Arabi et al. NCT02735707 REMAP-CAP HCQ RCT ICU PATIENTS
Is very late treatment with HCQ beneficial for COVID-19?
RCT 402 patients in multiple countries
Higher mortality with HCQ (p=0.015)
Arabi et al., Intensive Care Medicine
Lopinavir-ritonavir and hydroxychloroquine for critically ill patients with COVID-19: REMAP-CAP randomized controlled trial
Arabi et al.
Lopinavir-ritonavir and hydroxychloroquine for critically ill patients with COVID-19: REMAP-CAP randomized..
Intensive Care Medicine, REMAP-CAP, NCT02735707
Very late stage RCT with 50 ICU patients treated with HCQ, 255 lopinavir-ritonavir patients, and 27 combined therapy patients, showing higher mortality with all treatments.
the longer term followup results reported in Higgins et al. are included in meta analysis.
risk of death, , treatment 17 of 49 (34.7%), control 106 of 353 (30.0%), adjusted per study, inverted to make RR<1 favor treatment, odds ratio converted to relative risk, multivariable.
44.5% higher, RR 1.44, p = 0.01
Effect extraction follows
pre-specified rules prioritizing more serious outcomes. Submit updates
Arabi et al., 12 Jul 2021, Randomized Controlled Trial, multiple countries, peer-reviewed, 1 author, trial
Abstract: Intensive Care Med (2021) 47:867–886
Lopinavir‑ritonavir and hydroxychloroquine
for critically ill patients with COVID‑19:
REMAP‑CAP randomized controlled trial
Yaseen M. Arabi1,2,3* , Anthony C. Gordon4,5, Lennie P. G. Derde6,7, Alistair D. Nichol8,9,10, Srinivas Murthy11,
Farah Al Beidh4, Djillali Annane12,13,14, Lolowa Al Swaidan2,3,15, Abi Beane16, Richard Beasley17, Lindsay R. Berry18,
Zahra Bhimani19, Marc J. M. Bonten7,20, Charlotte A. Bradbury21,22, Frank M. Brunkhorst23, Meredith Buxton24,
Adrian Buzgau25, Allen Cheng25,26, Menno De Jong27, Michelle A. Detry18, Eamon J. Duffy28, Lise J. Estcourt29,30,
Mark Fitzgerald18, Rob Fowler31,32,33, Timothy D. Girard34,35, Ewan C. Goligher36, Herman Goossens37,
Rashan Haniffa38,39,40, Alisa M. Higgins9, Thomas E. Hills17,41, Christopher M. Horvat34,35,42, David T. Huang34,35,
Andrew J. King35, Francois Lamontagne43,44, Patrick R. Lawler31,36,45, Roger Lewis18,46, Kelsey Linstrum34,35,
Edward Litton47,48,49, Elizabeth Lorenzi18, Salim Malakouti50, Daniel F. McAuley51,52, Anna McGlothlin18,
Shay Mcguinness17,25,53, Bryan J. McVerry34,35, Stephanie K. Montgomery34,35, Susan C. Morpeth54,
Paul R. Mouncey55, Katrina Orr56, Rachael Parke17,53,57, Jane C. Parker9, Asad E. Patanwala58,59,
Kathryn M. Rowan60, Marlene S. Santos19, Christina T. Saunders18, Christopher W. Seymour34,35,
Manu Shankar‑Hari61,62, Steven Y. C. Tong63,64, Alexis F. Turgeon65,66, Anne M. Turner17,
Frank Leo Van de Veerdonk67, Ryan Zarychanski68, Cameron Green9, Scott Berry18, John C. Marshall19,69,
Colin McArthur70, Derek C. Angus34,35 and Steven A. Webb9,48 on behalf of the REMAP-CAP Investigators
© 2021 Springer-Verlag GmbH Germany, part of Springer Nature
Purpose: To study the efficacy of lopinavir-ritonavir and hydroxychloroquine in critically ill patients with coronavirus
disease 2019 (COVID-19).
Methods: Critically ill adults with COVID-19 were randomized to receive lopinavir-ritonavir, hydroxychloroquine,
combination therapy of lopinavir-ritonavir and hydroxychloroquine or no antiviral therapy (control). The primary
endpoint was an ordinal scale of organ support-free days. Analyses used a Bayesian cumulative logistic model and
expressed treatment effects as an adjusted odds ratio (OR) where an OR > 1 is favorable.
Results: We randomized 694 patients to receive lopinavir-ritonavir (n = 255), hydroxychloroquine (n = 50), combina‑
tion therapy (n = 27) or control (n = 362). The median organ support-free days among patients in lopinavir-ritonavir,
hydroxychloroquine, and combination therapy groups was 4 (– 1 to 15), 0 (– 1 to 9) and—1 (– 1 to 7), respectively,
Intensive Care Department, Ministry of the National Guard-Health
Affairs, ICU 1425, P.O. Box 22490, Riyadh 11426, Kingdom of Saudi Arabia
Full author information is available at the end of the article
The members of “The REMAP-CAP Investigators” are listed in
compared to 6 (– 1 to 16) in the control group with in-hospital mortality of 88/249 (35%), 17/49 (35%), 13/26 (50%),
respectively, compared to 106/353 (30%) in the control group. The three interventions decreased organ supportfree days compared to control (OR [95% credible interval]: 0.73 [0.55, 0.99], 0.57 [0.35, 0.83] 0.41 [0.24, 0.72]), yielding
posterior probabilities that reached the threshold futility (≥ 99.0%), and high probabilities of harm (98.0%, 99.9%
and > 99.9%,..
is less effective
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