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Ad26.COV2.S vaccine is a replication-incompetent human adenovirus type 26 vector containing the gene sequence that produces SARS-CoV-2 spike protein in a prefusion-stabilized conformation. In a randomized trial involving nearly 40,000 persons, vaccine efficacy was 66% against moderate to severe–critical Covid-19 and 85% against severe–critical Covid-19. Efficacy against the variant first identified in South Africa was 64% against moderate disease and 82% against severe–critical disease.

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. 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). 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). 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. UK Research and Innovation (Medical Research Council) and National Institute of Health Research.

In this randomized trial involving 438 hospitalized patients with severe Covid-19 pneumonia, the use of the monoclonal antibody tocilizumab did not result in significantly better clinical status or lower mortality than placebo at 28 days.

The interleukin-6 receptor blockers tocilizumab and sarilumab were tested against standard care in a randomized trial involving patients newly admitted to the intensive care unit and requiring respiratory or blood-pressure support. The median number of organ support–free days was 10 with tocilizumab, 11 with sarilumab, and 0 with standard care.

Hospitalized adults with severe Covid-19 pneumonia were randomly assigned in a 2:1 ratio to receive convalescent plasma or placebo. At 30 days, no significant difference in clinical status was noted between the two groups. Overall mortality was 11.43% with placebo and 10.96% with convalescent plasma, a difference that was not significant.

In a randomized trial, the risk of mechanical ventilation or death among patients hospitalized with Covid-19 pneumonia (56.0% Hispanic or Latino, 14.9% Black, and 12.7% American Indian or Alaska Native) was 12.0% in the tocilizumab group and 19.3% in the placebo group. Tocilizumab did not increase survival.

Patients who were seen in emergency departments within 7 days after the onset of Covid-19 symptoms and were considered appropriate for discharge were randomly assigned to receive either convalescent plasma or placebo. Convalescent plasma did not prevent disease progression.

Among hospitalized patients with Covid-19, treatment with dexamethasone resulted in lower 28-day mortality than usual care, according to the level of respiratory support the patients were receiving, indicating a possible correlation between efficacy and the stage of infection.

The randomized trial assessing the efficacy of a single injection of the Ad26.COV2.S showed 56.3% vaccine efficacy beginning 14 days after injection and 52.9% efficacy more than 28 days after injection against moderate to severe–critical Covid-19. Protection lasted at least 6 months without an added boost. Vaccination was associated with mild-to-moderate adverse effects.

In an observational study involving nearly 440,000 veterans, both the BNT162b2 vaccine and the mRNA-1273 vaccine were highly effective at preventing infection, hospitalization, and death from Covid-19. Infection risks were approximately 21% lower with mRNA-1273 than with BNT162b2. Follow-up included periods when either the alpha variant or the delta variant was dominant.