Utilisation des dispositifs de mesure de l’INR capillaire par les professionnels de santé en établissement d’hébergement pour personnes âgées dépendantes (EHPAD) pour la gestion des traitements antivitamine K par le médecin généraliste : une étude de faisabilité

Rationale. Surveillance of vitamin K antagonists (VKA) can be done by point-of-care INR testing.Methods. Prospective multicentric study assessing the feasibility of point-of-care INR testing performed by care givers in nursing homes for the elderly on VKA therapy.Results. During 9 months, 18 capillary INR have been performed in 9 patients (median age 90 years) in 3 different nrusing homes using the Coagucheck© XS Pro. Correlation between capillary and venous INR was good (r=0,959). All health care providers having used the device and general practitionners responsible for VKA prescription were in favour of capillary INR monitoringin nursing homes, thought to improve communication between them, patient comfort, INR surveillance and time in therapeutic range. The main impediment is the need for sufficient training of care givers in the use of the device.Conclusion. Point-of-care INR testing by care givers seems feasible in nursing homes for the elderly on VKA therapy.Rationnel. L'INR dans le suivi des antivitamine K (AVK) peut être mesuré par méthode capillaire.Matériel et méthodes. Étude prospective multicentrique de faisabilité de la mesure de l'INR capillaire par les soignants chez les résidents d'EHPAD sous AVK.Résultats. Pendant 9 mois, 18 INR capillaires ont été réalisés chez 9 patients (âge médian 90 ans) au sein de 3 EHPAD. Les INR capillaires et veineux étaient bien corrélés (r=0,959). La totalité des soignants ayant utilisé le dispositif et les médecins responsables du suivi étaient favorables au développement de cette méthode en EHPAD, dont les avantages seraient d'améliorer le confort du patient, la communication entre le personnel soignant et les médecins et les conditions de surveillance de l'INR. Le principal frein est la nécessité d'une formation suffisante des soignants à cette méthode.Conclusion. La mesure de l'INR capillaire par les soignants semble faisable pour les patients âgés sous AVK résidents d'EHPAD

Effect of anakinra versus usual care in adults in hospital with COVID-19 and mild-to-moderate pneumonia (CORIMUNO-ANA-1): a randomised controlled trial

International audienc

Effect of Tocilizumab vs Usual Care in Adults Hospitalized With COVID-19 and Moderate or Severe Pneumonia

International audienceImportance Severe pneumonia with hyperinflammation and elevated interleukin-6 is a common presentation of coronavirus disease 2019 (COVID-19).Objective To determine whether tocilizumab (TCZ) improves outcomes of patients hospitalized with moderate-to-severe COVID-19 pneumonia.Design, Setting, and Particpants This cohort-embedded, investigator-initiated, multicenter, open-label, bayesian randomized clinical trial investigating patients with COVID-19 and moderate or severe pneumonia requiring at least 3 L/min of oxygen but without ventilation or admission to the intensive care unit was conducted between March 31, 2020, to April 18, 2020, with follow-up through 28 days. Patients were recruited from 9 university hospitals in France. Analyses were performed on an intention-to-treat basis with no correction for multiplicity for secondary outcomes.Interventions Patients were randomly assigned to receive TCZ, 8 mg/kg, intravenously plus usual care on day 1 and on day 3 if clinically indicated (TCZ group) or to receive usual care alone (UC group). Usual care included antibiotic agents, antiviral agents, corticosteroids, vasopressor support, and anticoagulants.Main Outcomes and Measures Primary outcomes were scores higher than 5 on the World Health Organization 10-point Clinical Progression Scale (WHO-CPS) on day 4 and survival without need of ventilation (including noninvasive ventilation) at day 14. Secondary outcomes were clinical status assessed with the WHO-CPS scores at day 7 and day 14, overall survival, time to discharge, time to oxygen supply independency, biological factors such as C-reactive protein level, and adverse events.Results Of 131 patients, 64 patients were randomly assigned to the TCZ group and 67 to UC group; 1 patient in the TCZ group withdrew consent and was not included in the analysis. Of the 130 patients, 42 were women (32%), and median (interquartile range) age was 64 (57.1-74.3) years. In the TCZ group, 12 patients had a WHO-CPS score greater than 5 at day 4 vs 19 in the UC group (median posterior absolute risk difference [ARD] −9.0%; 90% credible interval [CrI], −21.0 to 3.1), with a posterior probability of negative ARD of 89.0% not achieving the 95% predefined efficacy threshold. At day 14, 12% (95% CI −28% to 4%) fewer patients needed noninvasive ventilation (NIV) or mechanical ventilation (MV) or died in the TCZ group than in the UC group (24% vs 36%, median posterior hazard ratio [HR] 0.58; 90% CrI, 0.33-1.00), with a posterior probability of HR less than 1 of 95.0%, achieving the predefined efficacy threshold. The HR for MV or death was 0.58 (90% CrI, 0.30 to 1.09). At day 28, 7 patients had died in the TCZ group and 8 in the UC group (adjusted HR, 0.92; 95% CI 0.33-2.53). Serious adverse events occurred in 20 (32%) patients in the TCZ group and 29 (43%) in the UC group (P = .21).Conclusions and Relevance In this randomized clinical trial of patients with COVID-19 and pneumonia requiring oxygen support but not admitted to the intensive care unit, TCZ did not reduce WHO-CPS scores lower than 5 at day 4 but might have reduced the risk of NIV, MV, or death by day 14. No difference on day 28 mortality was found. Further studies are necessary for confirming these preliminary results.Trial Registration ClinicalTrials.gov Identifier: NCT0433180

Sarilumab in adults hospitalised with moderate-to-severe COVID-19 pneumonia (CORIMUNO-SARI-1): An open-label randomised controlled trial

International audienc