Respiratory Trials·org

Topic

COVID-19

What the pandemic trials established about steroids, antivirals, and respiratory support.

Dexamethasone is the pandemic's most consequential result. It reduced 28-day mortality in patients receiving oxygen or invasive ventilation, and not in those needing neither (RECOVERY dexamethasone). The subgroup structure is the finding rather than a caveat: benefit tracks the severity of respiratory failure. IL-6 receptor blockade added further benefit in critically ill patients (REMAP-CAP IL-6).

Antivirals performed better on paper than in the populations that followed. Remdesivir shortened recovery by five days without a clear mortality benefit (ACTT-1). Nirmatrelvir-ritonavir cut hospitalisation or death by 89% (EPIC-HR) — in unvaccinated, previously uninfected, high-risk adults facing an earlier variant, which is the context anyone quoting that number needs.

Escalated anticoagulation did not help the critically ill (REMAP-CAP anticoagulation), despite the thrombosis rates that prompted it empirically. The trial was stopped for futility.

The methodological legacy may outlast the therapeutic one: adaptive platform trials answered these questions in months, and have since been turned on other diseases.

Anticoagulation in COVID-19

Trial Year Therapy Effect Finding
REMAP-CAP anticoagulation 2021 Therapeutic-dose heparin Full-dose anticoagulation did not help critically ill COVID-19 patients

Antivirals in hospitalised patients

Trial Year Therapy Effect Finding
ACTT-1 2020 Remdesivir Remdesivir shortened time to recovery by five days without a clear mortality benefit

Antivirals in outpatients

Trial Year Therapy Effect Finding
EPIC-HR 2022 Nirmatrelvir-ritonavir Nirmatrelvir-ritonavir cut hospitalisation or death by 89% in unvaccinated high-risk outpatients

Corticosteroids in COVID-19

Trial Year Therapy Effect Finding
RECOVERY dexamethasone 2021 Dexamethasone Dexamethasone reduced mortality in COVID-19 patients needing oxygen, and not in those who did not

Immunomodulation in critical COVID-19

Trial Year Therapy Effect Finding
REMAP-CAP IL-6 2021 Tocilizumab or sarilumab IL-6 receptor blockade improved organ support-free days and survival in critical COVID-19

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