Adapting in the Face of COVID-19: REMAP-CAP
A Randomised, Embedded, Multi-factorial, Adaptive Platform Trial for Community-Acquired Pneumonia
REMAP-CAP is an adaptive platform trial (APT) to treat patients with severe Community Acquired Pneumonia (sCAP) in a pre-planned, pre-approved, and practiced approach. This APT was specifically designed to adapt during a pandemic. As a result of the continued global spread of COVID-19, the REMAP-CAP Pandemic Strata was activated in March 2020.
Before the pandemic, REMAP-CAP was focusing on interventions to treat patients with sCAP.
Since the COVID-19 outbreak, the platform has extended to also investigate new specific treatments for COVID-19 in hospitalized patients on the ICU and on the ward. The aim is to improve outcomes for moderately or severely ill patients with COVID-19. COMBACTE’s CLIN-Net is involved in the site selection in 20 European countries, and aims to select 250 sites.
UMC Utrecht intensivist and researcher Dr. Lennie Derde is coordinating the REMAP-CAP study “What sets REMAP-CAP apart is that this is a smarter and more flexible randomized trial with a control group. In a traditional clinical study, participating patients receive one treatment from a short list of alternatives. In REMAP-CAP we can test several groups of medicines at the same time. An adaptive platform trial is fairer for the participants. If a particular drug shows better results, a larger percentage of new patients will be allocated to that drug. Fewer people are exposed to less promising medicines. As a result, patients are more likely to benefit from the knowledge that is gradually yielded by the study.
We also have faster results.”
First results: Corticosteroids work in severely ill COVID-19 patients
In a sub-study of the REMAP-CAP study, published in JAMA on 2 September, it was shown that the use of corticosteroids increases the likelihood of survival of critically ill COVID-19 patients. The results confirm what a study from the University of Oxford previously showed: a third fewer deaths with dexamethasone treatment.
REMAP-CAP Now on Instagram and Spotify
You can now follow and listen to the latest REMAP-CAP news on Instagram and Spotify respectively! The first episode of the REMAP-CAP Pocast is now available on Spotify.
The publication of our results, those of the other trials as well as the prospective meta-analysis, all within seven weeks of the RECOVERY publication, is a great example of what we can accomplish with global collaboration. And the joint effort of so many people across the globe to deliver this trial has been especially inspiring.