NEJM:反转!白介素-6受体拮抗剂可改善危重症新冠肺炎患者预后!

2021-02-26 MedSci原创 MedSci原创

白介素-6受体拮抗剂可改善危重症新冠肺炎患者预后

迄今为止,全球新冠肺炎COVID-19)死亡病例已超过252万例。只有糖皮质激素已知可改善重症肺炎患者生存率。白细胞介素-6受体(IL-6R)拮抗剂对新冠肺炎重症患者的疗效一直争议不决。

Tocilizumab(托珠单抗)和Sarilumab都是IL-6R的单克隆抗体,被用于治疗炎性疾病,如风湿性关节炎以及嵌合抗原受体(CAR)T细胞治疗后的细胞因子释放综合征。

一项正在进行的国际性、多因素、适应性平台试验评估了托珠单抗和sarilumab对重症新冠肺炎患者预后的影响。在重症监护病房(ICU)开始器官支持后24小时内,成年患者被随机分组接受托珠单抗(8 mg/kg)、sarilumab(400 mg)或标准护理(对照组)。主要预后是无呼吸和血管器官支持天数。

无器官支持天数

托珠单抗和sarilumab均达到了预定的疗效标准。353名患者被分到托珠单抗组、48名被分到sarilumab组、402名患者被分到对照组。托珠单抗组无器官支持天数的中位数为10天(四分位数区间为-1至16),sarilumab组的为11天(0至16),对照组的为0(-1至15)。与对照组相比,托珠单抗组调整后的累积优势比中位数为1.64(95%CI 1.25~2.14),sarilumab组的调整后累积优势比为1.76(95%CI 1.17~2.91),后验优势概率分别超过了99.9%和99.5%。

多种预后指标分析

90天存活率分析表明,白介素6受体拮抗剂组的存活率较对照组有所提高,与对照组相比,风险比为1.61(95%可信区间为1.25至2.08),后验优势概率超过了99.9%。所有二级分析都支持这些IL-6R拮抗剂的疗效。

总上,对于ICU接受器官支持的新冠肺炎危重症患者,白细胞介素6受体拮抗剂托珠单抗和sarilumab治疗可改善预后,包括生存期。

原始出处:

REMAP-CAP Investigators,Gordon Anthony C,Mouncey Paul R et al. Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19.[J] .N Engl J Med, 2021,https://doi.org/10.1056/NEJMoa2100433

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    2022-04-18 屋顶瞄爱赏月

    学习了!

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    2021-02-28 1464d6c6m53暂无昵称

    去年上半年,曾与同事讨论过关于与白介素-6相关的单抗有可能可以治疗新冠的话题。

    0

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  7. 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createdTime=Sat Jul 17 06:41:55 CST 2021, time=2021-07-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=944139, encodeId=9d39944139b0, content=去年上半年,曾与同事讨论过关于与白介素-6相关的单抗有可能可以治疗新冠的话题。, beContent=null, objectType=article, channel=null, level=null, likeNumber=105, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=46905128057, createdName=1464d6c6m53暂无昵称, createdTime=Sun Feb 28 11:34:01 CST 2021, time=2021-02-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1372151, encodeId=b4b713e21511c, content=<a href='/topic/show?id=6ca1e1621c4' target=_blank style='color:#2F92EE;'>#白介素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=71621, encryptionId=6ca1e1621c4, topicName=白介素)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0e95336, 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  8. 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style='color:#2F92EE;'>#新冠肺炎#</a>已经有很多报道了,结论不一致!, beContent=null, objectType=article, channel=null, level=null, likeNumber=442, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17616, encryptionId=8c2a1e616fd, topicName=tocilizumab), TopicDto(id=54681, encryptionId=e0d7546812c, topicName=托珠单抗), TopicDto(id=58078, encryptionId=46ce580e865, topicName=新冠肺炎)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=健康达人, createdTime=Fri Feb 26 21:44:13 CST 2021, time=2021-02-26, status=1, ipAttribution=)]
    2021-02-27 公卫新人

    新冠肺炎,疫情何时才能消失

    0

  9. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Sat Feb 27 00:41:55 CST 2021, time=2021-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035590, encodeId=e10510355900d, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sat Feb 27 00:41:55 CST 2021, time=2021-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=943826, encodeId=8db194382664, content=<a href='/topic/show?id=8c2a1e616fd' target=_blank style='color:#2F92EE;'>#tocilizumab#</a>(<a href='/topic/show?id=e0d7546812c' target=_blank style='color:#2F92EE;'>#托珠单抗#</a>)治疗<a href='/topic/show?id=46ce580e865' target=_blank 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    2021-02-27 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

  10. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=公卫新人, createdTime=Sat Feb 27 00:41:55 CST 2021, time=2021-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035590, encodeId=e10510355900d, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=58, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sat Feb 27 00:41:55 CST 2021, time=2021-02-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=943826, encodeId=8db194382664, content=<a href='/topic/show?id=8c2a1e616fd' target=_blank style='color:#2F92EE;'>#tocilizumab#</a>(<a href='/topic/show?id=e0d7546812c' target=_blank style='color:#2F92EE;'>#托珠单抗#</a>)治疗<a href='/topic/show?id=46ce580e865' target=_blank style='color:#2F92EE;'>#新冠肺炎#</a>已经有很多报道了,结论不一致!, beContent=null, objectType=article, channel=null, level=null, likeNumber=442, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17616, encryptionId=8c2a1e616fd, topicName=tocilizumab), TopicDto(id=54681, encryptionId=e0d7546812c, topicName=托珠单抗), TopicDto(id=58078, encryptionId=46ce580e865, topicName=新冠肺炎)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=健康达人, createdTime=Fri Feb 26 21:44:13 CST 2021, time=2021-02-26, status=1, ipAttribution=)]
    2021-02-26 健康达人

    #tocilizumab##托珠单抗#)治疗#新冠肺炎#已经有很多报道了,结论不一致!

    0

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