REMAP-CAP Publications: An Overview
Ever since the COVID-19 pandemic, REMAP-CAP, the global, innovative, adaptive platform trial, has stepped up in tackling the new SARS-CoV-2 virus by testing (a combination of) different treatments.
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.
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.
COVID-19 Publications from REMAP-CAP
Over the course of a little over a year, a series of REMAP-CAP publications with results from the Pandemic Strata have been published. We look back at the overview below.
Corticosteroid domain
REMAP-CAP’s first publication on COVID-19 study results was issued in September 2020 in the Journal of the American Medical Association. 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.
Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19
Results from this study were also included in the WHO meta-analysis published in JAMA on the same day.
COVID-19 Anti-Coagulation Domain
Two papers published in New England Journal of Medicine research from three clinical studies worldwide including REMAP-CAP (and ACTIV-4 and ATTACC), showed that treatment with higher doses of blood thinners Therapeutic anticoagulation improved outcomes in hospitalized COVID-10 patients. Treatment can prevent these patients from becoming seriously ill and can improve the patients’ recovery. However, treatment with such a dose of blood thinners is not effective, and possibly harmful, for patients in the ICU.
Therapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19
Therapeutic Anticoagulation with Heparin in Non-Critically Ill Patients with Covid-19
COVID-19 Immunoglobulin Domain
REMAP-CAP examined the effects of administering plasma antibodies to COVID-19 patients. In critically ill COVID-19 patients treated in the ICU, the administration of these antibodies showed no improvement. Shortly after this conclusion, the RECOVERY trial announced no significant difference in 28-day mortality in that trial. Considering these results, the REMAP-CAP ITSC decided to pause recruitment in the Moderate State of this domain.
Effect of Convalescent Plasma on Organ Support–Free Days in Critically Ill Patients With COVID-19
COVID-19 Immune Modulation Domain
In February 2021, REMAP-CAP published their paper Interleukin-6 Receptor Antagonists in Critically Ill Patients with COVID-19 in the New England Journal. This paper shows the results of the use of tocilizumab and sarilumab in patients with severe COVID-19.
Adult patients with COVID-19, within 24 hours after starting organ support in the intensive care unit (ICU), were randomly assigned to receive tocilizumab (8 mg per kilogram of body weight), sarilumab (400 mg), or standard care (control).
The publication shows that in critically ill patients with COVID-19 receiving organ support in ICUs, treatment with the interleukin-6 receptor antagonists tocilizumab and sarilumab improved outcome, including survival.
Results from this study were also included in the WHO meta-analysis published in JAMA.
COVID-19 Antiviral Domain
The goal of this domain was to study the efficacy of lopinavir-ritonavir and hydroxychloroquine in critically ill patients with COVID-19. Among critically ill patients with COVID-19, lopinavir-ritonavir, hydroxychloroquine, or combination therapy worsened outcomes compared to no antiviral therapy.
Lopinavir/ritonavir does not improve outcomes for critically ill patients with COVID-19.