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.

The brain is capable of producing coordinated fast changing neural dynamics across multiple brain regions in order to adapt to rapidly changing environments. However, it is non-trivial to identify multiregion dynamics at fast sub-second time-scales in electrophysiological data. We propose a method that, with no knowledge of any task timings, can simultaneously identify and describe fast transient multiregion dynamics in terms of their temporal, spectral and spatial properties. The approach models brain activity using a discrete set of sequential states, with each state distinguished by its own multiregion spectral properties. This can identify potentially very short-lived visits to a brain state, at the same time as inferring the state's properties, by pooling over many repeated visits to that state. We show how this can be used to compute state-specific measures such as power spectra and coherence. We demonstrate that this can be used to identify short-lived transient brain states with distinct power and functional connectivity (e.g., coherence) properties in an MEG data set collected during a volitional motor task.

Frequency-specific oscillations and phase-coupling of neuronal populations are essential mechanisms for the coordination of activity between brain areas during cognitive tasks. Therefore, the ongoing activity ascribed to the different functional brain networks should also be able to reorganise and coordinate via similar mechanisms. We develop a novel method for identifying large-scale phase-coupled network dynamics and show that resting networks in magnetoencephalography are well characterised by visits to short-lived transient brain states, with spatially distinct patterns of oscillatory power and coherence in specific frequency bands. Brain states are identified for sensory, motor networks and higher-order cognitive networks. The cognitive networks include a posterior alpha (8–12 Hz) and an anterior delta/theta range (1–7 Hz) network, both exhibiting high power and coherence in areas that correspond to posterior and anterior subdivisions of the default mode network. Our results show that large-scale cortical phase-coupling networks have characteristic signatures in very specific frequency bands, possibly reflecting functional specialisation at different intrinsic timescales.