Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Evaluating productivity gaps in maize production across different agroecological zones in Ghana

This paper evaluates the performance of maize farmers in three agroecological zones in Ghana. A metafrontier model is used to estimate the average technical efficiencies and maize productivty gaps across the agroecological zones. The results shows that land, labour and fertilizer significantly influence maize production. Managerial performance of farmers is influenced by land ownership, access to credit, monocropping, and participation in farmer based organisations across the agroecological zones. Additionally, the maize production technology in the Forest zone was found to be superior. Accordingly, farmers in Guinea Savanna and Transition zones can increase productivity by adopting prevailing improved technologies and good agronomic practices in the Forest zone. Such effort can be enhanced through increasing farmers' access to extension, credit, and participation in farmer based organisations

Hand pollination, mass spraying, and hybrid seedlings: Do these technologies affect the welfare of smallholder cocoa farmers in Ghana?

Adoption of cocoa production technologies has the potential to improve productivity and welfare of smallholder producers in low-income countries. While studies investigating synergies in agricultural technologies are growing, empirical evidence on the determinants and impacts of adopting multiple cocoa production technologies on smallholder farmers' welfare is scarce. Therefore, this study contributes by analyzing the determinants and effects of adoption of multiple cocoa production technologies on the welfare of smallholder farmers in Ghana. To achieve this, we used the multinomial endogenous switching regression and multivalued inverse probability regression adjustment models to a random sample of 2233 cocoa farmers from Ghana. The results show that various socioeconomic characteristics (e.g., farmer's age and experience), resource constraints (e.g., land ownership and credit access), market-related factors (e.g., distance to the market), and production shocks (e.g., rainfall) influence the adoption of multiple cocoa production technologies. Furthermore, the results reveal that adopting multiple production technologies significantly improves cocoa yields, gross income, per capita consumption expenditure, and reduces household food insecurity. Therefore, policies, such as financial support, need to be aimed at improving and strengthening smallholder cocoa producers' capacity to adopt synergistic conventional and non-conventional cocoa production technologies to maximize smallholder farmers' welfare

The Impact of Cooperative Membership on Fish Farm Households’ Income: The Case of Ghana

The emergence of agricultural cooperatives is extensively viewed as a necessary institutional arrangement that can help farmers in developing countries overcome the constraints that impede them from improving sustainable agricultural production and acquiring new marketing opportunities. Therefore, this study examines the determinants of cooperative membership and its impact on fish farm household income, using data collected from two regions in Ghana. An endogenous switching regression (ESR) model is utilized to address the potential sample selection bias issue. The results show that household heads’ decisions to join cooperatives are affected by their access to credit, off-farm work, education level, and peer influence. Cooperative membership can increase both household and farm income by 28.54% and 34.75%, respectively. Moreover, we show that different groups of households’ cooperative impacts on farm and household income are heterogeneous. Our findings highlight the importance of cooperative patronization and provide implications that can improve households’ welfare

The Impact of Cooperative Membership on Fish Farm Households’ Income: The Case of Ghana

The emergence of agricultural cooperatives is extensively viewed as a necessary institutional arrangement that can help farmers in developing countries overcome the constraints that impede them from improving sustainable agricultural production and acquiring new marketing opportunities. Therefore, this study examines the determinants of cooperative membership and its impact on fish farm household income, using data collected from two regions in Ghana. An endogenous switching regression (ESR) model is utilized to address the potential sample selection bias issue. The results show that household heads’ decisions to join cooperatives are affected by their access to credit, off-farm work, education level, and peer influence. Cooperative membership can increase both household and farm income by 28.54% and 34.75%, respectively. Moreover, we show that different groups of households’ cooperative impacts on farm and household income are heterogeneous. Our findings highlight the importance of cooperative patronization and provide implications that can improve households’ welfare