Summary
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.
Introduction
The majority of SARS-CoV-2 infections are either asymptomatic or result in only mild disease.1 However, a substantial proportion of infected individuals develop a respiratory illness requiring hospital care, which can progress to critical illness with hypoxic respiratory failure requiring prolonged ventilatory support. Among COVID-19 patients admitted to UK hospitals in spring, 2020, the case fatality rate was over 26%, and was in excess of 37% in patients requiring invasive mechanical ventilation.2
Hypoxic respiratory failure in patients with COVID-19 is associated with evidence of systemic inflammation, including release of pro-inflammatory cytokines, such as interleukin (IL)-1, IL-6, and tumour necrosis factor α, and elevated concentrations of D-dimer, ferritin, and C-reactive protein (CRP).3, 4 The host immune response is thought to play a key role in driving an acute inflammatory pneumonic process with diffuse alveolar damage, myeloid cell infiltrates, and microvascular thrombosis.5 The beneficial effects of dexamethasone and other corticosteroids in COVID-19 patients with hypoxic lung damage suggest that other, more specific, immunomodulatory agents might provide additional improvements in clinical outcomes.6, 7
Tocilizumab is a recombinant humanised anti-IL-6 receptor monoclonal antibody that inhibits the binding of IL-6 to both membrane and soluble IL-6 receptors, blocking IL-6 signalling and reducing inflammation. Tocilizumab is licensed in the UK as an intravenous treatment for patients with rheumatoid arthritis and for people with chimeric antigen receptor T-cell-induced severe or life-threatening cytokine release syndrome. Randomised trials of tocilizumab in COVID-19 have so far shown mixed results for 28-day mortality: seven small trials reported no benefit and the somewhat larger REMAP-CAP trial reported a benefit in patients requiring organ support.8, 9, 10, 11, 12, 13, 14, 15 Here we report the results of a large randomised, controlled trial aimed at evaluating the effects of tocilizumab in adult patients hospitalised with severe COVID-19 characterised by hypoxia and substantial inflammation.
Research in context.
Evidence before this study
We searched MEDLINE, Embase, and MedRxiv from inception up to March 5, 2021, for clinical trials or meta-analyses evaluating the effect of interleukin-6 inhibitor treatment on patients with COVID-19 using the search terms (“COVID-19” OR “COVID” OR “SARS-CoV-2” OR “2019-nCoV” OR “coronavirus”) AND (“tocilizumab” OR “sarilumab” OR “interleukin-6 inhibitor” or “IL-6 inhibitor”).
We identified eight relevant randomised trials that compared tocilizumab with usual care or placebo in hospitalised patients with COVID-19. All were assessed as at low risk of bias. Of these trials, only the REMAP-CAP trial in critically ill patients found a significant reduction in 28-day mortality with tocilizumab. A meta-analysis of these eight trials, which included a total of 439 deaths among 2379 patients showed no significant difference in 28-day mortality (death rate ratio 0·89, 95% CI 0·72–1·11).
Added value of this study
The Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial is the largest randomised trial of the effect of tocilizumab in hospitalised patients with COVID-19. We found that in 4116 COVID-19 patients with hypoxia and a raised C-reactive protein, tocilizumab reduced 28-day mortality, increased the probability of discharge within 28 days, and, among patients who were not receiving invasive mechanical ventilation at randomisation, reduced the probability of progression to the composite outcome of invasive mechanical ventilation or death. The benefits were in addition to corticosteroids and consistent in all subgroups, regardless of the amount of respiratory support.
Implications of all the available evidence
Our finding shows that tocilizumab improves survival and other clinical outcomes in a broad group of patients hospitalised with COVID-19 and that these benefits are additional to those of corticosteroids.
Methods
Study design and participants
The Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial is an investigator-initiated, individually randomised, controlled, open-label, platform trial to evaluate the effects of potential treatments in patients hospitalised with COVID-19. Details of the trial design and results for other possible treatments have been published previously.6, 16, 17, 18 The trial is being done in acute National Health Service hospitals in the UK, supported by the National Institute for Health Research Clinical Research Network (appendix pp 2–25). The trial is coordinated by the Nuffield Department of Population Health at University of Oxford (Oxford, UK), the trial sponsor. The trial is being done in accordance with the principles of the International Conference on Harmonisation–Good Clinical Practice guidelines and is approved by the UK Medicines and Healthcare products Regulatory Agency and the Cambridge East Research Ethics Committee. The protocol, statistical analysis plan, and additional information are available on the study website. This report is limited to adult patients. The randomised assessment of tocilizumab in children younger than 18 years is ongoing.
Patients admitted to hospital were eligible for the study if they had clinically suspected or laboratory confirmed SARS-CoV-2 infection and no medical history that might, in the opinion of the attending clinician, put the patient at substantial risk if they were to participate in the trial. Written informed consent was obtained from all patients, or their legal representative if they were too unwell or unable to provide consent.
Randomisation and masking
Data were collected at study entry using a web-based case report form that included demographics and major comorbidities (appendix p 32). All eligible and consenting patients received usual standard of care and underwent an initial (main) randomisation comprising up to three parts in a factorial design (appendix pp 29–30): part 1, no additional treatment versus either dexamethasone, lopinavir–ritonavir, hydroxychloroquine, azithromycin, or colchicine; part 2, no additional treatment versus either convalescent plasma or REGN-COV2 (a combination of two monoclonal antibodies directed against SARS-CoV-2 spike protein); and part 3, no additional treatment versus aspirin. Over time, treatment groups were added to and removed from the protocol (appendix pp 26–29), and not all treatments were available at every hospital. Similarly, not all treatments were suitable for some patients (eg, owing to comorbid conditions or concomitant medication). In any of these cases, randomisation was between fewer groups.
Up to 21 days after the main randomisation and regardless of treatment allocation, RECOVERY trial participants with clinical evidence of progressive COVID-19 (defined as oxygen saturation <92% on room air or receiving oxygen therapy, and CRP ≥75 mg/L) could be considered for randomisation to tocilizumab versus usual care alone. Baseline data collected for this randomisation included amount of respiratory support, markers of progressive COVID-19 (including most recent oxygen saturation, CRP, ferritin, and creatinine result before second randomisation), suitability for the study treatment, and treatment availability at the site (appendix pp 33–34). For some patients, tocilizumab was unavailable at the hospital at the time of enrolment or was considered by the managing physician to be either definitely indicated or definitely contraindicated. In such cases, the patients were not eligible for the tocilizumab randomisation. Patients with known hypersensitivity to tocilizumab, evidence of active tuberculosis infection or clear evidence of active bacterial, fungal, viral, or other infection (besides COVID-19) were not eligible for randomisation to tocilizumab.
Patients who were eligible for randomisation to tocilizumab were assigned to either usual standard of care or usual standard of care plus tocilizumab in a 1:1 ratio by means of web-based simple (unstratified) randomisation with allocation concealed until after randomisation. Allocated treatment was prescribed by the managing doctor. Roche Products (Welwyn Garden City, UK) supported the trial through provision of tocilizumab. Participants and local study staff were not masked to the allocated treatment. The steering committee, investigators, and all others involved in the trial were masked to the outcome data during the trial.
Procedures
Patients allocated to tocilizumab were to receive tocilizumab as a single intravenous infusion over 60 min. The dose of tocilizumab was established by bodyweight (800 mg if weight >90 kg; 600 mg if weight >65 and ≤90 kg; 400 mg if weight >40 and ≤65 kg; and 8 mg/kg if weight ≤40 kg). A second dose could be given 12–24 h later if, in the opinion of the attending clinician, the patient's condition had not improved.
A single online follow-up form was completed when participants were discharged, had died, or at 28 days after the initial randomisation, whichever occurred earliest (appendix pp 35–41). Information was recorded on adherence to allocated study treatment, receipt of other COVID-19 treatments, duration of admission, receipt of respiratory or renal support, and vital status (including cause of death). In addition, routine health-care and registry data were obtained for the full follow-up period, including information on vital status (with date and cause of death), discharge from hospital, receipt of respiratory support, or renal replacement therapy.
Outcomes
Outcomes were assessed at 28 days after randomisation to tocilizumab versus usual care alone, with further analyses specified at 6 months. The primary outcome was all-cause mortality. Secondary outcomes were time to discharge from hospital, and, among patients not receiving invasive mechanical ventilation at randomisation, receipt of invasive mechanical ventilation (including extracorporeal membrane oxygenation) or death. Prespecified subsidiary clinical outcomes were use of non-invasive respiratory support (defined as high-flow nasal oxygen, continuous positive airway pressure, or non-invasive ventilation), time to successful cessation of invasive mechanical ventilation (defined as cessation of invasive mechanical ventilation within, and survival to, 28 days), and use of renal dialysis or haemofiltration. Prespecified safety outcomes included cause-specific mortality and major cardiac arrhythmia. Information on suspected serious adverse reactions was collected in an expedited fashion to comply with regulatory requirements.
Statistical analysis
In accordance with the statistical analysis plan (version 2.1, appendix pp 93–117), an intention-to-treat comparison was done between patients who entered the randomised comparison of tocilizumab versus usual care. For the primary outcome of 28-day mortality, the log-rank observed minus expected statistic and its variance were used to test the null hypothesis of equal survival curves (ie, the log-rank test) and to calculate the one-step estimate of the average mortality rate ratio. We constructed Kaplan-Meier survival curves to display cumulative mortality over the 28-day period. We used the same method to analyse time to hospital discharge and successful cessation of invasive mechanical ventilation, with patients who died in hospital right-censored on day 29. For the prespecified composite secondary outcome of invasive mechanical ventilation or death within 28 days (among those not receiving invasive mechanical ventilation at randomisation) and the subsidiary clinical outcomes of receipt of ventilation and receipt of haemodialysis or haemofiltration, the precise dates were not available and so the risk ratio was estimated instead.
Prespecified analyses of the primary outcome were done in subgroups defined by six characteristics at the time of randomisation: age, sex, ethnicity, amount of respiratory support, days since symptom onset, and use of systemic corticosteroids (including dexamethasone). Observed effects within subgroup categories were compared by means of a χ2 test for heterogeneity or trend, in accordance with the prespecified analysis plan.
Estimates of rate and risk ratios are shown with 95% CIs. All p values are two-sided and are shown without adjustment for multiple testing. The full database is held by the study team which collected the data from study sites and did the analyses at the Nuffield Department of Population Health, University of Oxford (Oxford, UK).
Before commencement of the randomisation to tocilizumab versus usual care, the trial steering committee determined that if 28-day mortality in the usual care group was above 25% then recruitment of around 4000 patients to this comparison would provide 90% power at two-sided p=0·01 to detect a proportional reduction in 28-day mortality of one-fifth. Consequently, Roche Products provided sufficient treatment for 2000 patients to receive tocilizumab. The trial steering committee, masked to the results, closed recruitment to the tocilizumab comparison at the end of Jan 24, 2021, as over 4000 patients had been randomly assigned.
For the primary outcome of 28-day mortality, the results from RECOVERY were subsequently included in a meta-analysis of results from all previous randomised trials of tocilizumb versus usual care in patients with COVID-19. For each trial, we compared the observed number of deaths among patients allocated tocilizumab with the expected number if all patients were at equal risk (ie, we calculated the observed minus expected statistic [o–e], and its variance v). For RECOVERY, these were taken as the log-rank observed minus expected statistic and its variance but for other trials, where the exact timing of each death was not available, these were calculated from standard formulae for 2 × 2 contingency tables. We then combined trial results using the log of the mortality rate ratio calculated as the inverse-variance weighted average S/V with variance 1/V (and hence with 95% CI S/V ±1·96/√V), where S is the sum over all trials of (O–E) and V is the sum over all trials of v.19 Analyses were done by means of SAS version 9.4 and R version 3.4. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936).
Role of the funding source
Neither the funders of the study nor Roche Products had any role in study design, data collection, data analysis, data interpretation, or writing of the report. Roche Products supported the study through the supply of tocilizumab and reviewed the draft publication for factual accuracy relating to tocilizumab.
Results
Between April 23, 2020, and Jan 24, 2021, 4116 (19%) of 21 550 patients enrolled into the RECOVERY trial at one of the 131 sites in the UK participating in the tocilizumab comparison were eligible for random assignment. 2022 patients were randomly allocated to tocilizumab and 2094 were randomly allocated to usual care. The mean age of these participants was 63·6 years (SD 13·6). At randomisation, 562 (14%) of 4116 patients were receiving invasive mechanical ventilation, 1686 (41%) of 4116 were receiving non-invasive respiratory support (including high-flow nasal oxygen, continuous positive airway pressure, and non-invasive ventilation), and 1868 (45%) of 4116 were receiving no respiratory support other than simple oxygen therapy (nine of these patients were reportedly not receiving oxygen at randomisation; table 1). Median CRP was 143 (IQR 107–204) mg/L. 82% of patients were reported to be receiving corticosteroids at randomisation (and 97% of the patients enrolled since the announcement of the dexamethasone result from RECOVERY in June, 2020).
Table 1.
Baseline characteristics
| Tocilizumab group (n=2022) | Usual care group (n=2094) | ||
|---|---|---|---|
| Age, years | 63·3 (13·7) | 63·9 (13·6) | |
| ≥18 to <70 | 1331 (66%) | 1355 (65%) | |
| ≥70 to <80 | 478 (24%) | 480 (23%) | |
| ≥80 | 213 (11%) | 259 (12%) | |
| Sex | |||
| Male | 1337 (66%) | 1437 (69%) | |
| Female* | 685 (34%) | 657 (31%) | |
| Ethnicity | |||
| White | 1530 (76%) | 1597 (76%) | |
| Black, Asian, or minority ethnic | 354 (18%) | 378 (18%) | |
| Unknown | 138 (7%) | 119 (6%) | |
| Number of days since symptom onset | 9 (7–13) | 10 (7–14) | |
| Number of days since hospitalisation | 2 (1–5) | 2 (1–5) | |
| Oxygen saturation | 94% (92–96) | 94% (91–95) | |
| Respiratory support at second randomisation | |||
| No ventilator support† | 935 (46%) | 933 (45%) | |
| Non-invasive ventilation‡ | 819 (41%) | 867 (41%) | |
| Invasive mechanical ventilation§ | 268 (13%) | 294 (14%) | |
| Biochemistry at second randomisation | |||
| Latest C-reactive protein, mg/L | 143 (107–203) | 144 (106–205) | |
| Ferritin, ng/mL | 947 (497–1599) | 944 (507–1533) | |
| Creatinine, μmol/L | 77 (62–98) | 77 (62–100) | |
| Previous diseases | |||
| Diabetes | 569 (28%) | 600 (29%) | |
| Heart disease | 435 (22%) | 497 (24%) | |
| Chronic lung disease | 473 (23%) | 484 (23%) | |
| Tuberculosis | 3 (<1%) | 5 (<1%) | |
| HIV | 7 (<1%) | 8 (<1%) | |
| Severe liver disease¶ | 14 (1%) | 10 (<1%) | |
| Severe kidney impairment|| | 118 (6%) | 99 (5%) | |
| Any of the above | 1100 (54%) | 1163 (56%) | |
| SARS-CoV-2 test result | |||
| Positive | 1922 (95%) | 2005 (96%) | |
| Negative | 69 (3%) | 71 (3%) | |
| Not known | 31 (2%) | 18 (1%) | |
| First randomisation** | |||
| Number of days since first randomisation | 0 (0–1) | 0 (0–1) | |
| Part A allocation | |||
| Usual care | 839 (41%) | 869 (41%) | |
| Lopinavir–ritonavir | 51 (3%) | 64 (3%) | |
| Dexamethasone | 49 (2%) | 45 (2%) | |
| Hydroxychloroquine | 37 (2%) | 38 (2%) | |
| Azithromycin | 197 (10%) | 177 (8%) | |
| Use of systemic corticosteroids†† | |||
| Yes | 1664 (82%) | 1721 (82%) | |
| No | 357 (18%) | 367 (18%) | |
| Unknown | 1 (<1%) | 6 (<1%) | |
Data are mean (SD), n (%), or median (IQR). Information on sex, ethnicity, and SARS-CoV-2 test result were recorded on the main randomisation form when patients first entered the study. All other information was recorded on the second randomisation form (when patients were randomly assigned to tocilizumab vs usual care alone).
Includes ten pregnant women.
Includes nine patients not receiving any oxygen and 1859 patients receiving low-flow oxygen.
Includes patients receiving high-flow nasal oxygen, continuous positive airway pressure, or other non-invasive ventilation.
Includes patients receiving invasive mechanical ventilation or extracorporeal membranous oxygenation.
Defined as requiring ongoing specialist care.
Defined as estimated glomerular filtration rate <30 mL/min per 1·73 m2.
2631 participants were randomly assigned into part B and 1615 into part C of the first randomisation.
Information on use of corticosteroids was collected from June 18, 2020, onwards following announcement of the results of the dexamethasone comparison from the RECOVERY trial. Participants undergoing first randomisation before this date (and who were not allocated to dexamethasone) are assumed not to be receiving systemic corticosteroids.
The follow-up form was completed for 1964 (97%) of 2022 randomly assigned patients in the tocilizumab group and 2049 (98%) of 2094 patients in the usual care group. Among patients with a completed follow-up form, 1647 (84%) of 1964 allocated to tocilizumab and 77 (4%) of 2049 of those allocated to usual care received at least one dose of tocilizumab (or sarilumab, another IL-6 antagonist; figure 1; appendix p 44). 565 (29%) of 1964 patients in the tocilizumab group and 17 (1%) of 2049 in the usual care group received more than one dose of tocilizumab (or sarilumab). Use of other treatments for COVID-19 during the 28 days after randomisation was similar among patients allocated tocilizumab and among those allocated usual care (appendix p 44). Follow-up for the primary and secondary outcomes was complete for 99% of randomised participants.
Figure 1.
Trial profile
REGN-COV2=a combination of two monoclonal antibodies directed against SARS-CoV-2 spike protein. *Number of adult patients recruited at a site activated for the tocilizumab comparison. †The first randomisation comprised up to three factorial elements such that an eligible patient could be entered into between one and three randomised comparisons, depending on the then current protocol, the patient's suitability for particular treatments, and the availability of the treatment at the site. Median time between first and second randomisation was 0·3 h (IQR 0·1−25·3). ‡1964 (97%) of 2022 patients of those allocated to tocilizumab and 2049 (98%) of 2094 of those allocated to usual care had a completed follow-up form at time of analysis.
Allocation to tocilizumab was associated with a significant reduction in the primary outcome of 28-day mortality compared with usual care alone (621 [31%] of 2022 patients in the tocilizumab group vs 729 (35%) of 2094 patients in the usual care group; rate ratio 0·85; 95% CI, 0·76–0·94; p=0·0028; figure 2A). In an exploratory analysis restricted to the 3927 (95%) patients with a positive SARS-CoV-2 test result, the result was similar (rate ratio 0·86, 95% CI 0·77–0·97; p=0·0098).
Figure 2.
Effect of allocation to tocilizumab on 28-day mortality (A) and discharge from hospital within 28 days of randomisation (B)
Allocation to tocilizumab was associated with a greater probability of discharge from hospital within 28 days (57% vs 50%; rate ratio 1·22, 1·12–1·33, p<0·0001; figure 2B and table 2). Among those not on invasive mechanical ventilation at baseline, allocation to tocilizumab was associated with a reduction in the risk of progressing to the prespecified composite secondary outcome of invasive mechanical ventilation or death when compared with usual care alone (35% vs 42%, risk ratio 0·84, 0·77–0·92, p<0·0001; table 2).
Table 2.
Effect of allocation to tocilizumab on main study outcomes
|
Treatment allocation |
RR (95% CI) |
p value |
|||
|---|---|---|---|---|---|
| Tocilizumab group (n=2022) | Usual care group (n=2094) | ||||
| Primary outcome | |||||
| 28-day mortality | 621 (31%) | 729 (35%) | 0·85 (0·76–0·94) | 0·0028 | |
| Secondary outcomes | |||||
| Median time to being discharged, days | 19 | >28 | ·· | ·· | |
| Discharged from hospital within 28 days | 1150 (57%) | 1044 (50%) | 1·22 (1·12–1·33) | <0·0001 | |
| Receipt of invasive mechanical ventilation or death* | 619/1754 (35%) | 754/1800 (42%) | 0·84 (0·77–0·92) | <0·0001 | |
| Invasive mechanical ventilation | 265/1754 (15%) | 343/1800 (19%) | 0·79 (0·69–0·92) | 0·0019 | |
| Death | 490/1754 (28%) | 580/1800 (32%) | 0·87 (0·78–0·96) | 0·0055 | |
| Subsidiary clinical outcomes | |||||
| Receipt of ventilation† | 290/935 (31%) | 323/933 (35%) | 0·90 (0·79–1·02) | 0·10 | |
| Non-invasive ventilation | 281/935 (30%) | 309/933 (33%) | 0·91 (0·79–1·04) | 0·15 | |
| Invasive mechanical ventilation | 67/935 (7%) | 86/933 (9%) | 0·78 (0·57–1·06) | 0·11 | |
| Successful cessation of invasive mechanical ventilation‡ | 95/268 (35%) | 98/294 (33%) | 1·08 (0·81–1·43) | 0·60 | |
| Use of haemodialysis or haemofiltration§ | 120/1994 (6%) | 172/2065 (8%) | 0·72 (0·58–0·90) | 0·0046 | |
Data are n (%), n/N (%), or median (IQR) unless stated otherwise. RR=rate ratio for the outcomes of 28-day mortality, hospital discharge, and successful cessation of invasive mechanical ventilation, and risk ratio for other outcomes.
Analyses include only those on no ventilator support or non-invasive ventilation at second randomisation.
Analyses include only those on no ventilator support at second randomisation.
Analyses restricted to those on invasive mechanical ventilation at second randomisation.
Analyses exclude those on haemodialysis or haemofiltration at second randomisation.
We observed similar results across all prespecified subgroups (figure 3, appendix pp 48–49), including the amount of respiratory support at randomisation (figure 3). Given the number of hypothesis tests done, the suggestion of a larger proportional mortality reduction among those receiving a corticosteroid compared with those not (interaction p=0·01) might reflect the play of chance. An exploratory analysis showed that the effects of tocilizumab on 28-day mortality were similar for those randomly assigned ≤2 or >2 days since hospitalisation (interaction p=0·89). In eight previous trials of tocilizumab versus usual care, which included a total of 439 deaths among 2379 patients, allocation to tocilizumab was associated with a non-significant 11% reduction in mortality (rate ratio 0·89, 0·72–1·11; figure 4). After inclusion of the 28-day mortality results from RECOVERY into this meta-analysis, the mortality rate ratio from the nine trials was 0·86 (0·78–0·94), p=0·0017.
Figure 3.
Effect of allocation to tocilizumab on 28-day mortality by baseline characteristics
Subgroup-specific rate ratio estimates are represented by squares (with areas of the squares proportional to the amount of statistical information) and the lines through them correspond to the 95% CIs. *Includes nine patients not receiving any oxygen and 1859 patients receiving simple oxygen only. †Includes patients receiving high-flow nasal oxygen, continuous positive airway pressure ventilation, and other non-invasive ventilation. ‡Includes patients receiving invasive mechanical ventilation and extracorporeal membranous oxygenation. §Information on use of corticosteroids was collected from June 18, 2020, onwards following announcement of the results of the dexamethasone comparison from the RECOVERY trial. Participants undergoing first randomisation before this date (and who were not allocated to dexamethasone) are assumed not to be receiving systemic corticosteroids. In a model adjusted for all six baseline subgroups (in the categories shown) the overall rate ratio was 0·88 (95% CI 0·79−0·98).
Figure 4.
Meta-analysis of mortality in randomised, controlled trials of tocilizumab in patients hospitalised with COVID-19
O–E=observed–expected. Var=variance. *Log–rank O–E for RECOVERY, O–E from 2 × 2 contingency tables for the other trials. Rate ratio is calculated by taking ln rate ratio to be (O–E)/V with normal variance 1/V, where V=Var (O–E). Subtotals or totals of (O–E) and of V yield inverse-variance weighted averages of the ln rate ratio values. †For balance, controls in the 2:1 studies count twice in the control totals and subtotals, but do not count twice when calculating their O–E or V values. Heterogeneity between RECOVERY and eight previous trials combined, χ12=0·2 (p=0·7).
In prespecified subsidiary analyses, we found no significant effect of tocilizumab on subsequent receipt of non-invasive respiratory support or invasive mechanical ventilation among those on no respiratory support at randomisation (table 2, appendix p 50). Nor was there a significant effect on the rate of successful cessation of invasive mechanical ventilation among those on invasive mechanical ventilation at randomisation. However, allocation to tocilizumab reduced the use of haemodialysis or haemofiltration (6% vs 8%, risk ratio 0·72, 0·58–0·90, p=0·0046; table 2) among those not receiving haemodialysis or haemofiltration at randomisation. There was no evidence of excess deaths from non-COVID infections or other causes (appendix p 45). We observed no significant differences in the frequency of new cardiac arrhythmias (appendix p 46). There were three reports of serious adverse reactions believed to be related to tocilizumab: one each of otitis externa, Staphylococcus aureus bacteraemia, and lung abscess, all of which resolved with standard treatment.
Discussion
The results of this large, randomised trial indicate that tocilizumab is an effective treatment for hospitalised COVID-19 patients who have hypoxia and evidence of inflammation (CRP ≥75 mg/L). Treatment with tocilizumab improved survival and the chances of discharge from hospital by 28 days, and reduced the chances of progressing to require invasive mechanical ventilation. These benefits were consistent across all patient groups studied, including those receiving invasive mechanical ventilation, non-invasive respiratory support, or no respiratory support other than simple oxygen. The benefits of tocilizumab were clearly seen among those also receiving treatment with a systemic corticosteroid, which is now usual standard of care for COVID-19 patients requiring treatment with oxygen.6, 7
Previous trials have provided some evidence that tocilizumab might shorten time to discharge or reduce progression to invasive mechanical ventilation or death.9, 13 Since mid-2020, eight randomised, controlled trials of tocilizumab for the treatment of COVID-19 have reported. These include seven small trials (fewer than 100 deaths in each) and the somewhat larger REMAP-CAP trial, which recruited critically ill patients with COVID-19, over 99% of whom required non-invasive respiratory support or invasive mechanical ventilation.8, 9, 10, 11, 12, 13, 14, 15 Taken together, these previous trials did not show a significant mortality benefit for treatment with tocilizumab (death rate ratio 0·89, 95% CI 0·72–1·11; figure 4). The RECOVERY trial contains around four times as much information as all the previous trials combined. When all nine trials are considered together, allocation to tocilizumab is associated with a significant 14% proportional reduction in 28-day mortality. These results suggest that in COVID-19 patients who are hypoxic and have evidence of systematic inflammation, treatment with a combination of a systemic corticosteroid plus tocilizumab would be expected to reduce mortality by about one-third for patients receiving simple oxygen and nearly one-half for those receiving invasive mechanical ventilation.6
The RECOVERY results support the use of tocilizumab. Our results show that the benefits of tocilizumab extend to a broad group of patients receiving oxygen, with or without other forms of respiratory support, and that those benefits include a reduction in the need for invasive mechanical ventilation and renal replacement therapy. Since complicating bacterial infections are infrequent in the early hospitalisation period of COVID-19, this recognised concern in relation to the use of tocilizumab would be lessened with earlier use.20 On the basis of the ISARIC4C database, approximately 49% of hospitalised COVID-19 patients in the UK would meet our inclusion criteria and hence would benefit from tocilizumab (ISARIC4C Investigators, personal communication). Sarilumab, an alternative IL-6 antagonist, is available but evidence of its efficacy is inconclusive15, 21, 22 and the results of the largest trial (NCT04315298) are not yet published.
Strengths of this trial included that it was randomised, had a large sample size, and included patients requiring various amounts of respiratory support (from simple oxygen through to invasive mechanical ventilation) and has 99% completeness of follow-up for the primary outcome. CRP was chosen as the biomarker for inflammation in this study since it is widely used and affordable worldwide, it is correlated with serum IL-6 concentrations, and early clinical studies of COVID-19 had reported it to be associated with severity and prognosis, with a value of greater than 50 mg/L associated with severe disease and a concentration of around 75 mg/L distinguishing fatal from non-fatal cases.23, 24, 25, 26, 27, 28 Whether hypoxic patients with a CRP of less than 75 mg/L could benefit from tocilizumab is unknown. There are some limitations. We did not collect detailed information on non-COVID infections. Following random assignment, 16% of patients in the tocilizumab group reportedly did not receive this treatment and the reasons for this were not recorded. The size of the effects of tocilizumab reported in this paper are therefore an underestimate of the true effects of actually using the treatment. Hospital stay is very long for many of these patients and some outcomes beyond 28 days have not yet been captured. The preplanned analyses at 6 months will, however, provide additional information on the full effects of tocilizumab on clinical outcomes. Further work is also needed to consider the health economic benefits of tocilizumab and related IL-6 inhibitors in terms of both patient outcomes and usage of health-care resources (duration of hospital stay, and frequency of invasive mechanical ventilation and renal replacement therapy).
The RECOVERY trial has shown that for patients hospitalised with severe COVID-19, treatment with tocilizumab reduces mortality, increases the chances of successful hospital discharge, and reduces the chances of requiring invasive mechanical ventilation. These benefits are additional to those previously reported for dexamethasone. These findings require an update to clinical guidelines, which has already begun, and efforts to increase the global availability and affordability of tocilizumab.29, 30
Correspondence to: Prof Peter W Horby and Prof Martin J Landray, RECOVERY Central Coordinating Office, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford OX3 7LF, UK recoverytrial@ndph.ox.ac.uk
For policy and procedures see https://www.ndph.ox.ac.uk/data-access
Data sharing
The protocol, consent form, statistical analysis plan, definition and derivation of clinical characteristics and outcomes, training materials, regulatory documents, and other relevant study materials are available online. As described in the protocol, the trial steering committee will facilitate the use of the study data and approval will not be unreasonably withheld. De-identified participant data will be made available to bona fide researchers registered with an appropriate institution within 3 months of publication. However, the steering committee will need to be satisfied that any proposed publication is of high quality, honours the commitments made to the study participants in the consent documentation and ethical approvals, and is compliant with relevant legal and regulatory requirements (eg, relating to data protection and privacy). The steering committee will have the right to review and comment on any draft manuscripts before publication. Data will be made available in line with the policy and procedures. Those wishing to request access should complete the form.
Declaration of interests
The authors have no conflict of interest or financial relationships relevant to the submitted work to disclose. No form of payment was given to anyone to produce the manuscript. All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. The Nuffield Department of Population Health at the University of Oxford has a staff policy of not accepting honoraria or consultancy fees directly or indirectly from industry.
Acknowledgments
Acknowledgments
Above all, we thank the thousands of patients who participated in this study. We also thank the many doctors, nurses, pharmacists, other allied health professionals, and research administrators at 176 NHS hospital organisations across the whole of the UK, supported by staff at the National Institute of Health Research (NIHR) Clinical Research Network, NHS DigiTrials, Public Health England, Department of Health & Social Care, the Intensive Care National Audit & Research Centre, Public Health Scotland, National Records Service of Scotland, the Secure Anonymised Information Linkage at the University of Swansea, and the NHS in England, Scotland, Wales, and Northern Ireland. The RECOVERY trial is supported by a grant to the University of Oxford from UK Research and Innovation–NIHR (Grant reference: MC_PC_19056) and by core funding provided by NIHR Oxford Biomedical Research Centre, Wellcome, the Bill & Melinda Gates Foundation, the Department for International Development, Health Data Research UK, the Medical Research Council Population Health Research Unit, the NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, and NIHR Clinical Trials Unit Support Funding. TJ is supported by a grant from UK Medical Research Council (MC_UU_0002/14) and an NIHR Senior Research Fellowship (NIHR-SRF-2015-08-001). WSL is supported by core funding provided by NIHR Nottingham Biomedical Research Centre. AbbVie contributed some supplies of lopinavir–ritonavir for use in this study. Roche Products supported the trial through the provision of tocilizumab. REGEN-COV2 was provided for this study by Regeneron. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health and Social Care, or Roche Products.
Contributors
This manuscript was initially drafted by PWH and MJL, further developed by the writing committee, and approved by all members of the trial steering committee. PWH and MJL vouch for the data and analyses, and for the fidelity of this report to the study protocol and data analysis plan. PWH, MM, JKB, LCC, SNF, TJ, KJ, WSL, AMo, AMu, KR, EJ, RH, and MJL designed the trial and study protocol. MM, MC, LP, G P-A, CB, RSa, KT, VJ, AA, RPT, DC, MS, RSt, BR, RH, the Data Linkage team at the RECOVERY Coordinating Centre, Health Records, and local clinical centre staff listed in the appendix collected the data. ES, NS, and JRE accessed and verified the data and did the statistical analysis. All authors contributed to data interpretation and critical review and revision of the manuscript. PWH and MJL had access to the study data and had final responsibility for the decision to submit for publication.
Writing Committee (on behalf of the RECOVERY Collaborative Group)
Peter W Horby, Mark Campbell, Natalie Staplin, Enti Spata, Jonathan R Emberson, Guilherme Pessoa-Amorim, Leon Peto, Christopher Brightling, Rahuldeb Sarkar, Koshy Thomas, Vandana Jeebun, Abdul Ashish, Redmond P Tully, David Chadwick, Muhammad Sharafat, Richard Stewart, Banu Rudran, J Kenneth Baillie, Maya H Buch, Lucy C Chappell, Jeremy N Day, Saul N Faust, Thomas Jaki, Katie Jeffery, Edmund Juszczak, Wei Shen Lim, Alan Montgomery, Andrew Mumford, Kathryn Rowan, Guy Thwaites, Marion Mafham, Richard Haynes, Martin J Landray. PWH, MC, and NS contributed equally, and MM, RH, and MJL contributed equally.
Data Monitoring Committee
Peter Sandercock, Janet Darbyshire, David DeMets, Robert Fowler, David Lalloo, Ian Roberts (until December 2020), M Munavvar (since January 2021), Janet Wittes.
Contributor Information
RECOVERY Collaborative Group:
Obbina Abani, Ali Abbas, Fatima Abbas, Mustafa Abbas, Sadia Abbasi, Hakam Abbass, Alfie Abbott, Nabeel Abdallah, Ashraf Abdelaziz, Mohamed Abdelfattah, Bushra Abdelqader, Basir Abdul, Althaf Abdul Rasheed, Ajibode Abdulakeem, Rezan Abdul-Kadir, Abdulfatahi Abdulmumeen, Rasheed Abdul-Raheem, Niyaz Abdulshukkoor, Kula Abdusamad, Yazeed Abed El Khaleq, Mai Abedalla, Abeer Abeer Ul Amna, Katrina Abernethy, Adebanke Aboaba, Hani Abo-Leyah, Ahmed Abou-Haggar, Mahmoud Abouibrahim, Miriam Abraham, Tizzy Abraham, Abraheem Abraheem, Judith Abrams, Hyacinth-John Abu, Ahmed Abu-Arafeh, Syed M Abubacker, Akata Abung, Yaa Aceampong, Amaka Achara, Devikumar Acharya, Sarah Acheampong, Janet Acheson, Andres Acosta, Catherine Acton, Jacqueline Adabie-Ankrah, Fiona Adam, Matthew Adam, Huzaifa Adamali, Carol Adams, Charlotte Adams, Kate Adams, Richard Adams, Tim Adams, Kirsty Adcock, Jemaimah Addai, Ade Adebiyi, Ken Adegoke, Vicki Adell, Sherna Adenwalla, Oluwasegun A Adesemoye, Emmanuel O Adewunmi, Joyce Adeyemi, Rina Adhikary, Gabrielle Adkins, Adnan Adnan, John Aeron-Thomas, Debbie Affleck, Carmel Afnan, Muhammad Afridi, Zainab A Aftab, Meenakshi Agarwal, Rachel Agbeko, Chris Agbo, Penny Agent, Sunil Aggarwal, Arameh Aghababaie, Shafana Ahamed Sadiq, Mohamed H Ahammed Nazeer, Mohammad Ahmad, Syed Ahmad, Asim Ahmed, Bilal Ahmed, Forizuddin Ahmed, Hamze Ahmed, Iram Ahmed, Irshad Ahmed, Khaled Ahmed, Liban Ahmed, Mahin Ahmed, Maria C Ahmed, Muhammad S Ahmed, Naseer Ahmed, Nausheen Ahmed, Osama Ahmed, Rajia A Ahmed, Rizwan Ahmed, Saif Ahmed, Sammiya Ahmed, Sara Ahmed, Syed Ahmed, Syed Haris Ahmed, Roa Ahmed Ali, Sana Ahmed, Sana Ahmer, Dhiraj Ail, Mark Ainsworth, Myriam Aissa, Lindianne Aitken, Bini Ajay, Abdulakeem Ajibode, Ayesha Ajmi, Nasim Akhtar, Nauman Akhtar, Suha Akili, Oludoyinsola Akindolie, Yinka Akinfenwa, Olugbenga Akinkugbe, Olugbenro Aktinade, Ahmad Al Aaraj, Asma Al Balushi, Majd Al Dakhola, Aladdin Al Swaifi, Eslam Al-Abadi, Narendra Aladangady, Ayaz Alam, Sajid Alam, Abbas Al-Asadi, Kyriaki Alatzoglou, Paul Albert, Lorraine Albon, Gemma Alcorn, Stephen Alcorn, Aggie Aldana, David Alderdice, Rayan Aldouri, Jonathan Aldridge, Nicolas Aldridge, Ana Alegria, Alison Alexander, John Alexander, Peter D G Alexander, Charlotte Alford, Julyan Al-Fori, Laith Alghazawi, Bahij Al-Hakim, Shams Al-Hity, Ali Ali, Asad Ali, Fawzia R Ali, Jawad Ali, Mariam Ali, Mohammad Ali, Nayab Ali, Oudai Ali, Sakina Ali, Syed Ali, Abid Alina, Fine Aliyuda, Katrin Alizaedeh, Maithem Al-Jibury, Saba Al-Juboori, Majid Al-Khalil, Moutaz Alkhusheh, Fiona Allan, Alison Allanson, Robert Allcock, Eireann Allen, Kerry Allen, Louise Allen, Poppy Allen, Rebecca Allen, Sam Allen, Sharon Allen, Simon Allen, Kathryn Allison, Bethan Allman, Lynne Allsop, Hassan Al-Moasseb, Magda Al-Obaidi, Lina Alomari, Akram Al-Rabahi, Bahar Al-Ramadhani, Zayneb Al-Saadi, Inji Alshaer, Rustam Al-Shahi Salman, Warkaq Al-Shamkhani, Bashar Al-Sheklly, Sara Altaf, Mary Alvarez, Maysaa Alzetani, Susan Amamou, Noor Amar, Sakkarai Ambalavanan, Sarah-Jayne Ambler, Robert Ambrogetti, Chris Ambrose, Amir Ameen, Ken Amenyah, Maria R Amezaga, Allison Amin, Amina Amin, Kanish Amin, Syed Amin, Tara Amin, Amjad Amjad, Neelma Amjad, Victoria Amosun, Khaled Amsha, Pugh Amy, Atul Anand, Samantha Anandappa, Julie Anderson, Laura Anderson, Michelle Anderson, Nicola Anderson, Rachel Anderson, Rory Anderson, Wendy Anderson, Prematie Andreou, Angela Andrews, Antonette Andrews, Jill Andrews, Kanayochukwu Aneke, Andrew Ang, Wan Wei Ang, Tammy Angel, Aramburo Angela, Paola Angelini, Lazarus Anguvaa, Oleg Anichtchik, Millicent Anim-Somuah, Krishnan Aniruddhan, Marie Anne Ledingham, Jessica Annett, Patrick James Anstey, Rebekah Anstey, Alpha Anthony, Aaron Anthony-Pillai, Philip Antill, Zhelyazkova Antonina, Varghese Anu, Muhammad Anwar, Aristeidis Apostolopoulos, Diane Appleyard, Maia Far Aquino, Bianca Araba, Samuel Aransiola, Mariana Araujo, Ann Archer, Denise Archer, Simon Archer, Christian Ardley, Ana-Maria Arias, Ryoki Arimoto, Charlotte Arkley, Charlotte Armah, Ilianna Armata, Adam Armitage, Ceri Armstrong, Maureen Armstrong, Sonia Armstrong, Philippa Armtrong, Heike Arndt, Clare Arnison-Newgass, David Arnold, Rachael Arnold, Dhawal Arora, Kavan Arora, Pardeep Arora, Rishi Arora, Arslam Arter, Ayush Arya, Rita Arya, Denisa Asandei, Adeeba Asghar, Catherine Ashbrook-Raby, Helen Ashby, Jan Ashcroft, John Ashcroft, Samuel Ashcroft, Deborah Asher, Ayesha Ashfaq, Abdul Ashish, Sally Ashman-Flavell, Sundar Ashok, Abd-El-Aziz Ashour, Muhammad Z Ashraf, Saima Ashraf, Mohammad B Ashraq, Deborah Ashton, Susan Ashton, Andrew Ashworth, Rebecca Ashworth, Arshia Aslam, Harshini Asogan, Atif Asrar, Omar Assaf, Raine Astin-Chamberlain, Deborah Athorne, Billie Atkins, Christopher Atkins, Stacey Atkins, John Atkinson, Vicki Atkinson, Brygitta Atraskiewicz, Abdul Ahmad Attia, Rita Atugonza, Rita Atugonza, Paula Aubrey, Avinash Aujayeb, Aye C T Aung, Hnin Aung, Kyaw T Aung, Yin Aung, Zaw M Aung, Emily Austin, Karen Austin, Abdusshakur Auwal, Miriam Avery, Joanne Avis, Georgina Aviss, Cristina Avram, Paula Avram, Gabriel Awadzi, Atia Awan, Aszad Aya, Eman Ayaz, Amanda Ayers, Jawwad Azam, Mohammed Azharuddin, Ghazala Aziz, N Aziz, Ali Azkoul, Ashaari Azman Shah, Giada Azzopardi, Hocine Azzoug, Fiyinfoluwa Babatunde, Melvin Babi, Babiker Babiker, Gayna Babington, Matthew Babirecki, Marta Babores, Adetona O Babs-Osibodu, Sammy Bacciarelli, Roudi Bachar, Gina Bacon, Jenny Bacon, Bibi Badal, Gurpreet R Badhan, Shreya Badhrinarayanan, Joseph P Bae, Sibel Bafekr, Alice Baggaley, Amy Baggott, Graham Bagley, Dinesh Bagmane, Lynsey Bagshaw, Kasra Bahadori, James Bailey, Katie Bailey, Lindsey Bailey, Liz Bailey, Morgan Bailey, Pippa Bailey, Sarah Bailey, Hamish Baillie, J Kenneth Baillie, Jennifer Bain, Vikram Bains, David Baird, Susan Baird, Tracy Baird, Yolanda Baird, Aiysha Bajandouh, Evelyn Baker, Johanne Baker, Josephine Baker, Kenneth Baker, Rebecca Baker, Terri-Anne Baker, Victoria 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Clements, Suzanne Clements, Rachael Clifford, Sarah Clifford, Amelia Clive, Samantha Clueit, Andrea Clyne, Michelle Coakley, Peter G L Coakley, Tony Coates, Kathryn Cobain, Alexandra Cochrane, Patricia Cochrane, Maeve Cockerell, Helen Cockerill, Shirley Cocks, Rachel Codling, Adam Coe, Samantha Coetzee, David Coey, Danielle Cohen, Jonathan Cohen, Oliver Cohen, Mike Cohn, Louise Coke, Olutoyin Coker, Nicholas Colbeck, Roghan Colbert, Esther Cole, Jade Cole, Joby Cole, Julie Cole, Richard Cole, Garry Coleman, Matt Coleman, Holly Coles, Macleod Colin, Alicia Colino-Acevedo, Julie Colley, Dawn Collier, Heather Collier, Paul Collini, Emma Collins, Jaimie Collins, Joanne Collins, Nicola Collins, Sally Collins, Vicky Collins, Andrew Collinson, Bernadette Collinson, Jennifer Collinson, Matthew Collis, Madeleine Colmar, Hayley Emma Colton, James Colton, Katie Colville, Carolyn Colvin, Ryan Colwell, Edward Combes, David Comer, Alison Comerford, Dónal Concannon, Robin Condliffe, Lynne Connell, Natalie Connell, Karen Connelly, Gavin Connolly, Emma Connor, Antonia Conroy, Veronica Conteh, Rory Convery, Francesca Conway, Grainne Conway, Rhiannon Conway, Jo-Anna Conyngham, Colette Cook, Eloise Cook, Gemma Cook, Helen Cook, Julie Cook, Danielle Cooke, Graham Cooke, Katrina Cooke, Tim Cooke, Adele Cooper, Chris Cooper, David Cooper, Helen Cooper, Jamie Cooper, Joanne Cooper, Joshua Cooper, Lauren Cooper, Nick Cooper, Rowena Cooper, Thomas Cope, Sinead Corbet, Carolyn Corbett, John Corcoran, Chris Cordell, Jessica Cordle, Alasdair Corfield, John Corless, Alison Corlett, Joe Cornwell, Michael Cornwell, Diana Corogeanu, Mirella Corredera, Ruth Corrigan, Rita Corser, Denise Cosgrove, Tracey Cosier, Patricia Costa, Charlie Coston, Susannah Cotgrove, Zoe Coton, Lisa-Jayne Cottam, Rhiannon Cotter, Donna Cotterill, Caroline Cotton, Katy Cotton, Andrew Coull, James Coulson, David Counsell, David Counter, Cherry Coupland, Ellie Courtney, Julia Courtney, Rebecca Cousins, Alexander Cowan, Elena Cowan, Richard Cowell, Louise Cowen, Steve Cowman, Amanda Cowton, Ellie Cox, Giles Cox, Karina Cox, Miriam Cox, Karen Coy, Beverly Craig, Victoria Craig, Felicity Craighead, Matthew Cramp, Jacolene Crause, Adrian Crawford, Angie Crawford, Emma Crawford, Isobel Crawford, Richard Crawforth, Sarah Crawshaw, Ben Creagh-Brown, Andrew Creamer, Joanne Cremona, Saveria Cremona, Janet Cresswell, Mark Cribb, Charles Crichton, Declan Crilly, Lauren Crisp, Nikki Crisp, Dominic Crocombe, Maria Croft, Jennifer Crooks, Harriet Crosby, Tim Cross, Amy Crothers, Stephen Crotty, Susan Crouch, Madeleine Crow, Amanda Crowder, Kate Crowley, Teresa Crowley, Rebecca Croysdill, Callum Cruickshank, Conor Cruickshank, Irena Cruickshank, James Cruise, Carina Cruz, Trino Cruz Cervera, Dominic Cryans, Guanguo Cui, Helen Cui, Lorraine Cullen, Gillian Cummings-Fosong, Marie Cundall, Victoria Cunliffe, Lorraine Cunningham, Neil Cunningham, Nicola Cunningham, Jason Cupitt, Hollie Curgenven, David Curran, Simon Curran, Craig Currie, Jacqueline Currie, Scarlett Currie, Jonathan Curtis, Katrina Curtis, Olivia Curtis, Thomas Curtis, Rebecca Cuthbertson, Sean Cutler, Marta Czekaj, Patrycja Czylok, Dhanishta D Ramdin, Joana da Rocha, Andrew Dagens, Helen Daggett, Jacqui Daglish, Sandeep Dahiya, Anne Dale, Katie Dale, Michaela Dale, Sam Dale, Jolyon Dales, Helen Dalgleish, Helen Dallow, Dermot Dalton, Zoe Daly, Eleanor Damian, Akila Danga, Amelia Daniel, Priya Daniel, Allison Daniels, Adela Dann, Sandra Danso-Bamfo, Nimo Daoud, Alex Darbyshire, Janet Darbyshire, Paul Dargan, Paul Dark, Kate Darlington, Tom Darton, Guledew Darylile, Manjusha Das, Sukamal Das, Martin Daschel, Joanne Dasgin, Dibyendu Datta, Anna Daunt, Emily Davenport, Mark Davey, Miriam Davey, Molly Davey, Mini David, Alexander Davidson, Laura Davidson, Neil Davidson Davidson, Richard Davidson, Albert Davies, Alison Davies, Amanda Davies, Amy Davies, Angela Davies, Carolyn Davies, Catrin Davies, Cheryl Davies, Drew Davies, Elaine Davies, Ffyon Davies, Helen Davies, Jeni Davies, Jim Davies, Karen Davies, Kelly Davies, Kim Davies, Louisa Davies, Matthew Davies, Michelle Davies, Nina Davies, Owen Davies, Patrick Davies, Rachel Davies, Rhys Davies, Ruth Davies, Sarah Davies, Simon Davies, Alison Davis, Gwyneth Davis, Illinos Davis, Julie-Ann Davis, Katherine Davis, Peter Davis, Alexander Davison, Mark Davy, Christine Dawe, H Dawe, Mark Dawkins, Danielle Dawson, Elizabeth Dawson, Joy Dawson, Susan Dawson, Tom Dawson, Andrew Daxter, Andrew Day, Jacob Day, Jeremy Day, Jamie D'Costa, Parijat De, Duneesha de Fonseka, Toni de Freitas, Frederico De Santana Miranda, Eleanor de Sausmarez, Shanika de Silva, Thushan de Silva, Jessica De Sousa, Paulo De Sousa, James de Souza, Anthony de Soyza, Natasha de Vere, Johannes de Vos, Bethan Deacon, Sharon Dealing, Anna Dean, Julie Dean, Katrina Dean, Stephen Dean, Tessa Dean, Jill Deane, James Dear, Effie Dearden, Catherine Deas, Samuel Debbie, Gabor Debreceni, Vashist Deelchand, Matthew Deeley, Joanne Deery, Emmanuel Defever, Manuela Del Forno, Arnold Dela Rosa, Amanda Dell, Carrie Demetriou, David DeMets, Jane Democratis, Jacqueline Denham, Emmanuelle Denis, Laura Denley, Craig Denmade, Kathy Dent, Martin Dent, Elise Denton, Tom Denwood, Nishigandh Deole, Darshita Depala, Maria Depante, Susan Dermody, Amisha Desai, Asmita Desai, Purav Desai, Sanjeev Deshpande, Vai Deshpande, Sirjana Devkota, Prakash Dey, Vishal Dey, Rogin Deylami, Kevin Dhaliwal, Sundip Dhani, Amandeep Dhanoa, Mili Dhar, Devesh Dhasmana, Ekanjali Dhillon, Reiss Dhillon, Priya Dias, Stephanie Diaz, Kayleigh Diaz-Pratt, Debbie Dickerson, Pamela Dicks, Stuart Dickson, Sean Dillane, Sarah Diment, ThaiHa Dinh, Alex Dipper, Laura Dirmantaite, Lisa Ditchfield, Sarah Diver, Lavanya Diwakar, Caroline Dixon, Giles Dixon, Brice Djeugam, Petr Dlouhy, Paul Dmitri, Laurence Dobbie, Marinela Dobranszky Oroian, Charlotte Dobson, Lee Dobson, Marie Docherty, David Dockrell, James Dodd, Jackie Dodds, Rebecca Dodds, Steve Dodds, Richi Dogra, Erin Doherty, Warren Doherty, Yumiko Doi, Iain Doig, Eleanor Doke, Daniel Dolan, Mark Dolman, Rozzie Dolman, Lisa Donald, Callum Donaldson, Christopher Donaldson, Denise Donaldson, Gillian Donaldson, Kate Donaldson, Joanne Donnachie, Christopher Donnelly, Eilish Donnelly, Ronan Donnelly, Aravindhan Donohoe, Gemma Donohoe, Bryan Donohue, Sinead Donton, Emma Dooks, Grainne Doran, Kane Dorey, Sharon Dorgan, Moonira Dosani, Davinder Dosanjh, Paula Dospinescu, Katie Douglas, Jonathan Douse, Lucy Dowden, Michelle Dower, Kerry Dowling, Sud Dowling, Nicola Downer, Charlotte Downes, Rob Downes, Thomas Downes, Damian Downey, Robert Downey, Louise Downs, Simon Dowson, Cornel Dragan, Cristina Dragos, Maire Drain, Chelsea Drake, Victoria Drew, Olivia Drewett, Celine Driscoll, Helena Drogan, Graham Drummond, Ronald Druyeh, Simon Drysdale, An Du Thinh, Hazel Dube, Judith Dube, Stephen Duberley, Hayley Duckles-Leech, Nicola Duff, Emma Duffield, Helen Duffy, Lionel Dufour, Annette Duggan, Parveen Dugh, Janice Duignan, Simon Dummer, Andrew Duncan, Christopher Duncan, Fullerton Duncan, Gregory Duncan, Stephanie Dundas, Alessia Dunn, Charlotte Dunn, Damian Dunn, Laura Dunn, Paul Dunn, Charlene Dunne, Karen Dunne, Fiona Dunning, Aidan Dunphy, Venkat Duraiswamy, Beatriz Duran, Ingrid DuRand, Natalie Duric, Alison Durie, Emily Durie, Hannah Durrington, Haris Duvnjak, Akshay Dwarakanath, Laasya Dwarakanath, Ellen Dwyer, Claudia Dyball, Kristyn Dyer, Harvey Dymond, Tom Dymond, Chris Eades, Laura Eagles, Joanne Early, Melissa Earwaker, Nicholas Easom, Clare East, Amy Easthope, Fraser Easton, Ruth Eatough, Oluwadamilola Ebigbola, Martin Ebon, Sinan Eccles, Chloe Eddings, Michael Eddleston, Maureen Edgar, Katharine Edgerley, Nicholas Edmond, Julie Edmonds, Mary Edmondson, Tracy Edmunds, Alexandra Edwards, Catherine Edwards, Joy Edwards, Kennedy Edwards, Mandy Edwards, Tomos Edwards, Jenny Eedle, Dawn Egginton, Loveth Ehiorobo, Sarah Eisen, Ugochukwu Ekeowa, Mohamed Ekoi, Ayomide Ekunola, Soha El Behery, Mohamed Elbeshy, Kate El-Bouzidi, Jennifer Elder, Mohammed El-Din, Diana Eleanor, Ibrahim Eletu, Eman Elfar, Mayy M Elgamal, Amr Elgohary, Stellios Elia, Jennifer Elias, Tania Elias, Nadia Elkaram, Mohammed El-Karim, Andrew V Elkins, Julie Ellam, Nikki Ellard, Laura N Ellerton, Lucy Elliot, Amy Elliott, Chris Elliott, Fiona Elliott, Kerry Elliott, Scott Elliott, Annie Ellis, Christine Ellis, Kaytie Ellis, Tak-Yan Ellis, Yvette Ellis, Megan Ellison, Rahma Elmahdi, Einas Elmahi, Hannah-May Elmasry, Mohamed Elmi, Najla Elndari, Omer Elneima, Mohamed Elokl, Ahmed Elradi, Mohamed Elsaadany, Sally El-Sayeh, Hana El-Sbahi, Tarek Elsefi, Karim El-Shakankery, Robert Elshaw, Hosni El-Taweel, Sarah Elyoussfi, Jonathan Emberey, Jonathan R Emberson, John Emberton, Julian Emmanuel, Ingrid Emmerson, Michael Emms, Florence Emond, Marieke Emonts, Nicu Enachi, Angila Engden, Katy English, Emma Entwistle, Hene Enyi, Marios Erotocritou, Peter Eskander, Hanif Esmail, Brynach Evans, Chris Evans, Debra evans, Gail Evans, Gareth Evans, Jennifer Evans, Lisa Evans, Lynn Evans, Margaret Evans, Mim Evans, Morgan Evans, Ranoromanana Evans, Teriann Evans, Terry J Evans, Caroline Everden, Serenydd Everden, Hayley Evison, Lynsey Evison, Penny Eyton-Jones, Jacqueline Faccenda, Leila Fahel, Youstina Fahmay, Sara Fairbairn, Terry Fairbairn, Andy Fairclough, Louise Fairlie, Mark Fairweather, Anne Fajardo, Naomi Falcone, Euan Falconer, Jonathan Falconer, John Fallon, Andrea Fallow, David Faluyi, Victoria Fancois, Qayyum Farah, Nowin Fard, Amr Farg, Margaret Farinto, Adam Farmer, Katie Farmer, Toni Farmery, Samantha Farnworth, Faiyaz Farook, Hadia Farooq, Sidrah Farooq, Fiona Farquhar, Karen Farrar, Aaron Farrell, Barbara Farrell, James Farthing, Syeda Farzana, Rahmatu Fasina, Azam Fatemi, Mina Fatemi, Nibah Fatimah, Maria Faulkner, Saul N Faust, Joe Fawke, Sinmidele Fawohunre, Abul Fazal, Simon Fearby, Alex Feben, Federico Fedel, Daria Fedorova, Christopher Fegan, Mae Felongco, Lynsey Felton, Tim Felton, Kate Fenlon, Andrea Fenn, Isabelle Fenner, Ciara Fenton, Melisa Fenton, Cameron Ferguson, Jenny Ferguson, Kathryn Ferguson, Katie Ferguson, Susan Ferguson, Susie Ferguson, Victoria Ferguson, Denzil Fernandes, Candida Fernandez, Eduardo Fernandez, Maria Fernandez, Sonia Fernandez Lopez, Callum Jeevan Fernando, Ahmed Feroz, Pietro Ferranti, Thais Ferrari, Eleanor Ferrelly, Alexandra Ferrera, Emma Ferriman, Nicholas Fethers, Ben Field, Janet Field, Rebecca Field, Karen Fielder, Lindsey Fieldhouse, Andra Fielding, Julie Fielding, Len Fielding, Sarah Fielding, Asma Fikree, Sarah Ann Filson, Sarah Finbow, Debbie Finch, Joanne Finch, Laurie Finch, Natalie Fineman, Lauren Finlayson, Adam Finn, Joanne Finn, Clare Finney, Sofia Fiouni, Jo Fiquet, James Fisher, Neil Fisher, Daniel Fishman, Krystofer Fishwick, Lorraine Fitzgerald, Jan Flaherty, Michael Flanagan, Charles Flanders, Julie Fleming, Lucy Fleming, Paul Fleming, William Flesher, Alison Fletcher, Jonathan Fletcher, Lucy Fletcher, Simon Fletcher, Sophie Fletcher, Karen Flewitt, Christopher Flood, Ian Floodgate, Vincent Florence, Sharon Floyd, Rachel Flynn, Claire Foden, Adama Fofana, Georgina Fogarty, Paul Foley, Linda Folkes, Daniela M Font, Aiwyne Foo, Jane Foo, Andrew Foot, Jayne Foot, Jane Forbes, Jamie Ford, Jennifer Foreman, Caroline Fornolles, Adam Forrest, Ellie Forsey, Miranda Forsey, Thomas Forshall, Elliot Forster, Julian Forton, Emily Foster, Joseph Foster, Rachel Anne Foster, Tracy Foster, Theodora Foukanelli, Angela Foulds, Ian Foulds, Folakemi Fowe, Emily Fowler, Robert Fowler, Stephen Fowler, Caroline Fox, Claire Fox, Heather Fox, Jonathan Fox, Lauren Fox, Natalie Fox, Olivia Fox, Simon Fox, Sarah-Jane Foxton, Rebecca Frake, Alex Francioni, Olesya Francis, Rebecca Francis, Sarah Francis, Theodora Francis-Bacon, Jason Frankcam, Helen Frankland, Jessica Franklin, Catherine Fraser, Sharon Frayling, Martyn Fredlund, Matthew Free, Carol Freeman, Elaine Freeman, Hannah Freeman, Nicola Freeman, Clare Freer, Eleanor French, Matthew Frise, Renate Fromson, Claire Froneman, Adam Frosh, John Frost, Victoria Frost, Oliver Froud, Rachel Frowd, Arun Fryatt, Janet Fu, Bridget Fuller, Liz Fuller, Neil Fuller, Tracy Fuller, Duncan Fullerton, Jenny Fullthorpe, Carrie Fung, Gayle Fung, Sarah Funnell, John Furness, Andrew Fyfe, Nytianandan G, Elizabeth Gabbitas, Claire Gabriel, Diana Gabriel, Hadiza Gachi, Joshua Gahir, Sarveen Gajebasia, Katarzyna Gajewska-Knapik, Christopher Gale, Hugo Gale, Rebecca Gale, Swetha Gali, Bernadette Gallagher, Jude Gallagher, Rosie Gallagher, William Gallagher, Joanne Galliford, Catherine Galloway, Chris Galloway, Emma Galloway, Jacqui Galloway, James Galloway, Laura Gamble, Liz Gamble, Brian Gammon, Jaikumar Ganapathi, Ramesh Ganapathy, Kaminiben Gandhi, Sarah Gandhi, Usha Ganesh, Abrar Gani, Emma-James Garden, Antoni Dariusz Gardener, Emma Gardiner, Michael Gardiner, Phil Gardiner, Siobhan Gardiner, Caroline Gardiner-Hill, Jonathan Gardner, Mark Garfield, Atul Garg, Nathan Garlick, Justin Garner, Lucie Garner, Zoe Garner, Kim Garnett, Rosaline Garr, Florence Garty, Rachel Gascoyne, Hyeriju Gashau, Aoife Gatenby, Erin Gaughan, Alok Gaurav, Mariana Gavrila, Jane Gaylard, Emma Gaywood, Catherine Geddie, Ian Gedge, Sarah Gee, Minerva Gellamucho, Karzan Gelly, Leila Gelmon, Sandra Gelves-Zapata, Gemma Genato, Susan Gent, Natalie Geoghegan, Sam George, Tina George, Simon Georges, Domonique Georgiou, Peter Gerard, Leigh Gerdes, Louise Germain, Helen Gerrish, Abel Getachew, Louise Gethin, Hisham Ghanayem, Amardeep Ghattaoraya, Anca Gherman, Alison Ghosh, Justin Ghosh, Sudhamay Ghosh, Sarra Giannopoulou, Malick Gibani, Ben Gibbison, Kerry Gibbons, Alex Gibson, Bethan Gibson, Kimberley Gibson, Kirsty Gibson, Sian Gibson, Cat Gilbert, Jeanette Gilbert, Joanne Gilbert, Kayleigh Gilbert, Benjamin Giles, Mandy Gill, Lynne Gill, Paul Gillen, Annelies Gillesen, Katherine Gillespie, Elizabeth Gillham, Andrew Gillian, Deborah Gilliland, Robert Gillott, Danielle Gilmour, Kate Gilmour, Theodora Giokanini-Royal, Anna Gipson, Joanna Girling, Rhian Gisby, Angelena Gkioni, Aikaterini Gkoritsa, Effrossyni Gkrania-Klotsas, Amy Gladwell, James Glanville, Jessica Glasgow, Susannah Glasgow, Jon Glass, Lynn Glass, Sharon Glaysher, Lisa Gledhill, Ana Glennon, John Glover, Kyle Glover, Jan Glover Bengtsson, Chevanthy Gnanalingam, Julie Goddard, Wendy Goddard, Emily Godden, Jo Godden, Emma Godson, Sukanya Gogoi, Aiky Goh, Rebeca Goiriz, Sriya Gokaraju, Raphael Goldacre, Arthur Goldsmith, Portia Goldsmith, Darren Gomersall, Lucia Gomez, Raquel Gomez-Marcos, Ali Gondal, Celia Gonzalez, Jack Goodall, Bob Goodenough, Laura Goodfellow, James Goodlife, Camelia Goodwin, Elizabeth Goodwin, Jayne Goodwin, Paula Goodyear, Rajiv Gooentilleke, Michelle Goonasekara, Sheila Gooseman, Shameer Gopal, Sally Gordon, Hugh Gorick, Caitlin Gorman, Claire Gorman, Stuart Gormely, Diana Gorog, Michelle Gorst, Thomas Gorsuch, Jayshreebahen Gosai, Rebecca Gosling, Sally Gosling, Georgina Gosney, Vanessa Goss, Dzintars Gotham, Naomi Gott, Elizabeth Goudie, Angela Gould, Susan Gould, Lysander Gourbault, Abha Govind, Sharon Gowans, Girish Gowda, Rohit Gowda, Hannah Gower, Thomas Gower, Pankaj Goyal, Sunil Goyal, Sushant Goyal, Clive Graham, Jonathan Graham, Justin Graham, Libby Graham, Sharon Graham, Matthew Graham-Brown, Julia Grahamslaw, Gianluca Grana, Tracyanne Grandison, Louis Grandjean, Alison Grant, Ann Grant, David Grant, Matthew Grant, Pauleen Grant, Rhys Gravell, Jenny Graves, Alasdair Gray, Catherine Gray, Georgina Gray, Jackie Gray, Karen Gray, Nicola Gray, Sebastian Gray, Alan Grayson, Fiona Greaves, Paul Greaves, Charlotte Green, Christopher Green, David Green, Frederick Green, Joel Green, Marie Green, Nicola Green, Stacey Green, Teresa Green, Diarra Greene, Philippa Greenfield, Alan Greenhalgh, Daniel Greenwood, Sandra Greer, James Gregory, Jane Gregory, Katie Gregory, Tamsin Gregory, Jill Greig, Julia Greig, Rebecca Grenfell, Teena Grenier, Susan Grevatt, Glaxy Grey, Andrew Gribbin, Amy Gribble, Natasha Grieg, Douglas Grieve, Ben Griffin, Denise Griffin, Mel Griffin, Sian Griffith, Andrew Griffiths, Daniel Griffiths, David Griffiths, Donna Griffiths, Isabel Griffiths, Mark Griffiths, Nicola Griffiths, Oliver Griffiths, Sarah Griffiths, Yvonne Griffiths, Sofia Grigoriadou, Steph Grigsby, Evelina Grobovaite, Rachel Groome, Liliana Grosu, Jenny Grounds, Margaret Grout, Helen Grover, Jayne Groves, Neil Grubb, Julie Grundy, Francesca Guarino, Sharada Gudur, Sharazeq Guettari, Shivang Gulati, Vikas Gulia, Pumali Gunasekera, Malin Gunawardena, Kirun Gunganah, Jessica Gunn, Emma Gunter, Alok Gupta, Atul Gupta, Rajeev Gupta, Richa Gupta, Rishi Gupta, Tarun Gupta, Vineet Gupta, Ankur Gupta-Wright, Victoria Guratsky, Alvyda Gureviciute, Sambasivarao Gurram, Bhawana Gurung, Shraddha Gurung, Hazel Guth, Ruth Habibi, Berkin Hack, Pamela Hackney, Christian Hacon, Aiman Haddad, Denise Hadfield, Michalis Hadjiandreou, Nikolaos Hadjisavvas, Anna Haestier, Nauman Hafiz, Rana Hafiz-Ur-Rehman, Javed Hafsa, Samantha Hagan, Jack William Hague, Rosemary Hague, Kate Haigh, Christina Haines, Scott Hainey, Morton Hair, Brigid Hairsine, Juraj Hajnik, Anne Haldeos, Writaja Halder, Jennie Hale, Carmel Halevy, Paul Halford, William Halford, Alistair Hall, Anthony Hall, Claire Hall, Elizabeth Hall, Fiona Hall, Helen Hall, Jennifer Hall, Kathryn Hall, Jan Hallas, Kyle Hallas, Charles Hallett, Becky-Lee Halls, Heather Halls, Maryam Hamdollah-Zadeh, Bilal Hameed, Imran Hamid, Mohamad Hamie, Bethany Hamilton, Fergus Hamilton, Leigh Hamilton, Nicola Hamilton, Ruth Hamlin, Eleanor Hamlyn, Beatrice Hammans, Shirley Hammersley, Kate Hammerton, Bev Hammond, Leah Hammond, Fiona Hammonds, Ibrahim Hamoodi, Karen Hampshire, Jude Hampson, Lucy Hampson, Ozan Hanci, Ian Hancock, Sadiyah Hand, Jasmine Handford, Soran Handrean, Sarah Haney, Sheharyar Hanif, E Hanison, Jennifer Hannah, Amy Hannington, Merhej Hannun, Aidan Hanrath, Anita Hanson, Jane Hanson, Kathryn Hanson, Steve Hanson, Mazhar Ul Haq, Ala Haqiqi, Monjurul Haque, Lesley Harden, Zoe Harding, Simon Hardman, Joanna Hardy, Kumar Haresh, Rachel Harford, Beverley Hargadon, Carolyn Hargreaves, James Hargreaves, Alice Harin, Mohammed Haris, Edward Harlock, Paula Harman, Tracy Harman, Mark Harmer, Muhammad A Haroon, Charlie Harper, Heather Harper, Peter Harper, Rosemary Harper, Sarah Harrhy, Sian Harrington, Yasmin Harrington-Davies, Jade Harris, Jess Harris, John Harris, Laura Harris, Marie-Clare Harris, Nichola Harris, Sophie Harris (CTP), David Harrison, Julie Harrison, Laura Harrison, Melanie Harrison, Rowan Harrison, Susie Harrison, Thomas Harrison, Wendy Harrison, Elizabeth Harrod, Ciaran Hart, Dominic Hart, Lisa Hartley, Rosemary Hartley, Ruth Hartley, Tom Hartley, William Hartrey, Phillipa Hartridge, Stuart Hartshorn, Alice Harvey, Angela Harvey, Max Harvey, Catherine Harwood, Helen Harwood, Brigitte Haselden, Kazi Hashem, Mohammed Hashimm, Tadaaki Hashimoto, Imranullah Hashmi, Zena Haslam, Adil Hassan, Ali Hassan, Wagae UI Hassan, Sapna Hassasing, Jane Hassell, Philip Hassell, Alex Hastings, Bethany Hastings, Janice Hastings, Jonathan Hatton, May Havinden-Williams, Stefan Havlik, Daniel B Hawcutt, Kadean Hawes, Liz Hawes, Nicola Hawes, Annie Hawkins, Nancy Hawkins, Tanya Hawkins, Dan Hawley, Ed Hawley-Jones, Edward Haworth, Cathy Hay, Amna Hayat, Jamal Hayat, Mohamed-Riyal Hayathu, Anne Hayes, Jonas Hayes, Kate Hayes, Melony Hayes, Fiona Hayes, Patrick Hayle, Chloe Haylett, Antara Hayman, Melanie Hayman, Matthew Haynes, Richard Haynes, Rachel Hayre, Sarah Haysom, James Hayward, Patrick Haywood, Tracy Hazelton, Phoebe Hazenberg, Zhengmai He, Elizabeth Headon, Carrie Heal, Brendan Healy, Amy Hearn, Angela Heath, Rowan Heath, Diane Heaton, Kerry Hebbron, Gemma Hector, Andy Hedges, Katrine Hedges, Cheryl Heeley, Elaine Heeney, Rajdeep Heire, Ulla Hemmila, Cassie Hemmings, Scott Hemphill, Deborah Hemsley, Abigail Henderson, Jennifer Henderson, Steven Henderson, Natalie Hennesy, Carol Ann Henry, Joanne Henry, Karol Henry, Lavinia Henry, Margo Henry, Natalie Henry, David Henshall, Mike Herbert, Gillian Herdman, Rosaleen Herdman-Grant, Morag Herkes, Emma Heron, William Herrington, Emilia Heselden, Peta Heslop, Simon Hester, Emily Hetherington, Joseph Hetherington, Chamila Hettiarachchi, Pramodh Hettiarachchi, Hayley Hewer, John Hewertson, Anna Hewetson, Sue Hewins, Claire Hewitt, Davina Hewitt, Richard Hewitt, Robert Heyderman, Mathis Heydtmann, Joseph Heys, Jonathan Heywood, Meg Hibbert, John Hickey, Naomi Hickey, Peter Hickey, Alex Hicks, Jenny Hicks, Scott Rory Hicks, Daniel Higbee, Lucy Higgins, Andrew Higham, Martin Highcock, Judith Highgate, Mondy Hikmat, Amanda Hill, Helen Hill, Joanne Hill, Lisa Hill, Phoebe Hill, Uta Hill, Annette Hilldrith, Catherine Hillman-Cooper, Zoe Hilton, Sarah Hinch, Andrew Hindle, Alice Hindmarsh, Paul Hine, Kim Hinshaw, Clare Hird, Jemma Hives, Benson Ho, Michaela Hoare, David Hobden, Gill Hobden, Maria Hobrok, Simon Hobson, Simon Hodge, Lesley Hodgen, Holly Hodgkins, Louise Hodgkinson, Sally Hodgkinson, David Hodgson, Helen Hodgson, Luke Hodgson, Sheila Hodgson, Gemma Hodkinson, Kenneth Hodson, Matthew Hogben, Lucy Hogg, Lee Hoggett, Abigail Holborow, Catherine Holbrook, Melinda Holden, Thomas Holder, Niels Holdhof, Hannah Holdsworth, Lisa Holland, Maureen Holland, Nicky Holland, Marie Hollands, Elizabeth Holliday, Nina Holling, Laszlo Hollos, Simon Holloway, Marcus Hollyer, Amy Holman, Ann Holmes, Benjamin Holmes, Megan Holmes, Raphael Holmes, Rebecca Holmes, Kelly Holroyd, Caroline Holt, Lyndsey Holt, Siobhan Holt, Susie Holt, Alexandra Holyome, Marie Home, Toni Home, Renate Homewood, Kate Hong, Clare Hooper, Samantha Hope, Susan Hope, Bridget Hopkins, Peter W Horby, Stephanie Horler, Anil Hormis, Daniel Hornan, Nicola Hornby, Zoey Horne, Latoya Horsford, Megan Horsford, Mark Horsford, Valana Horsham, Alexander Horsley, Ashley Horsley, Elizabeth Horsley, Sarah Horton, Jane Hosea, Toby Hoskins, Muhammad S Hossain, Rashed Hossain, Maxine Hough, Sarah Hough, Catherine Houghton, Kathryn Houghton, Rebecca Houlihan, Hamish Houston, Tawe Hove, Roseanna Hovvels, Lee How, Laura Howaniec, Laura Howard, Linda Howard, Lucy Howard, Sarah Howard, Stuart Howard, Richard Howard-Griffin, Serena Howe, Mark Howells, Lyn Howie, Kerry Howlett, Josh Hrycaiczuk, Naing Z Htoon, Su Htwe, Ying Hu, Chiang O H Huah, Abby Huckle, Shahzya Huda, Alison Hudak, Lisa Hudig, Heather Hudson, Oli Hudson, Alison Hufton, Alistair Hughes, Emma Hughes, Gareth Hughes, Heather Hughes, Luke Hughes, Rachel Hughes, Rebecca Hughes, Samantha Hughes, Stephen Hughes, Vikki Hughes, Wesley Hughes, Lukas Huhn, Ching Hui, Ruth Hulbert, Diana Hull, Grace Hull, Robert Hull, Amanda Hulme, Peter Hulme, Wendy Hulse, George Hulston, Ryan Hum, Megan Hume, Charlotte Humphrey, Ismay Humphreys, Alasdair Humphries, Joanne Humphries, Fiona Hunt, Kristen Hunt, Luke Hunt, Sophie Hunt, Alexandra Hunter, Karl Hunter, Neil Hunter, George Huntington, Elizabeth Hurditch, Cian Hurley, Katrina Hurley, Mohammed A Husain, Syeda Y Husaini, Coralie Huson, Afreen Hussain, Ibraar Hussain, Ifza Hussain, Mohammad Hussain, Muhammad Hussain, Reda Hussain, Sajid Hussain, Samia Hussain, Sanniah Hussain, Yasmin Hussain, Mohammed Hussam El-Din, Rebecca Hussey, Camille Hutchinson, Dorothy Hutchinson, Elizabeth Hutchinson, John Hutchinson, Claire Hutsby, Paula Hutton, Daniella Hydes, Jamie Hyde-Wyatt, Niamh Hynes, Megan Hyslop, Mazen Ibraheim, Abdalla Ibrahim, Ahmed Ibrahim, Asil Ibrahim, Mohamed Ibrahim, Wadah Ibrahim, Adetokunbo I Idowu, Muhammad Idrees, Hina Iftikhar, Mawara Iftikhar, Chukwuemeka Igwe, Mohammad Ijaz, Amaju Ikomi, Clare Iles, Stamatina Iliodromiti, Mary Ilsley, Lorna Ilves, La'ali Imam-Gutierrez, Christopher Imray, Haider Imtiaz, Jack Ingham, Julie Ingham, Rory Ingham, Tejas Ingle, Jennifer Inglis, Anne Ingram, Luke Ingram, Peter Inns, Ken Inweregbu, Andreea A Ionescu, Ana Ionita, Ilian P Iordanov, Anil Ipe, Madiha Iqbal, Mohammed Iqbal, Faisal Iqbal Sait, Jane Ireland, Robert Irons, Mohannad Irshad, Muhammad S Irshad, Janice Irvine, Val Irvine, Robert Irving, Mina Ishak, Erica IsherwoodOC User, Aminul Islam, Abdurrahman Islim, Ali Ismail, Omar Ismail, Caroline Ison, M'hamedi Israa, Sharon Isralls, Monica Ivan, Chineze Ivenso, Ashleigh Ivy, Sophie Iwanikiw, Karen Ixer, Menaka Iyer, Mia Iyer, Calum Jack, Amanda Jackson, Ben Jackson, Beth Jackson, Ella Jackson, Hayley Jackson, Helen Jackson, Jane Jackson, Lauren Jackson, Melanie Jackson, Nicola Jackson, Shane Jackson, Patricia Jacob, Reni Jacob, Nicola Jacques, Anisa Jafar, Daniel Jafferji, Ali Jaffery, Chandrashekar Jagadish, Vijay Jagannathan, Mandeep Jagpal, Fernandez R Jaime, Neemisha Jain, Seema Jain, Susan Jain, Sanjay Jaiswal, Danyal Jajbhay, Thomas Jaki, Bintou Jallow, Yusuf Jaly, Sabine Jamal, Zeba Jamal, Yasmin Jameel, Albie James, Christie James, Kate James, Lee James, Linda James, Mark James, Nicholas James, Olivia James, Rebecca James, Ruth James, Tracy James, Jack Jameson, Aaron Jamison, Phoebe Jane, Azara Janmohamed, Sabrina Jansz, Deepa Japp, Victor Jardim, Catherine Jardine, Emma Jarnell, Ellie Jarvie, Claire Jarvis, Rosina Jarvis, Patrycja Jastrzebska, Hafsa Javed, Mays Jawad, Lona Jawaheer, Anu Jayachandran, D Jayachandran, Angelina Jayakumar, Deepak Jayaram, Ravi Jayaram, Geeshath Jayasekera, Thilina Jayatilleke, Abi Jayebalan, Saman Jeddi, Vandana Jeebun, Mohammad S Jeelani, Katie Jeffery, Helen Jeffrey, Jenni Jeffrey, Nathan Jeffreys, Benjamin Jeffs, Debbie Jegede, Taylor Jemima, Ifan Jenkin, Alison Jenkins, Christopher Jenkins, David Jenkins, Elinor Jenkins, Sarah Jenkins, Sian Jenkins, Stephen Jenkins, Jacqui Jennings, Louise Jennings, Virginia Jennings, Ellen Jerome, Douglas Jerry, Ellen Jessup-Dunton, Jorge Antonio Jesus Silva, Champa Jetha, Kishan Jethwa, Jeby Jeyachandran, Shaman Jhanji, Khoo Jian, Zhixin Jiao, Laura Jimenez, Ana Jimenez Gil, Jithin Jith, Teishel Joefield, Navraj Johal, Karine Johannessen, Aisyah Johari, Annie John, Anu John, Navin John, Emma Johns, Margaret Johns, Antoinette Johnson, David Johnson, Emma Johnson, Gillian Johnson, Kathryn Johnson, Katie Johnson, Luke Johnson, Mark Johnson, Nelson Johnson, Oliver Johnson, Tracy Johnson, Claire Johnston, Janet Johnston, Laura Johnston, Susan Johnston, Victoria Johnston, Dawn Johnstone, Ed Johnstone, Janet Johnstone, Manohar Joishy, Adam Jones, Alistair Jones, Annabel Jones, Ben Jones, Bryony Jones, Carys Jones, Ceri Jones, Charlotte Jones, Christine E Jones, Debra Jones, Emily Jones, Gareth Jones, Geraldine Jones, Jac Jones, James Jones, Jessica Jones, Jonathon Jones, Julie Jones, Kate E Jones, Laura Jones, Laura M Jones, Louise Jones, Mathew Jones, Nicola Jones, Paul Jones, R E Jones, Rhianna Jones, Samantha Jones, Sophie Jones, Stefanie Jones, Steve Jones, Taya Jones, Tim Jones, Tracey Jones, Ramya Jonnalagadda, Rebecca Jordache, Sanal Jose, Anna Joseph, Rosane Joseph, Sibet Joseph, Dhaara Joshi, Mehul Joshi, Pratichi Joshi, Benz Josiah, Tiffany Joyce, Adriel Ju Wen Kwek, Edward Jude, Parminder Judge, Jessica Juhl, Sirisha Jujjavarapu, Mark Juniper, Edmund Juszczak, Deepthi Jyothish, Kasamu Kabiru Dawa, Mark Kacar, Nikhil Kadam, Rebecca Kahari, Gail Kakoullis, Azad Kala Bhushan, Richard J K Kalayi, Roobala Kaliannan Periyasami, Efthymia Kallistrou, Seika Kalsoom, Elisa Kam, John Kamara, Mohamed Kamara, Ajay Kamath, Prakash Kamath, Ravindra Kamath, Siddharth A Kamerkar, Nick Kametas, Musaiwale Kamfose, Leia Kane, Osei Kankam, Thogulava Kannan, Abhinav Kant, Vikas Kapil, Ritoo Kapoor, Sonal Kapoor, Sourjya Kar, Janaka Kara, Rona Kark, Nicholas Karunaratne, Natashja Kasianczuk, Vidya Kasipandian, Rizwan Kassam, Janarth Kathirgamachelvam, Victoria Katsande, Kulbinder Kaul, Daljit Kaur, Dervinder Kaur, Jasmin Kaur, Jaspreet Kaur, Zunaira Kausar, Mohammad A Kawser, Andrea Kay, Sarah Kay, Jossy N Kayappurathu, Callum Kaye, Ahemd Kazeem, Naved Kazi, Rachel Kearns, Nichola Kearsley, Joanne Keating, John Keating, Liza Keating, Elizabeth Keddie-Gray, Natalie Keenan, Jonathan Kefas, Stephen Kegg, Laura Keith, Uzoamaka Keke, Joanne Kellett, Alison Kelly, David Kelly, Diane Kelly, Dominic Kelly, Emma Kelly, Laura Kelly, Martin Kelly, Michael Kelly, Rosalind Kelly, Sinead Kelly, Stephen Kelly, Stephen Kelly, Mary Kelly-Baxter, Marketa Keltos, Timothy Kemp, Kelly Kemsley, Alexandra Kendall-Smith, Sarah Kennard, Ann Kennedy, James Kennedy, Sophie Kennedy-Hay, Julia Kenny, Melanie Kent, Lynne Keogan, Alexander Keough, Andrew Kerr, Caroline Kerrison, Anthony Kerry, Sam Kershaw, Helen Kerslake, Ian Kerslake, Helen Kerss, Jocelyn Keshet-Price, Georgina Keyte, Abdul Khadar, Ali Khalid, Muhammad U Khalid, Syed Khalid, Amir Khalil, Asma Khalil, Sijjad Khalil, Abubakar Khan, Ali Khan, Al-Imran Khan, Arham Khan, Asad Khan, Aurangzeb Khan, Burhan Khan, Camran Khan, Fatimah Khan, Kausik Khan, Malik A Khan, Marria Khan, Mehrunnisha Khan, Mohammad Khan, Nayeem Khan, Omar Khan, Rahila Khan, Shabana Khan, Shahul Khan, Shoaib Khan, Tasaduksultan Khan, Waseem Khan, Usman F Khatana, Jibran Khatri, Jyoti Khatri, Hafiza Khatun, Taslima Khatun, Mena Kheia, Jacyntha Khera, Htet H E Khin, Najaf Khoja, Kiran Khokhar, Chloe Khurana, Faith Kibutu, Andrew damian, Michelle Kidd, Joe Kidney, Shane Kidney, Will Kieffer, James Kilbane, Caroline Kilby, Eileen Killen, Susan Kilroy, Bomee Kim, Jee Whang Kim, Sarah Kimber, Andy King, Barbara King, Jennifer King, Kirsten King, Rachel King, Sarah King, Victoria King, Emily King-Oakley, Laura Kingsmore, Fiona Kinney, Sidra Kiran, Jeremy Kirk, Jodie Kirk, Amy Kirkby, Emily Kirkham, Gemma Kirkman, Ursula Kirwan, Kelly Kislingbury, Toby Kitching, Laura Kitto, Lauren Kittridge, Sarah Klaczek, Frieder Kleemann, Susan Kmachia, Chris Knapp, Lucy Knibbs, Alicia Knight, Fraser Knight, Marian Knight, Sarah Knight, Steven Knight, Tom Knight, Ellen Knights, Jane Knights, Martin Knolle, Carol Knott, Charlotte Knowles, Karen Knowles, Karen Knowles, Laurence Knowles, Emily Knox, Lucy Knox, Oliver Koch, Ronan Kodituwakku, Gouri Koduri, Aisha Koirata, Eirene Kolakaluri, Magdalena Kolodziej, Eirini Kolokouri, Samantha Kon, Niladri Konar, Mari Kononen, Athanasios Konstantinidis, Hui Fen Koo, Imogen Koopmans, Emmanuela Kopyj, Laura Korcierz, James Korolewicz, George Koshy, Chris Kosmidis, Jalpa Kotecha, Easwari Kothandaraman, Koushan Kouranloo, Rukhsana Kousar, Margarita Kousteni, Maja Kovac, Alex Kozak Eskenazia, Kestutis Krasauskas, Raghu Krishnamurthy, Vinodh Krishnamurthy, Manju Krishnan, Hari Krishnan, Suzanne Krizak, Sean Krupej, Agnieszka Kubisz-Pudelko, Soren Kudsk-Iversen, Aurimas Kudzinskas, Chirag Kukadiya, Nainesha Kulkarni, Aditi Kumar, Mayur Kumar, Ramesh Kumar, Ravi Kumar, Rita Kumar, Rupa Kumar, Satish Kumar, Vimal Kumar, Arun Kundu, Heinke Kunst, Amit Kurani, Mohammed Kurdy, Rincy Kurian, Vimal Kurmars, Cameron Kuronen-Stewart, Ranganai S Kusangaya, Vlad Kushakovsky, Mandy Kuunal, Apexa Kuverji, Amma Kyei-Mensah, Thyra Kyere-Diabour, Moe Kyi, Nyan M Kyi, Laura Kyle, Karali-Tsilimpari Kyriaki, Julius Labao, Louise Lacey, Nikki Lack, Emma Ladlow, Heather Lafferty, Shondipon Laha, Sushil Lahane, Clement Lai, James Lai, Robert Laing, Inez Laing-Faiers, Emily Laity, Nicki Lakeman, David Lalloo, Fiona Lalloo, Alison Lam, Fiona Lamb, Lucy Lamb, Thomas Lamb, Pauline Lambert, Claudia Lameirinhas, Mohammed K G Lami, Holly Lamont, Michal Lamparski, Djillali Lamrani, Christine Lanaghan, Ivone Lancona-Malcolm, Julia Lancut, Geraldine Landers, Martin J Landray, Matthew Lane, Nicholas Lane, Alidih Lang, Stephen Lang, Daniel Langer, Margaret Langley, Charles Langoya, Emily Langthorne, Taiya Large, Anna Last, Scott Latham, John Latham-Mollart, Afzal Latheef, Nang Latt, Carly Lattimore, Dawn Lau, Eva Lau, Myra Laurenson, Hou Law, Jennifer Law, Jessica Law, Penny Law, Richard Law, Emma Lawrence, Neil Lawrence, Ryan Lawrie, Joanne Lawson, Louise Lawson, Michael Lay, Christine Laycock, Reina Layug, Maria Lazo, Vietland Le, Amelia Lea, William Lea, Ian Leadbitter, Thomas Leahy, Richard Lean, Lorna Leandro, Darren Leaning, Sandra Leason, Emma Lee, Hannah Lee, Irish Lee, Judith Lee, Sam Lee, Shi H Lee, Simon Lee, Sindy Lee, Stephanie Lee, Tracey Lee, Xiang Lee, Diana Lees, Jennifer Lees, Helen Legge, Julian Leggett, Katie Leigh-Ellis, Kevan Leighton, Nicky Leitch, Eleni Lekoudis, Petula Lemessy, Nicholas Lemoine, Katy Leng, Katrina Lennon, Liz Lennon, Kelly Leonard, Wen Leong, Nicky Leopold, Oskar Lepiarczyk, Isla Leslie, Eleni Lester, Joe Leung, Emma Levell, Chris Levett, Alice Lewin, Michaela Lewin, Alison Lewis, David Lewis, Dee Lewis, Gillian Lewis, Joanne Lewis, Joseph Lewis, Kathryn Lewis, Keir Lewis, Leon Lewis, Marissa Lewis, Rob Lewis, Robert Lewis, Catherine Lewis-Clarke, Katherine Lewiston, Adam Lewszuk, Penny Lewthwaite, Samantha Ley, Angela Liao, Victoria Licence, David Lieberman, Susan 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Laura Looby, Ronda Loosley, Paola Lopez, Paula Lopez, Robert Lord, Catherine Lorenzen, Claire Lorimer, Francesco Loro, Rachel Lorusso, Robert Loveless, Maxine Lovell, Angeliki Loverdou, Andrew Low, Jen M Low, Alastair Lowe, Caroline Lowe, Catherine Lowe, Emily Lowe, Faye Lowe, Michael Lowe, Richard Lowsby, Vicki Lowthorpe, Gamu Lubimbi, Alexandra Lubina Solomon, Georgia Lucas, Jacob Lucas, Alice Lucey, Olivia Lucey, Suzanne Luck, Jane Luke, Apurva Lunia, Muriel Lunn, Ji Luo, Cindy Nisha Luximon, Barrie Lyell, Elisavet Lyka, Audrey Lynas, Ceri Lynch, Daniel Lynch, Daniella Lynch, Stephen Lynch, Helen Lyon, Rea-Grace Maamari, Hannah Mabb, Louies Mabelin, Jessica Macaro, Kateryna Macconaill, Chloe Macdonald, Stuart MacDonald, Claire Macfadyen, James Gray Macfarlane, Jill Macfarlane, Laura Macfarlane, Lisa MacInnes, Iain MacIntyre, Jill MacIntyre, Kirsten Mack, Callum Mackay, Euan Mackay, Laura Mackay, Alexander Mackenzie, Matt Mackenzie, Robert MacKenzie Ross, Ami Mackey, Fiona Mackie, 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Emmeline Martin, Hayley Martin, Hope Martin, Jane Martin, Karen Martin, Kate Martin, Laila Martin, Michael Martin, Noelia Martin, Tim Martin, Winston Martin, Tim Martindale, Marcus Martineau, Lauren Martinez, Jose C Martinez Garrido, Juan Martin-Lazaro, Vijay K Maruthamuthu, Gemma Maryan, Roman Mary-Genetu, Sam Maryosh, Vidan Masani, Diego Maseda, Sheila Mashate, Yasaman Mashhoudi, Al Mashta, Izhaq Masih, Sanna Masih, Nick Maskell, Nick Maskell, Perry Maskell, Matthew Masoli, Rebecca Mason, Richard Mason, Ruth Mason, Claire Mason, Mohammad Masood, Mohammad T Masood, Syed Masood, Syed S M E Masood, Aaqib Masud, Lear Matapure, Cristina Matei, Ropafadzo Matewe, Manraj Matharu, Stephy Mathen, Alex Mather, Nicole Mather, Jonathan Mathers, Joanna Matheson, Amal Mathew, Anna Mathew, Moncy Mathew, Verghese Mathew, Caroline Mathews, Jesha Mathews, Kate Mathias, Darwin Matila, Wadzanai Matimba-Mupaya, Nashaba Matin, Elina Matisa, Max Matonhodze, Elijah Matovu, Jaysankar Mattappillil, Alison J 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Min, Samuel Mindel, Chrissie Minnis, Paul Minnis, Jane Minton, Frederico Miranda, Lucy Mires, Taimur Mirza, Anjum Misbahuddin, Aseem Mishra, Biswa Mishra, Eleanor Mishra, Ritu Mishra, Sannidhya Misra, Deena Mistry, Heena Mistry, Dushyant Mital, Sarah Mitchard, Alan Mitchell, Ben Mitchell, Piers Mitchell, Susan Mitchell, Philip Mitchelmore, Andrew Mitra, Atideb Mitra, Sandip Mitra, Clarisse Mizzi, Emma Moakes, Emma Moatt, Gita Modgil, Abdelrahman Mohamed, Arez Mohamed, Osab Mohamed, Waheed Mohammad, Aliabdulla Mohammed, Omer Mohammed, Yaser N S Mohammed, Bilal A Mohamud, Mahalakshmi Mohan, Amr Moharram, Jonathan Mok, Christine Moller-Christensen, Mateus Mollet, Malid Molloholli, Aoife Molloy, Linda Molloy, Andrew Molyneux, Tasnim Momoniat, Holly Monaghan, Krista Monaghan, Shiva Mongolu, Katelyn Monsell, Mahmoud Montasser, Alan Montgomery, Hugh Montgomery, Prebashan Moodley, Margaret Moody, Nick Moody, Angela Moon, James Moon, Ji-Hye Moon, Maria Moon, May Moonan, Parvez Moondi, Alex 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Sheree Mutton, Natasha Muzengi, Memory Mwadeyi, Bettina Mwale, Esther Mwaura, Raji Myagerimath, Alice Myers, Sam Myers, Khin S Myint, Yadee Myint, Libor Myslivecek, Helen Nabakka, Evelyn Nadar, Iftikhar Nadeem, Moosa Nadheem, Asma Naeem, Hassan Naeem, Salman Naeem, Samraiz Nafees, Mohamed Nafei, Thapas Nagarajan, Imrun Nagra, Deepak Nagra, Mina Naguib, Kirushthiga Naguleswaran, K Shonit Nagumantry, Kevin Naicker, Sarveshni Naidoo, Gireesha Naik, Rishi Naik, Samir Naik, Devu Sasikumar Nair, Rajiv Nair, Tanushree Nair, Jay Naisbitt, Kerry Naismith, Sri Nallapareddy, Soum Nallapeta, Arumugan Nallasivan, Uttam Nanda, Aarti Nandani, Ali R Naqvi, Asadullah Naqvi, Sara Naqvi, Sophia Nasa, Dominic Nash, Nader Nasheed, Abdul Nasimudeen, Umer Nasir, Marwan Nassari, Tahir Nasser, Anuja Natarajan, Geetha Natarajan, Nalin Natarajan, Nikhila Natarajan, Rajkumar Natarajan, Noel Nathaniel, Mala Nathvani, Priyan Nathwani, George Nava, Neena Navaneetham, Jeya Navaratnam, Helen Navarra, Sadaf Naveed, 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Georgii Nikonovich, Annette Nilsson, Kofi Nimako, Louise Nimako, Camus Nimmo, Preethy Ninan, Mahesh Nirmalan, Muhammad Nisar, Toby Nisbett, Aksinya Nisha James, Sabaahat Nishat, Tomoko Nishiyama, Sara Nix, Jennifer Nixon, Maxine Nixon, Khwaja Nizam Ud Din, Maria Nizami, Lyrics Noba, Harriet Noble, Hsu Noe, Jerry Nolan, Zahid Noor, Zaid Noori, Louis Norman, Rachel Norman, Karen Norris, Lillian Norris, Sally Ann Nortcliffe, Fiona North, Julie North, Thomas North, John Northfield, Samantha Northover, Jurgens Nortje, Donna Norton, Rowen Norton, Holly Notman, Khalid Nourein, Timea Novak, Alan Noyon, Arlene Nubi, Mohamed Nugdallah, Anne Marie Nugent, Justine Nugent, Kribashnie Nundlall, Kieran Nunn, Michelle Nunn, Jane Nunnick, Yvonne Nupa, Zubeir Nurgat, Godfrey Nyamugunduru, Maggie Nyirenda, Kerry Nyland, Daire O Shea, Sara O'Brien, Ruth O'Donnell, Chloe O'Hara, Kevin O'Reilly, Caroline Oakley, Begho Obale, Clements Oboh, Clare O'Brien, Julie O'Brien, Kirsty O'Brien, Linda O'Brien, Marese O'Brien, Neale O'Brien, Rachel O'Brien, Tracey O'Brien, Emma O'Bryan, Ross Obukofe, Christopher O'Callaghan, Lorcan O'Connell, Tadg O'Connor, Chris O'Connor, Grainne O'Connor, Miranda Odam, Sam Oddie, Sharon Oddy, Yejide Odedina, Krishma Odedra, Sven Wilhelm Odelberg, Natasha Odell, Omolola Oderinde, Jessica Odone, Catherine O'Donovan, Stephen O'Farrell, Pamela Offord, Tanwa Ogbara, Catherine Ogilvie, Ciaran O'Gorman, Oluwatomilola Ogunkeye, Udeme Ohia, Shinjali Ohja, Ohiowele Ojo, Mark O'Kane, Tolu Okeke, Eleanor OKell, Alicia Okines, Iheoma Okpala, Ernest Okpo, Maryanne Okubanjo, Raphael Olaiya, Tim Old, Jane Oldham, Gregory Oleszkiewicz, Annie Oliver, Catherine Oliver, Jesse Oliver, Martyn Oliver, Zoe Oliver, Nurudeen O Olokoto, Folusho Olonipile, Olumide Olufuwa, Olatomiwa Olukoya, Akinlolu Oluwole-Ojo, Laura O'Malley, Maryam Omar, Zohra Omar, Nimca Omer, Connaire O'Neill, Lauran O'Neill, Chon Sum Ong, Chidera Onyeagor, Huah Chiang Ooi, Amin Oomatia, Maria Opena, Richard Oram, 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Wei Pang, Laura Pannell, Kanwar Pannu, Sathianathan Panthakalam, Charles T Pantin, Norman Pao, Helen Papaconstantinou, Padmasayee Papineni, Kitty Paques, Kerry Paradowski, Vinay Parambil, Supathum Paranamana, Siddhant Parashar, Ian Parberry, Amy Parekh, Dhruv Parekh, Louise Parfitt, Helen Parfrey, Omi Parikh, Gemma Parish, John Park, Angela Parker, Ben Parker, Emma Parker, Fiona Parker, Jacob Parker, Julie Parker, Laura Parker, Lucy Parker, Sara Parker, Sean Parker, Kirstin Parkin, Anna Parkinson, Valerie Parkinson, Chetan Parmar, Viraj Parmar, Victoria Parris, Helen C Parry, Siobhan Parslow-Williams, Maria Parsonage, Penny Parsons, Sarah Parsons, Richard Partridge, Kevin Parvin, Lauren Passby, Juan Pastrana, Mital Patal, Sarah Patch, Aamie Patel, Alkesh Patel, Amisha Patel, Dakshesh Patel, Darshna Patel, Hemani Patel, Jaymik Patel, Kamal Patel, Kayur Patel, Kiran Patel, Krish Patel, Manish Patel, Martyn Patel, Mehul Patel, Naleem Patel, Nehalbhai Patel, Prital Patel, Rebecca Patel, Saagar Patel, Soonie Patel, Trishna Patel, Vishal Patel, Sangeeta Pathak, Nazima Pathan, Alexandra Patience, Donna Patience, Abigail Patrick, Georgie Patrick, Jean Patrick, Simon Patten, Ben Pattenden, Charlotte Patterson, Linda Patterson, Molly Patterson, Rob Patterson, Robert Patterson, Leigh Pauls, Stephane Paulus, Amelia Pavely, Susan Pavord, Brendan Payne, David Payne, Elizabeth Payne, Ruth Payne, Tammy Payne, Linda Peacock, Louise Peacock, Sarah Peacock, Henry Peake, Rupert Pearse, Andrew Pearson, Daniel Pearson, Harriet Pearson, Karen Pearson, Kirsty Pearson, Samuel A Pearson, Sandra Pearson, Alice Peasley, Hilary Peddie, Russell Peek, Claire Pegg, Suzannah Peglar, Benjamin H Peirce, Claire Pelham, Abigail Pemberton, Melchizedek Penacerrada, Anthony Pender, Carmel Pendlebury, Jessica Pendlebury, Rachel Penfold, Catherine Penman, Julie Penman, Rachel Penman, Justin Penner, Kristi Penney, Alistair Penny, James Penny, Justin Pepperell, Huw Peregrine, Adriana Pereira, Adriana Pereira, Rita Pereira, Carlota Pereira Dias Alves, Elena Perez, Jane Perez, Tanaraj Perinpanathan, Lakshmi Periyasamy, Francesca Perkins, Elizabeth Perritt, Alison Perry, Emily Perry, Meghan Perry, Terrie Perry, Thomas M Perumpral, Guilherme Pessoa-Amorim, Ruth Petch, Lionel Peter, Cecilia Peters, Mark Peters, Steve Peters, Tim Peters, Remy Petersen, Alexandra Peterson, Leon Peto, Iulia Petras, Ilianna Petrou, Boyanka Petrova, Mirela Petrova, Paul Pfeffer, Mysore Phanish, Paul Phelan, Christopher Philbey, Jennifer Philbin, Alex Phillips, Dylan Phillips, Karen Phillips, Rachael Phillips, Marie Phipps, Virach Phongsathorn, Mandeep Phull, Masroor M Phulpoto, Myat T T PI, Sara Pick, James Pickard, Charlotte Pickering, Gillian Pickering, Thomas Pickett, Joanna Pickles, Benjamin Pickwell-Smith, Natalia Pieniazek, Charlie Piercy, Angelo Pieris, Samia Pilgrim, Paul A Pillai, Zoe Pilsworth, Heather Pinches, Stacey Pinches, Kirsty Pine, Muni T Pinjala, Stefania Pintus, Graeme Piper, Tasneem Pirani, Marcus Pittman, Sally Pitts, Nicolene Plaatjies, Aiden J Plant, Naomi Platt, Robert Pleass, Laura Plummer, Charles Plumptre, Jonathan Pobjoy, Tatiana Pogreban, Stephen Poku, Rachel Pollard, Louisa Pollock, Louisa Pollock, Oluwamayowa Poluyi, Gary J Polwarth, Fiona Pomery, Ponmurugan Ponnusamy, Suresh Ponnusamy, Aravind Ponnuswamy, Inês Ponte Bettencourt dos Reis, Suman Pooboni, Alice Poole, Christopher Poole, Lorraine Poole, Lynda Poole, Michele Poole, Sharon Poon, Tajinder Poonian, David Porter, Jo Porter, Linda Porter, Ross Porter, Kelly Postlethwaite, Narayana Pothina, Priyadarshan Potla, Dorota Potoczna, Jason Pott, Alison Potter, Jean Potter, Sarah Potter, Tracey Potter, Elspeth Potton, Joanne B Potts, Julie Potts, Kathryn Potts, K Poultney, Una Poultney, Vanessa Poustie, James Powell, Jordan Powell, Deborah Power, Nick Power, Joseph Poxon, Robin Poyner, Vidushi Pradhan, Helena Prady, Aalekh Prasad, Krishna Prasad, Fredy Prasanth Raj, Sangeetha Prasath, Anezka Pratley, 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Geshwin Ramnarain, Lidia Ramos, Shanthi Ramraj, Alex Ramshaw, Aleem Rana, Ghulam F Rana, Rehman Rana, Abby Rand, James Rand, Harpal Randheva, Poonam Ranga, Manmeet Rangar, Harini Rangarajan, Sameer Ranjan, Poormina Ranka, Rajesh Rankhelawon, Anita Rao, Sandhya Rao, Sanjay Rao, Deepak Rao, Anuja Rasarathnam, Althaf A Rasheed, Khalid Rashid, Simbisai Ratcliff, Sam Ratcliffe, Sophy Ratcliffe, Sanjeev Rath, Mohmad I Rather, Selina Rathore, Aravinden Ratnakumar, Jonathan Ratoff, Deepa Rattehalli, Jason Raw, Hywel Rawlins, Gautam Ray, Adam Raymond-White, Dana Raynard, Nicola Rayner, Amy Raynsford, Salman Razvi, Zarine Razvi, Kerry Read, Sarah Read, Ajay Reddy, Anvesh Reddy, Harsha Reddy, Ravi Reddy, Aine Redfern-Walsh, Joan Redome, Anna Reed, John Reed, Andrew Rees, James Rees, Martyn Rees, Sarah Rees, Stephanie Rees, Tabitha Rees, Fiona Regan, Karen Regan, Susan Regan, Kanchan Rege, Ahmed Rehan, A Rehman, Shoib Rehman, Zainab Rehman, Ada Reid, Andrew Reid, Jennifer Reid, Jeremy Reid, Sharon 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Nicky Roberts, Philip Roberts, Rebecca Roberts, Calum Robertson, James Robertson, Jamie Robertson, Nichola Robertson, Stuart Robertson, Nicole Robin, Caroline Robinson, Emma Robinson, Gisela Robinson, Hannah Robinson, Jemima Robinson, Kate Robinson, Matthew Robinson, Ryan Robinson, Sandra Robinson, Steve Robson, Lisa Roche, Samantha Roche, Natalie Rodden, Alistair Roddick, Jack Roddy, Marion Roderick, Alison Rodger, Faye Rodger, Megan Rodger, Alicia Rodgers, Deirdre Rodgers, Natasha Rodgers, Penny Rodgers, Rocio Rodriguez-Belmonte, Nicholas Roe, Charles Roehr, Gill Rogers, Jason Rogers, Joanne Rogers, John Rogers Rogers, Leigh Rogers, Lindsay Rogers, Louise Rogers, Michaela Rogers, Paula Rogers, Susan Rogers, Thomas Rogers, Paula Rogers, Sakib Rokadiya, Lee Rollins, Jennifer Rollo, Catherine Rolls, Claire Rook, Rashmi Rook, Kevin Rooney, Lynsey Rooney, Lace P Rosaroso, Alastair Rose, Annie Rose, Steve Rose, Zoe Rose, Josephine Rosier, Jack Ross, Jenny Rossdale, Andrew Ross-Parker, Alex 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Lisa Tarrant, Antonia Tasiou, Elizabeth Tatam, Margaret L Tate, Kate Tatham, Vera Tavoukjian, Alexander Taylor, Beverley Taylor, Brian Taylor, Charlie Taylor, David Taylor, Elisabeth Taylor, Janet Taylor, Jennifer Taylor, Joanne Taylor, Julie Taylor, Karen Taylor, Leanne Taylor, Margaret Taylor, Matthew Taylor, Melanie Taylor, Natalie Taylor, Rachael Taylor, Rachel Taylor, Samantha Taylor, Suzanne Taylor, Suzanne Taylor, Tina Taylor, Tracey Taylor, Vicky Taylor, Michelle Taylor-Siddons, Thomas Taynton, Amelia Te, Jessica Teasdale, Julie Tebbutt, Caroline Tee, Rajni Tejwani, Adam Telfer, Vibha Teli, Jennifer Tempany, Julie Temple, Natalie Temple, Helen Tench, Yi He Teoh, Lynne Terrett, Louise Terry, Dariusz Tetla, Shirish Tewari, Daniel Tewkesbury, Joana Texeira, ChiaLing Tey, Clare Thakker, Manish Thakker, Hilary Thatcher, Andrew Thayanandan, Krishna Thazhatheyil, Eaint Thein, Lambrini Theocharidou, Phyu Thet, Kapeendran Thevarajah, Mayooran Thevendra, Nang Thiri Phoo, Yvette Thirlwall, Muthu Thirumaran, Alice Thomas, Andrew Thomas, Caradog Thomas, Emma Thomas, Enson Thomas, Esther Thomas, Helen Thomas, James Thomas, Karen Thomas, Koshy Thomas, Lucy Thomas, Rachel Thomas, Rebecca Thomas, Rhys Thomas, Ruth Thomas, Samantha Thomas, Sarah Thomas, Sherine Thomas, Tessy Thomas, Vicky Thomas, Rhian Thomas-Turner, Catherine Thompson, Christopher Thompson, Clara Thompson, Fiona Thompson, Katharine Thompson, Laura Thompson, Liz Thompson, Luke Thompson, Michael Thompson, Orla Thompson, Rebecca Thompson, Roger Thompson, Nicola Thomson, Natasha Thorn, Charlotte Thorne, Nicola Thorne, Jim Thornton, Richard Thornton, Sara Thornton, Susan Thornton, Thomas Thornton, Tracey Thornton, Christopher Thorpe, Sarah Thorpe, Paradeep Thozthumparambil, Laura Thrasyvoulou, Hannah Thraves, Elisha Thuesday, Vicky Thwaiotes, Guy Thwaites, Simon Tiberi, Jane Tidman, Serena Tieger, Carey Tierney, Caroline Tierney, Mark Tighe, Sorrell Tilbey, Amanda Tiller, John Timerick, Elizabeth 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Abdullah M Virk, Elisa Visentin, Jeyakumar Visuvanathan, Karunakaran Vithian, Sorice Vittoria, Elena Vlad, Ben Vlies, Alain Vuylsteke, Eleftheria Vyras, Richard Wach, Beverley Wadams, Susan Wadd, Natalia Waddington, Kirsten Wadsworth, Syed E I Wafa, Daniel Wagstaff, Lynda Wagstaff, Dalia Wahab, Zaroug Wahbi, Abiodun Waheed Adigun, Sawan Waidyanatha, Rachel Wake, Alice Wakefield, William Wakeford, Fiona Wakinshaw, Andrew Walden, Lorna Walding, Alexandria Waldron, Gemma Walker, Harriet Walker, Ian Walker, Kevin Walker, Kim Walker, Linda Walker, Marie Walker, Olivia Walker, Rachel Walker, Rebecca Walker, Susan Walker, Rebecca Wallbutton, Jessica Wallen, Karl Wallendszus, Arabella Waller, Rosemary Waller, Gabriel Wallis, Louise Wallis, Donna Walsh, Elizabeth Walsh, Livia Walsh, Deborah Walstow, Daniel Walter, Alex Walters, Holt Walters, James Walters, Jocelyn Walters, Eileen Walton, Lucy Walton, Olivia Walton, Sharon Walton, Susan Walton, Mandy Wan, Thin Wan, Mary Wands, Rachel Wane, Frank 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Chi-Hung Wong, Edwin Wong, Jessica S Y Wong, Kit Y Wong, Mei Yin Wong, Nick Wong, Sam Wong, Amanda Wood, Caroline Wood, Dianne Wood, Fiona Wood, Hannah Wood, Jennifer Wood, Joe Wood, Kathryn Wood, Lisa Wood, Louise Wood, Michelle Wood, Stephen Wood, Tracy Wood, Rebecca Woodfield, Christopher Woodford, Elizabeth Woodford, Jill Woodford, Louise Woodhead, Timothy Woodhead, Philip Woodland, Marc Woodman, Jane Woods, Katherine Woods, Sarah Woods, Zoe Woodward, Megan Woolcock, Gemma Wooldridge, Rebecca Woolf, Chris Woollard, Christopher Woollard, Louisa Woollen, Emma Woolley, Jade Woolley, Katharine Wooodall, Daniel Woosey, Dan Wootton, Joanne Wootton, Daniel Worley, Stephy Worton, Jonathan Wraight, Maria Wray, Tim Wreford-Bush, Joanne Wren, Kim Wren, Lynn Wren, Caroline Wrey Brown, Catherine Wright, Demi Wright, Francesca Wright, Imogen Wright, Lianne Wright, Rachel Wright, Rebecca Wright, Stephanie Wright, Tim Wright, Caroline Wroe, Hannah Wroe, Henry Wu, Peishan Wu, Pensee Wu, Jonathan 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Supplementary Material
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Associated Data
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Supplementary Materials
Data Availability Statement
The protocol, consent form, statistical analysis plan, definition and derivation of clinical characteristics and outcomes, training materials, regulatory documents, and other relevant study materials are available online. As described in the protocol, the trial steering committee will facilitate the use of the study data and approval will not be unreasonably withheld. De-identified participant data will be made available to bona fide researchers registered with an appropriate institution within 3 months of publication. However, the steering committee will need to be satisfied that any proposed publication is of high quality, honours the commitments made to the study participants in the consent documentation and ethical approvals, and is compliant with relevant legal and regulatory requirements (eg, relating to data protection and privacy). The steering committee will have the right to review and comment on any draft manuscripts before publication. Data will be made available in line with the policy and procedures. Those wishing to request access should complete the form.