Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19.

BACKGROUND: The efficacy of interleukin-6 receptor antagonists in critically ill patients with coronavirus disease 2019 (Covid-19) is unclear. METHODS: We evaluated tocilizumab and sarilumab in an ongoing international, multifactorial, adaptive platform trial. Adult patients with Covid-19, within 24 hours after starting organ support in the intensive care unit (ICU), were randomly assigned to receive tocilizumab (8 mg per kilogram of body weight), sarilumab (400 mg), or standard care (control). The primary outcome was respiratory and cardiovascular organ support-free days, on an ordinal scale combining in-hospital death (assigned a value of -1) and days free of organ support to day 21. The trial uses a Bayesian statistical model with predefined criteria for superiority, efficacy, equivalence, or futility. An odds ratio greater than 1 represented improved survival, more organ support-free days, or both. RESULTS: Both tocilizumab and sarilumab met the predefined criteria for efficacy. At that time, 353 patients had been assigned to tocilizumab, 48 to sarilumab, and 402 to control. The median number of organ support-free days was 10 (interquartile range, -1 to 16) in the tocilizumab group, 11 (interquartile range, 0 to 16) in the sarilumab group, and 0 (interquartile range, -1 to 15) in the control group. The median adjusted cumulative odds ratios were 1.64 (95% credible interval, 1.25 to 2.14) for tocilizumab and 1.76 (95% credible interval, 1.17 to 2.91) for sarilumab as compared with control, yielding posterior probabilities of superiority to control of more than 99.9% and of 99.5%, respectively. An analysis of 90-day survival showed improved survival in the pooled interleukin-6 receptor antagonist groups, yielding a hazard ratio for the comparison with the control group of 1.61 (95% credible interval, 1.25 to 2.08) and a posterior probability of superiority of more than 99.9%. All secondary analyses supported efficacy of these interleukin-6 receptor antagonists. CONCLUSIONS: In critically ill patients with Covid-19 receiving organ support in ICUs, treatment with the interleukin-6 receptor antagonists tocilizumab and sarilumab improved outcomes, including survival. (REMAP-CAP ClinicalTrials.gov number, NCT02735707.)

'A slice of life' : food narratives and menus from mass-observers in 1982 and 1945

This paper reports on an analysis of hitherto unexamined documentary data on food held within the UK Mass Observation Archive (MOA). In particular it discusses responses to the 1982 Winter Directive which asked MOA correspondents about their experiences of food and eating, and the food diaries submitted by MOA panel members in 1945. What is striking about these data is the extent to which memories of food and eating are interwoven with recollections of the lifecourse; in particular social relations, family life, and work. It seems asking people about food generates insight into aspects of everyday life. In essence, memories of food provide a crucial and potentially overlooked medium for developing an appreciation of social change. We propose the concept 'food narratives' to capture the essence of these reflections because they reveal something more than personal stories; they are both individual and collective experiences in that personal food narratives draw upon shared cultural repertoires, generational memories, and tensions between age cohorts. Food narratives are embodied and embedded in social networks, socio-cultural contexts and socio-economic epochs. Thus the daily menus recorded in 1945 and memories scribed in 1982 do not simply communicate what people ate, liked and disliked but throw light on two contrasting moments of British history; the end of the second world war and an era of transition, reform, individualization, diversity which was taking place in the early 1980s