cardiac Intensive Care Unit, Peter Munk Cardiac Centre, University Health Network, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia.Berry Consultants LLC, Austin, Texas.Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada. Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada.Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom.Berry Consultants LLC, Austin, Texas.Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand. The Health Research Council of New Zealand, Wellington, New Zealand. Medical Research Institute of New Zealand, Wellington, New Zealand.Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania.Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom.University of British Columbia School of Medicine, Vancouver, Canada.Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. Department of Anesthesia and Intensive Care, St Vincent's University Hospital, Dublin, Ireland. School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland. Department of Intensive Care, Alfred Health, Melbourne, Victoria, Australia.Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Auckland, New Zealand. The Health Research Council of New Zealand, Wellington, New Zealand. Medical Research Institute of New Zealand, Wellington, New Zealand. School of Nursing, University of Auckland, Auckland, New Zealand.Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.Clinical Trials Unit, Intensive Care National Audit & Research Centre (ICNARC), London, United Kingdom.Berry Consultants LLC, Austin, Texas.Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada.Berry Consultants LLC, Austin, Texas.The Clinical Research Investigation and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. The UPMC Health System Office of Healthcare Innovation, Pittsburgh, Pennsylvania.Medical Research Institute of New Zealand, Wellington, New Zealand.Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.Southside Clinical Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia. The George Institute for Global Health, Sydney, Australia.Department of Medicine, Critical Care and Hematology/Medical Oncology, University of Manitoba, Winnipeg, Manitoba, Canada.Berry Consultants LLC, Austin, Texas.Berry Consultants LLC, Austin, Texas. Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California. Department of Emergency Medicine, David Geffen School of Medicine at University of California, Los Angeles.Medical Research Institute of New Zealand, Wellington, New Zealand. Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand.Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia. St John of God Hospital, Subiaco, Western Australia, Australia.Division of Anaesthetics, Pain Medicine and Intensive Care Medicine, Department of Surgery and Cancer, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info 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Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32876697

Citation

Angus, Derek C., et al. "Effect of Hydrocortisone On Mortality and Organ Support in Patients With Severe COVID-19: the REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial." JAMA, vol. 324, no. 13, 2020, pp. 1317-1329.
Angus DC, Derde L, Al-Beidh F, et al. Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial. JAMA. 2020;324(13):1317-1329.
Angus, D. C., Derde, L., Al-Beidh, F., Annane, D., Arabi, Y., Beane, A., van Bentum-Puijk, W., Berry, L., Bhimani, Z., Bonten, M., Bradbury, C., Brunkhorst, F., Buxton, M., Buzgau, A., Cheng, A. C., de Jong, M., Detry, M., Estcourt, L., Fitzgerald, M., ... Summers, C. (2020). Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial. JAMA, 324(13), 1317-1329. https://doi.org/10.1001/jama.2020.17022
Angus DC, et al. Effect of Hydrocortisone On Mortality and Organ Support in Patients With Severe COVID-19: the REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial. JAMA. 2020 10 6;324(13):1317-1329. PubMed PMID: 32876697.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial. AU - Angus,Derek C, AU - Derde,Lennie, AU - Al-Beidh,Farah, AU - Annane,Djillali, AU - Arabi,Yaseen, AU - Beane,Abigail, AU - van Bentum-Puijk,Wilma, AU - Berry,Lindsay, AU - Bhimani,Zahra, AU - Bonten,Marc, AU - Bradbury,Charlotte, AU - Brunkhorst,Frank, AU - Buxton,Meredith, AU - Buzgau,Adrian, AU - Cheng,Allen C, AU - de Jong,Menno, AU - Detry,Michelle, AU - Estcourt,Lise, AU - Fitzgerald,Mark, AU - Goossens,Herman, AU - Green,Cameron, AU - Haniffa,Rashan, AU - Higgins,Alisa M, AU - Horvat,Christopher, AU - Hullegie,Sebastiaan J, AU - Kruger,Peter, AU - Lamontagne,Francois, AU - Lawler,Patrick R, AU - Linstrum,Kelsey, AU - Litton,Edward, AU - Lorenzi,Elizabeth, AU - Marshall,John, AU - McAuley,Daniel, AU - McGlothin,Anna, AU - McGuinness,Shay, AU - McVerry,Bryan, AU - Montgomery,Stephanie, AU - Mouncey,Paul, AU - Murthy,Srinivas, AU - Nichol,Alistair, AU - Parke,Rachael, AU - Parker,Jane, AU - Rowan,Kathryn, AU - Sanil,Ashish, AU - Santos,Marlene, AU - Saunders,Christina, AU - Seymour,Christopher, AU - Turner,Anne, AU - van de Veerdonk,Frank, AU - Venkatesh,Balasubramanian, AU - Zarychanski,Ryan, AU - Berry,Scott, AU - Lewis,Roger J, AU - McArthur,Colin, AU - Webb,Steven A, AU - Gordon,Anthony C, AU - ,, AU - Al-Beidh,Farah, AU - Angus,Derek, AU - Annane,Djillali, AU - Arabi,Yaseen, AU - van Bentum-Puijk,Wilma, AU - Berry,Scott, AU - Beane,Abigail, AU - Bhimani,Zahra, AU - Bonten,Marc, AU - Bradbury,Charlotte, AU - Brunkhorst,Frank, AU - Buxton,Meredith, AU - Cheng,Allen, AU - De Jong,Menno, AU - Derde,Lennie, AU - Estcourt,Lise, AU - Goossens,Herman, AU - Gordon,Anthony, AU - Green,Cameron, AU - Haniffa,Rashan, AU - Lamontagne,Francois, AU - Lawler,Patrick, AU - Litton,Edward, AU - Marshall,John, AU - McArthur,Colin, AU - McAuley,Daniel, AU - McGuinness,Shay, AU - McVerry,Bryan, AU - Montgomery,Stephanie, AU - Mouncey,Paul, AU - Murthy,Srinivas, AU - Nichol,Alistair, AU - Parke,Rachael, AU - Rowan,Kathryn, AU - Seymour,Christopher, AU - Turner,Anne, AU - van de Veerdonk,Frank, AU - 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Laffey,John, AU - McAuley,Danny, AU - Orford,Neil, AU - Neto,Ary, AU - Detry,Michelle, AU - Fitzgerald,Mark, AU - Lewis,Roger, AU - McGlothlin,Anna, AU - Sanil,Ashish, AU - Saunders,Christina, AU - Berry,Lindsay, AU - Lorenzi,Elizabeth, AU - Miller,Eliza, AU - Singh,Vanessa, AU - Zammit,Claire, AU - van Bentum Puijk,Wilma, AU - Bouwman,Wietske, AU - Mangindaan,Yara, AU - Parker,Lorraine, AU - Peters,Svenja, AU - Rietveld,Ilse, AU - Raymakers,Kik, AU - Ganpat,Radhika, AU - Brillinger,Nicole, AU - Markgraf,Rene, AU - Ainscough,Kate, AU - Brickell,Kathy, AU - Anjum,Aisha, AU - Lane,Janis-Best, AU - Richards-Belle,Alvin, AU - Saull,Michelle, AU - Wiley,Daisy, AU - Bion,Julian, AU - Connor,Jason, AU - Gates,Simon, AU - Manax,Victoria, AU - van der Poll,Tom, AU - Reynolds,John, AU - van Beurden,Marloes, AU - Effelaar,Evelien, AU - Schotsman,Joost, AU - Boyd,Craig, AU - Harland,Cain, AU - Shearer,Audrey, AU - Wren,Jess, AU - Clermont,Giles, AU - Garrard,William, AU - Kalchthaler,Kyle, AU - King,Andrew, AU - Ricketts,Daniel, AU - Malakoutis,Salim, AU - Marroquin,Oscar, AU - Music,Edvin, AU - Quinn,Kevin, AU - Cate,Heidi, AU - Pearson,Karen, AU - Collins,Joanne, AU - Hanson,Jane, AU - Williams,Penny, AU - Jackson,Shane, AU - Asghar,Adeeba, AU - Dyas,Sarah, AU - Sutu,Mihaela, AU - Murphy,Sheenagh, AU - Williamson,Dawn, AU - Mguni,Nhlanhla, AU - Potter,Alison, AU - Porter,David, AU - Goodwin,Jayne, AU - Rook,Clare, AU - Harrison,Susie, AU - Williams,Hannah, AU - Campbell,Hilary, AU - Lomme,Kaatje, AU - Williamson,James, AU - Sheffield,Jonathan, AU - van’t Hoff,Willian, AU - McCracken,Phobe, AU - Young,Meredith, AU - Board,Jasmin, AU - Mart,Emma, AU - Knott,Cameron, AU - Smith,Julie, AU - Boschert,Catherine, AU - Affleck,Julia, AU - Ramanan,Mahesh, AU - D’Souza,Ramsy, AU - Pateman,Kelsey, AU - Shakih,Arif, AU - Cheung,Winston, AU - Kol,Mark, AU - Wong,Helen, AU - Shah,Asim, AU - Wagh,Atul, AU - Simpson,Joanne, AU - Duke,Graeme, AU - Chan,Peter, AU - Cartner,Brittney, AU - Hunter,Stephanie, AU - Laver,Russell, AU - Shrestha,Tapaswi, AU - Regli,Adrian, AU - Pellicano,Annamaria, AU - McCullough,James, AU - Tallott,Mandy, AU - Kumar,Nikhil, AU - Panwar,Rakshit, AU - Brinkerhoff,Gail, AU - Koppen,Cassandra, AU - Cazzola,Federica, AU - Brain,Matthew, AU - Mineall,Sarah, AU - Fischer,Roy, AU - Biradar,Vishwanath, AU - Soar,Natalie, AU - White,Hayden, AU - Estensen,Kristen, AU - Morrison,Lynette, AU - Smith,Joanne, AU - Cooper,Melanie, AU - Health,Monash, AU - Shehabi,Yahya, AU - Al-Bassam,Wisam, AU - Hulley,Amanda, AU - Whitehead,Christina, AU - Lowrey,Julie, AU - Gresha,Rebecca, AU - Walsham,James, AU - Meyer,Jason, AU - Harward,Meg, AU - Venz,Ellen, AU - Williams,Patricia, AU - Kurenda,Catherine, AU - Smith,Kirsy, AU - Smith,Margaret, AU - Garcia,Rebecca, AU - Barge,Deborah, AU - Byrne,Deborah, AU - Byrne,Kathleen, AU - Driscoll,Alana, AU - Fortune,Louise, AU - Janin,Pierre, AU - Yarad,Elizabeth, AU - Hammond,Naomi, AU - Bass,Frances, AU - Ashelford,Angela, AU - Waterson,Sharon, AU - Wedd,Steve, AU - McNamara,Robert, AU - Buhr,Heidi, AU - Coles,Jennifer, AU - Schweikert,Sacha, AU - Wibrow,Bradley, AU - Rauniyar,Rashmi, AU - Myers,Erina, AU - Fysh,Ed, AU - Dawda,Ashlish, AU - Mevavala,Bhaumik, AU - Litton,Ed, AU - Ferrier,Janet, AU - Nair,Priya, AU - Buscher,Hergen, AU - Reynolds,Claire, AU - Santamaria,John, AU - Barbazza,Leanne, AU - Homes,Jennifer, AU - Smith,Roger, AU - Murray,Lauren, AU - Brailsford,Jane, AU - Forbes,Loretta, AU - Maguire,Teena, AU - Mariappa,Vasanth, AU - Smith,Judith, AU - Simpson,Scott, AU - Maiden,Matthew, AU - Bone,Allsion, AU - Horton,Michelle, AU - Salerno,Tania, AU - Sterba,Martin, AU - Geng,Wenli, AU - Depuydt,Pieter, AU - De Waele,Jan, AU - De Bus,Liesbet, AU - Fierens,Jan, AU - Bracke,Stephanie, AU - Reeve,Brenda, AU - Dechert,William, AU - Chassé,Michaël, AU - Carrier,François Martin, AU - Boumahni,Dounia, AU - Benettaib,Fatna, AU - Ghamraoui,Ali, AU - Bellemare,David, AU - Cloutier,Ève, AU - Francoeur,Charles, AU - Lamontagne,François, AU - D’Aragon,Frédérick, AU - Carbonneau,Elaine, AU - Leblond,Julie, AU - Vazquez-Grande,Gloria, AU - Marten,Nicole, AU - Wilson,Maggie, AU - Albert,Martin, AU - Serri,Karim, AU - Cavayas,Alexandros, AU - Duplaix,Mathilde, AU - Williams,Virginie, AU - Rochwerg,Bram, AU - Karachi,Tim, AU - Oczkowski,Simon, AU - Centofanti,John, AU - Millen,Tina, AU - Duan,Erick, AU - Tsang,Jennifer, AU - Patterson,Lisa, AU - English,Shane, AU - Watpool,Irene, AU - Porteous,Rebecca, AU - Miezitis,Sydney, AU - McIntyre,Lauralyn, AU - Brochard,Laurent, AU - Burns,Karen, AU - Sandhu,Gyan, AU - Khalid,Imrana, AU - Binnie,Alexandra, AU - Powell,Elizabeth, AU - McMillan,Alexandra, AU - Luk,Tracy, AU - Aref,Noah, AU - Andric,Zdravko, AU - Cviljevic,Sabina, AU - Đimoti,Renata, AU - Zapalac,Marija, AU - Mirković,Gordan, AU - Baršić,Bruno, AU - Kutleša,Marko, AU - Kotarski,Viktor, AU - Vujaklija Brajković,Ana, AU - Babel,Jakša, AU - Sever,Helena, AU - Dragija,Lidija, AU - Kušan,Ira, AU - Vaara,Suvi, AU - Pettilä,Leena, AU - Heinonen,Jonna, AU - Kuitunen,Anne, AU - Karlsson,Sari, AU - Vahtera,Annukka, AU - Kiiski,Heikki, AU - Ristimäki,Sanna, AU - Azaiz,Amine, AU - Charron,Cyril, AU - Godement,Mathieu, AU - Geri,Guillaume, AU - Vieillard-Baron,Antoine, AU - Pourcine,Franck, AU - Monchi,Mehran, AU - Luis,David, AU - Mercier,Romain, AU - Sagnier,Anne, AU - Verrier,Nathalie, AU - Caplin,Cecile, AU - Siami,Shidasp, AU - Aparicio,Christelle, AU - Vautier,Sarah, AU - Jeblaoui,Asma, AU - Fartoukh,Muriel, AU - Courtin,Laura, AU - Labbe,Vincent, AU - Leparco,Cécile, AU - Muller,Grégoire, AU - Nay,Mai-Anh, AU - Kamel,Toufik, AU - Benzekri,Dalila, AU - Jacquier,Sophie, AU - Mercier,Emmanuelle, AU - Chartier,Delphine, AU - Salmon,Charlotte, AU - Dequin,PierreFrançois, AU - Schneider,Francis, AU - Morel,Guillaume, AU - L’Hotellier,Sylvie, AU - Badie,Julio, AU - Berdaguer,Fernando Daniel, AU - Malfroy,Sylvain, AU - Mezher,Chaouki, AU - Bourgoin,Charlotte, AU - Megarbane,Bruno, AU - Voicu,Sebastian, AU - Deye,Nicolas, AU - Malissin,Isabelle, AU - Sutterlin,Laetitia, AU - Guitton,Christophe, AU - Darreau,Cédric, AU - Landais,Mickaël, AU - Chudeau,Nicolas, AU - Robert,Alain, AU - Moine,Pierre, AU - Heming,Nicholas, AU - Maxime,Virginie, AU - Bossard,Isabelle, AU - Nicholier,Tiphaine Barbarin, AU - Colin,Gwenhael, AU - Zinzoni,Vanessa, AU - Maquigneau,Natacham, AU - Finn,André, AU - Kreβ,Gabriele, AU - Hoff,Uwe, AU - Friedrich Hinrichs,Carl, AU - Nee,Jens, AU - Pletz,Mathias, AU - Hagel,Stefan, AU - Ankert,Juliane, AU - Kolanos,Steffi, AU - Bloos,Frank, AU - Petros,Sirak, AU - Pasieka,Bastian, AU - Kunz,Kevin, AU - Appelt,Peter, AU - Schütze,Bianka, AU - Kluge,Stefan, AU - Nierhaus,Axel, AU - Jarczak,Dominik, AU - Roedl,Kevin, AU - Weismann,Dirk, AU - Frey,Anna, AU - Klinikum Neukölln,Vivantes, AU - Reill,Lorenz, AU - Distler,Michael, AU - Maselli,Astrid, AU - Bélteczki,János, AU - Magyar,István, AU - Fazekas,Ágnes, AU - Kovács,Sándor, AU - Szőke,Viktória, AU - Szigligeti,Gábor, AU - Leszkoven,János, AU - Collins,Daniel, AU - Breen,Patrick, AU - Frohlich,Stephen, AU - Whelan,Ruth, AU - McNicholas,Bairbre, AU - Scully,Michael, AU - Casey,Siobhan, AU - Kernan,Maeve, AU - Doran,Peter, AU - O’Dywer,Michael, AU - Smyth,Michelle, AU - Hayes,Leanne, AU - Hoiting,Oscar, AU - Peters,Marco, AU - Rengers,Els, AU - Evers,Mirjam, AU - Prinssen,Anton, AU - Bosch Ziekenhuis,Jeroen, AU - Simons,Koen, AU - Rozendaal,Wim, AU - Polderman,F, AU - de Jager,P, AU - Moviat,M, AU - Paling,A, AU - Salet,A, AU - Rademaker,Emma, AU - Peters,Anna Linda, AU - de Jonge,E, AU - Wigbers,J, AU - Guilder,E, AU - Butler,M, AU - Cowdrey,Keri-Anne, AU - Newby,Lynette, AU - Chen,Yan, AU - Simmonds,Catherine, AU - McConnochie,Rachael, AU - Ritzema Carter,Jay, AU - Henderson,Seton, AU - Van Der Heyden,Kym, AU - Mehrtens,Jan, AU - Williams,Tony, AU - Kazemi,Alex, AU - Song,Rima, AU - Lai,Vivian, AU - Girijadevi,Dinu, AU - Everitt,Robert, AU - Russell,Robert, AU - Hacking,Danielle, AU - Buehner,Ulrike, AU - Williams,Erin, AU - Browne,Troy, AU - Grimwade,Kate, AU - Goodson,Jennifer, AU - Keet,Owen, AU - Callender,Owen, AU - Martynoga,Robert, AU - Trask,Kara, AU - Butler,Amelia, AU - Schischka,Livia, AU - Young,Chelsea, AU - Lesona,Eden, AU - Olatunji,Shaanti, AU - Robertson,Yvonne, AU - José,Nuno, AU - Amaro dos Santos Catorze,Teodoro, AU - de Lima Pereira,Tiago Nuno Alfaro, AU - Neves Pessoa,Lucilia Maria, AU - Castro Ferreira,Ricardo Manuel, AU - Pereira Sousa Bastos,Joana Margarida, AU - Aysel Florescu,Simin, AU - Stanciu,Delia, AU - Zaharia,Miahela Florentina, AU - Kosa,Alma Gabriela, AU - Codreanu,Daniel, AU - Marabi,Yaseen, AU - Al Qasim,Eman, AU - Moneer Hagazy,Mohamned, AU - Al Swaidan,Lolowa, AU - Arishi,Hatim, AU - Muñoz-Bermúdez,Rosana, AU - Marin-Corral,Judith, AU - Salazar Degracia,Anna, AU - Parrilla Gómez,Francisco, AU - Mateo López,Maria Isabel, AU - Rodriguez Fernandez,Jorge, AU - Cárcel Fernández,Sheila, AU - Carmona Flores,Rosario, AU - León López,Rafael, AU - de la Fuente Martos,Carmen, AU - Allan,Angela, AU - Polgarova,Petra, AU - Farahi,Neda, AU - McWilliam,Stephen, AU - Hawcutt,Daniel, AU - Rad,Laura, AU - O’Malley,Laura, AU - Whitbread,Jennifer, AU - Kelsall,Olivia, AU - Wild,Laura, AU - Thrush,Jessica, AU - Wood,Hannah, AU - Austin,Karen, AU - Donnelly,Adrian, AU - Kelly,Martin, AU - O’Kane,Sinéad, AU - McClintock,Declan, AU - Warnock,Majella, AU - Johnston,Paul, AU - Gallagher,Linda Jude, AU - Mc Goldrick,Clare, AU - Mc Master,Moyra, AU - Strzelecka,Anna, AU - Jha,Rajeev, AU - Kalogirou,Michael, AU - Ellis,Christine, AU - Krishnamurthy,Vinodh, AU - Deelchand,Vashish, AU - Silversides,Jon, AU - McGuigan,Peter, AU - Ward,Kathryn, AU - O’Neill,Aisling, AU - Finn,Stephanie, AU - Phillips,Barbara, AU - Mullan,Dee, AU - Oritz-Ruiz de Gordoa,Laura, AU - Thomas,Matthew, AU - Sweet,Katie, AU - Grimmer,Lisa, AU - Johnson,Rebekah, AU - Pinnell,Jez, AU - Robinson,Matt, AU - Gledhill,Lisa, AU - Wood,Tracy, AU - Morgan,Matt, AU - Cole,Jade, AU - Hill,Helen, AU - Davies,Michelle, AU - Antcliffe,David, AU - Templeton,Maie, AU - Rojo,Roceld, AU - Coghlan,Phoebe, AU - Smee,Joanna, AU - Mackay,Euan, AU - Cort,Jon, AU - Whileman,Amanda, AU - Spencer,Thomas, AU - Spittle,Nick, AU - Kasipandian,Vidya, AU - Patel,Amit, AU - Allibone,Suzanne, AU - Genetu,Roman Mary, AU - Ramali,Mohamed, AU - Ghosh,Alison, AU - Bamford,Peter, AU - London,Emily, AU - Cawley,Kathryn, AU - Faulkner,Maria, AU - Jeffrey,Helen, AU - Smith,Tim, AU - Brewer,Chris, AU - Gregory,Jane, AU - Limb,James, AU - Cowton,Amanda, AU - O’Brien,Julie, AU - Nikitas,Nikitas, AU - Wells,Colin, AU - Lankester,Liana, AU - Pulletz,Mark, AU - Williams,Patricia, AU - Birch,Jenny, AU - Wiseman,Sophie, AU - Horton,Sarah, AU - Alegria,Ana, AU - Turki,Salah, AU - Elsefi,Tarek, AU - Crisp,Nikki, AU - Allen,Louise, AU - McCullagh,Iain, AU - Robinson,Philip, AU - Hays,Carole, AU - Babio-Galan,Maite, AU - Stevenson,Hannah, AU - Khare,Divya, AU - Pinder,Meredith, AU - Selvamoni,Selvin, AU - Gopinath,Amitha, AU - Pugh,Richard, AU - Menzies,Daniel, AU - Mackay,Callum, AU - Allan,Elizabeth, AU - Davies,Gwyneth, AU - Puxty,Kathryn, AU - McCue,Claire, AU - Cathcart,Susanne, AU - Hickey,Naomi, AU - Ireland,Jane, AU - Yusuff,Hakeem, AU - Isgro,Graziella, AU - Brightling,Chris, AU - Bourne,Michelle, AU - Craner,Michelle, AU - Watters,Malcolm, AU - Prout,Rachel, AU - Davies,Louisa, AU - Pegler,Suzannah, AU - Kyeremeh,Lynsey, AU - Arbane,Gill, AU - Wilson,Karen, AU - Gomm,Linda, AU - Francia,Federica, AU - Brett,Stephen, AU - Sousa Arias,Sonia, AU - Elin Hall,Rebecca, AU - Budd,Joanna, AU - Small,Charlotte, AU - Birch,Janine, AU - Collins,Emma, AU - Henning,Jeremy, AU - Bonner,Stephen, AU - Hugill,Keith, AU - Cirstea,Emanuel, AU - Wilkinson,Dean, AU - Karlikowski,Michal, AU - Sutherland,Helen, AU - Wilhelmsen,Elva, AU - Woods,Jane, AU - North,Julie, AU - Sundaran,Dhinesh, AU - Hollos,Laszlo, AU - Coburn,Susan, AU - Walsh,Joanne, AU - Turns,Margaret, AU - Hopkins,Phil, AU - Smith,John, AU - Noble,Harriet, AU - Depante,Maria Theresa, AU - Clarey,Emma, AU - Laha,Shondipon, AU - 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Smallwood,Andrew, AU - Harris,Nichola, AU - Metherell,Stella, AU - Lazaro,Juan Martin, AU - Newman,Tabitha, AU - Fletcher,Simon, AU - Nortje,Jurgens, AU - Fottrell-Gould,Deirdre, AU - Randell,Georgina, AU - Zaman,Mohsin, AU - Elmahi,Einas, AU - Jones,Andrea, AU - Hall,Kathryn, AU - Mills,Gary, AU - Ryalls,Kim, AU - Bowler,Helen, AU - Sall,Jas, AU - Bourne,Richard, AU - Borrill,Zoe, AU - Duncan,Tracey, AU - Lamb,Thomas, AU - Shaw,Joanne, AU - Fox,Claire, AU - Moreno Cuesta,Jeronimo, AU - Xavier,Kugan, AU - Purohit,Dharam, AU - Elhassan,Munzir, AU - Bakthavatsalam,Dhanalakshmi, AU - Rowland,Matthew, AU - Hutton,Paula, AU - Bashyal,Archana, AU - Davidson,Neil, AU - Hird,Clare, AU - Chhablani,Manish, AU - Phalod,Gunjan, AU - Kirkby,Amy, AU - Archer,Simon, AU - Netherton,Kimberley, AU - Reschreiter,Henrik, AU - Camsooksai,Julie, AU - Patch,Sarah, AU - Jenkins,Sarah, AU - Pogson,David, AU - Rose,Steve, AU - Daly,Zoe, AU - Brimfield,Lutece, AU - Claridge,Helen, AU - Parekh,Dhruv, AU - Bergin,Colin, AU - Bates,Michelle, AU - Dasgin,Joanne, AU - McGhee,Christopher, AU - Sim,Malcolm, AU - Hay,Sophie Kennedy, AU - Henderson,Steven, AU - Phull,Mandeep-Kaur, AU - Zaidi,Abbas, AU - Pogreban,Tatiana, AU - Rosaroso,Lace Paulyn, AU - Harvey,Daniel, AU - Lowe,Benjamin, AU - Meredith,Megan, AU - Ryan,Lucy, AU - Hormis,Anil, AU - Walker,Rachel, AU - Collier,Dawn, AU - Kimpton,Sarah, AU - Oakley,Susan, AU - Rooney,Kevin, AU - Rodden,Natalie, AU - Hughes,Emma, AU - Thomson,Nicola, AU - McGlynn,Deborah, AU - Walden,Andrew, AU - Jacques,Nicola, AU - Coles,Holly, AU - Tilney,Emma, AU - Vowell,Emma, AU - Schuster-Bruce,Martin, AU - Pitts,Sally, AU - Miln,Rebecca, AU - Purandare,Laura, AU - Vamplew,Luke, AU - Spivey,Michael, AU - Bean,Sarah, AU - Burt,Karen, AU - Moore,Lorraine, AU - Day,Christopher, AU - Gibson,Charly, AU - Gordon,Elizabeth, AU - Zitter,Letizia, AU - Keenan,Samantha, AU - Baker,Evelyn, AU - Cherian,Shiney, AU - Cutler,Sean, AU - Roynon-Reed,Anna, AU - Harrington,Kate, AU - Raithatha,Ajay, AU - Bauchmuller,Kris, AU - Ahmad,Norfaizan, AU - Grecu,Irina, AU - Trodd,Dawn, AU - Martin,Jane, AU - Wrey Brown,Caroline, AU - Arias,Ana-Marie, AU - Craven,Thomas, AU - Hope,David, AU - Singleton,Jo, AU - Clark,Sarah, AU - Rae,Nicola, AU - Welters,Ingeborg, AU - Hamilton,David Oliver, AU - Williams,Karen, AU - Waugh,Victoria, AU - Shaw,David, AU - Puthucheary,Zudin, AU - Martin,Timothy, AU - Santos,Filipa, AU - Uddin,Ruzena, AU - Somerville,Alastair, AU - Tatham,Kate Colette, AU - Jhanji,Shaman, AU - Black,Ethel, AU - Dela Rosa,Arnold, AU - Howle,Ryan, AU - Tully,Redmond, AU - Drummond,Andrew, AU - Dearden,Joy, AU - Philbin,Jennifer, AU - Munt,Sheila, AU - Vuylsteke,Alain, AU - Chan,Charles, AU - Victor,Saji, AU - Matsa,Ramprasad, AU - Gellamucho,Minerva, AU - Creagh-Brown,Ben, AU - Tooley,Joe, AU - Montague,Laura, AU - De Beaux,Fiona, AU - Bullman,Laetitia, AU - Kersiake,Ian, AU - Demetriou,Carrie, AU - Mitchard,Sarah, AU - Ramos,Lidia, AU - White,Katie, AU - Donnison,Phil, AU - Johns,Maggie, AU - Casey,Ruth, AU - Mattocks,Lehentha, AU - Salisbury,Sarah, AU - Dark,Paul, AU - Claxton,Andrew, AU - McLachlan,Danielle, AU - Slevin,Kathryn, AU - Lee,Stephanie, AU - Hulme,Jonathan, AU - Joseph,Sibet, AU - Kinney,Fiona, AU - Senya,Ho Jan, AU - Oborska,Aneta, AU - Kayani,Abdul, AU - Hadebe,Bernard, AU - Orath Prabakaran,Rajalakshmi, AU - Nichols,Lesley, AU - Thomas,Matt, AU - Worner,Ruth, AU - Faulkner,Beverley, AU - Gendall,Emma, AU - Hayes,Kati, AU - Hamilton-Davies,Colin, AU - Chan,Carmen, AU - Mfuko,Celina, AU - Abbass,Hakam, AU - Mandadapu,Vineela, AU - Leaver,Susannah, AU - Forton,Daniel, AU - Patel,Kamal, AU - Paramasivam,Elankumaran, AU - Powell,Matthew, AU - Gould,Richard, AU - Wilby,Elizabeth, AU - Howcroft,Clare, AU - Banach,Dorota, AU - Fernández de Pinedo Artaraz,Ziortza, AU - Cabreros,Leilani, AU - White,Ian, AU - Croft,Maria, AU - Holland,Nicky, AU - Pereira,Rita, AU - Zaki,Ahmed, AU - Johnson,David, AU - Jackson,Matthew, AU - Garrard,Hywel, AU - Juhaz,Vera, AU - Roy,Alistair, AU - Rostron,Anthony, AU - Woods,Lindsey, AU - Cornell,Sarah, AU - Pillai,Suresh, AU - Harford,Rachel, AU - Rees,Tabitha, AU - Ivatt,Helen, AU - Sundara Raman,Ajay, AU - Davey,Miriam, AU - Lee,Kelvin, AU - Barber,Russell, AU - Chablani,Manish, AU - Brohi,Farooq, AU - Jagannathan,Vijay, AU - Clark,Michele, AU - Purvis,Sarah, AU - Wetherill,Bill, AU - Dushianthan,Ahilanandan, AU - Cusack,Rebecca, AU - de Courcy-Golder,Kim, AU - Smith,Simon, AU - Jackson,Susan, AU - Attwood,Ben, AU - Parsons,Penny, AU - Page,Valerie, AU - Zhao,Xiao Bei, AU - Oza,Deepali, AU - Rhodes,Jonathan, AU - Anderson,Tom, AU - Morris,Sheila, AU - Xia Le Tai,Charlotte, AU - Thomas,Amy, AU - Keen,Alexandra, AU - Digby,Stephen, AU - Cowley,Nicholas, AU - Wild,Laura, AU - Southern,David, AU - Reddy,Harsha, AU - Campbell,Andy, AU - Watkins,Claire, AU - Smuts,Sara, AU - Touma,Omar, AU - Barnes,Nicky, AU - Alexander,Peter, AU - Felton,Tim, AU - Ferguson,Susan, AU - Sellers,Katharine, AU - Bradley-Potts,Joanne, AU - Yates,David, AU - Birkinshaw,Isobel, AU - Kell,Kay, AU - Marshall,Nicola, AU - Carr-Knott,Lisa, AU - Summers,Charlotte, PY - 2020/9/3/pubmed PY - 2020/11/5/medline PY - 2020/9/3/entrez SP - 1317 EP - 1329 JF - JAMA JO - JAMA VL - 324 IS - 13 N2 - Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/32876697/Effect_of_Hydrocortisone_on_Mortality_and_Organ_Support_in_Patients_With_Severe_COVID_19:_The_REMAP_CAP_COVID_19_Corticosteroid_Domain_Randomized_Clinical_Trial_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2020.17022 DB - PRIME DP - Unbound Medicine ER -