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

A molecular phylogeny of annelids

Copyright © The Willi Hennig Society 2006.Vincent Rousset, Fredrik Pleijel, Greg W. Rouse, Christer Erséus and Mark E. Siddal

Population dynamics and secondary production of Euzonus furciferus Ehlers (Polychaeta, Opheliidae) in an exposed sandy beach of Southern Brazil Dinâmica populacional e produção secundaria de Euzonus furciferus Ehlers (Polychaeta, Opheliidae) numa praia exposta do sul do Brasil

The distribution, population dynamics and secondary production of the polychaete Euzonus furciferus was studied in Atami Beach (Southern Brazil), from February 1992 to March 1993. Euzonus furciferus Ehlers, 1897 is the only deposit feeder species of the upper intertidal region. The organisms were present in the sandy beach all over the year, concentrated in a narrow band, and reaching maximal densities of 3,029 individuals m-2. Peaks of abundance occurred in September 1992, with a mean of 681.8 individuals m-2. Recruitment occurred in winter, with a peak in July. Mean annual biomass was estimated in 0.218 gAFDW m-2, with a total annual production of 0.466 gAFDW m-2 y-1, giving a P/B ratio of 2.13 y-1. Similar values were found for a filter-feeder polychaete inhabiting the same beach, suggesting that general food disposability of each particular environment is more important for production than the trophic strategic employed by those organisms exploring this environment.<br>A dinâmica populacional e a produção secundária do poliqueta Euzonus furciferus foi estudada em uma praia arenosa exposta do sul do Brasil. O estudo foi realizado na praia de Atami, de fevereiro de 1992 a março de 1993. Euzonus furciferus Ehlers, 1897 é a única espécie comedora de depósito da região superior do intermareal. Os organismos foram encontrados na praia ao longo de todo o ano, concentrados em uma estreita faixa, e alcançando densidades máximas de 3.029 indivíduos.m-2. Picos de abundância ocorreram em setembro de 1992, com uma média de 681,8 indivíduos.m-2. O recrutamento ocorreu no inverno, com um pico em julho. A biomassa média anual foi estimada em 0,218 gPSLC m-2, com uma produção anual total de 0,466 gPSLC m-2ano-1, e com uma razão P/B de 2,13 ano-1. Valores similares foram encontrados para um poliqueta filtrador existentes na mesma praia, sugerindo que a disponibilidade geral de alimento para cada ambiente particular é mais importante para a produção do que a estratégia trófica empregada pelos organismos que exploram este ambiente