Evidence map›Paper›PMID 40360262›Full record

Trial reportThorax2025

Tocilizumab, sarilumab and anakinra in critically ill patients with COVID-19: a randomised, controlled, open-label, adaptive platform trial.

Lennie Derde, Anthony C Gordon, Paul R Mouncey, Farah Al-Beidh, Kathryn M Rowan, Alistair D Nichol, Yaseen M Arabi, Djillali Annane, Abigail Beane, Richard Beasley and 62 more

Registry-linked trialAbstract readRandomized Controlled TrialMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Thorax, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02735707 (Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community- Acquired Pneumonia), which is not on this map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT02735707 phase3recruitingnot on this map

Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community- Acquired Pneumonia

TypeinterventionalSponsorUMC UtrechtRan2016 to 2028Enrolled20,000ConditionsCommunity-acquired Pneumonia, Influenza, COVID-19ArmsCeftriaxone, Moxifloxacin or Levofloxacin, Piperacillin-tazobactam, Ceftaroline, Amoxicillin-clavulanate
3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Observational
  2. A precision approach to translational research in acute lung injury.American journal of respiratory and critical care medicine · 2026
    Article
  3. Article
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

72 authors.

Lennie DerdeIntensive Care Center, University Medical Centre, Utrecht, Netherlands.
Anthony C GordonImperial College London, London, UK.ORCID 0000-0002-0419-547X
Paul R MounceyIntensive Care National Audit and Research Centre, London, UK.
Farah Al-BeidhImperial College London, London, UK.
Kathryn M RowanIntensive Care National Audit and Research Centre, London, UK.
Alistair D NicholUniversity College Dublin, Dublin, Ireland.
Yaseen M ArabiCritical Care, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.ORCID 0000-0001-5735-6241
Djillali AnnaneService de Réanimation médicale et unité de ventilation à domicile, centre de référence neuromusculaire GNHM, CHU Raymond Poincaré, APHP, Université de Versailles Saint Quentin en Yvelines, Garches, France.
Abigail BeaneMahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.
Richard BeasleyMedical Research Institute, Wellington, New Zealand.ORCID 0000-0003-0337-406X
Marc J M BontenDepartment of Medical Microbiology, University Medical Center, Utrecht, Netherlands.
Charlotte A BradburyUniversity of Bristol, Bristol, UK.
Frank M BrunkhorstJena University Hospital, Jena, Germany.
Adrian BuzgauMonash University, Melbourne, Victoria, Australia.
Meredith BuxtonGlobal Coalition for Adaptive Research, Larkspur, California, USA.
Allen C ChengDepartment of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Nicola CooperImperial College London Faculty of Medicine, London, UK.
Matthew CoveNational University of Singapore, Singapore.
Olaf L CremerUMC, Utrecht, Netherlands.
Michelle A DetryBerry Consultants, Austin, Texas, USA.
Eamon J DuffyAuckland City Hospital, Auckland, New Zealand.
Lise J EstcourtUniversity of Oxford, Oxford, UK.
Mark FitzgeraldBerry Consultants, Austin, Texas, USA.
James GaleaNHS Blood and Transplant, Bristol, UK.
Herman GoossensMedical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.
Rashan HaniffaMahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand.
Thomas E HillsMedical Research Institute, Wellington, New Zealand.
David T HuangUniversity of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Nao IchiharaThe University of Tokyo, Bunkyo-ku, Tokyo, Japan.
Andrew KingNHS Blood and Transplant, Bristol, UK.
François LamontagneUniversite de Sherbrooke, Sherbrooke, Quebec, Canada.
Patrick R LawlerMcGill University Faculty of Medicine, Montreal, Quebec, Canada.
Helen L LeavisUMC, Utrecht, Netherlands.
Roger J LewisBerry Consultants, Austin, Texas, USA.
Edward LittonThe University of Western Australia, Perth, Western Australia, Australia.
John C MarshallUniversity of Toronto, Toronto, Ontario, Canada.
Florian B MayrCritical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.ORCID 0000-0002-2298-9011
Daniel F McAuleyICU, QUB, Belfast, UK.
Anna McGlothlinBerry Consultants, Austin, Texas, USA.
Shay P McGuinnessAuckland City Hospital, Auckland, New Zealand.
Bryan J McVerryPulmonary Allergy and Critical Care Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA.
Susan C MorpethMiddlemore Hospital, Auckland, Auckland, New Zealand.
Srinivas MurthyThe University of British Columbia, Vancouver, British Columbia, Canada srinivas.murthy@ubc.ca.ORCID 0000-0002-9476-839X
Mihai G NeteaRadboud Universitair Medisch Centrum, Nijmegen, Netherlands.
Kayode OgungbenroThe University of Manchester, Manchester, UK.
Katrina OrrFiona Stanley Hospital, Murdoch, Western Australia, Australia.
Rachael L ParkeThe University of Auckland, Auckland, New Zealand.
Jane C ParkerMonash University, Melbourne, Victoria, Australia.
Asad E PatanwalaAuckland City Hospital, Auckland, New Zealand.
Ville PettilaUniversity of Helsinki, Helsinki, Finland.
Luis Felipe ReyesUniversidad de La Sabana, Chia, Colombia.ORCID 0000-0003-1172-6539
Hiroki SaitoSt Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
Marlene S SantosUnity Health Toronto, Toronto, Ontario, Canada.
Christina T SaundersBerry Consultants, Austin, Texas, USA.
Christopher W SeymourUniversity of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Manu Shankar-HariCentre for Inflammation Research, The University of Edinburgh College of Medicine and Veterinary Medicine, Edinburgh, UK.ORCID 0000-0002-5338-2538
Wendy I SliglUniversity of Alberta, Edmonton, Alberta, Canada.
Alexis F TurgeonUniversite Laval, Quebec, Quebec, Canada.
Anne M TurnerMedical Research Institute, Wellington, New Zealand.
Steven Y C TongThe Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
Suvi VaaraUniversity of Helsinki, Helsinki, Finland.
Taryn YoungsteinImperial College London, London, UK.
Ryan ZarychanskiUniversity of Manitoba, Winnipeg, Manitoba, Canada.
Cameron GreenMonash University, Melbourne, Victoria, Australia.
Alisa M HigginsANZIC-RC, SPHPM, Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, Victoria, Australia.ORCID 0000-0001-8295-7559
Colin J McArthurAuckland City Hospital, Auckland, New Zealand.
Lindsay R BerryBerry Consultants, Austin, Texas, USA.
Elizabeth LorenziBerry Consultants, Austin, Texas, USA.
Scott BerryBerry Consultants, Austin, Texas, USA.
Steve A WebbMonash University, Clayton, Victoria, Australia.
Derek C AngusUniversity of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Frank L van de VeerdonkDepartment of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands.

Funding

Wellcome Trust
6 · The paper itself

Abstract

introductionTocilizumab improves outcomes in critically ill patients with COVID-19. Whether other immune-modulator strategies are equally effective or better is unknown.

methodsWe investigated treatment with tocilizumab, sarilumab, anakinra and no immune modulator in these patients. In this ongoing, adaptive platform trial in 133 sites in 9 countries, we randomly assigned patients with allocation ratios dependent on the number of interventions available at each site. The primary outcome was an ordinal scale combining in-hospital mortality (assigned -1) and days free of organ support to day 21 in survivors. The trial used a Bayesian statistical model with predefined triggers for superiority, inferiority, efficacy, equivalence or futility.

resultsOf 2274 critically ill participants enrolled between 25 March 2020 and 10 April 2021, 972 were assigned to tocilizumab, 485 to sarilumab, 378 to anakinra and 418 to control. Median organ support-free days were 7 (IQR -1, 16), 9 (IQR -1, 17), 0 (IQR -1, 15) and 0 (IQR -1, 15) for tocilizumab, sarilumab, anakinra and control, respectively. Median adjusted ORs were 1.46 (95% credible intervals (CrI) 1.13, 1.87), 1.50 (95% CrI 1.13, 2.00) and 0.99 (95% CrI 0.74, 1.35) for tocilizumab, sarilumab and anakinra relative to control, yielding 99.8%, 99.8% and 46.6% posterior probabilities of superiority, respectively, compared with control. All treatments appeared safe.

conclusionsIn critically ill patients with COVID-19, tocilizumab and sarilumab have equivalent effectiveness at reducing duration of organ support and death. Anakinra is not effective in this population. TRIAL REGISTRATION NUMBER: NCT02735707.

Indexed as

Antibodies, Monoclonal, HumanizedCOVID-19 Drug TreatmentInterleukin 1 Receptor Antagonist ProteinAgedCOVID-19Critical IllnessFemaleHospital MortalityHumansMaleMiddle AgedSARS-CoV-2Treatment OutcomeAntibodies, Monoclonal, HumanizedInterleukin 1 Receptor Antagonist ProteinsarilumabtocilizumabCOVID-19Critical CarePneumonia

Identifiers

PMID40360262
PMCPMC12322455

What Socratic holds

Textmetadata
LicenceCC BY
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.