REMAP-CAP

A Randomised, Embedded, Multi-factorial, Adaptive Platform Trial for Community-Acquired Pneumonia






Sites open

Global: 299  UK: 143

Patients randomised (all)

Global: 6484 UK: 4377

Patients randomised (COVID-19)

Global: 5680 UK: 4305

Individual COVID-19 site recruitment is available here. Last updated 1 March 2020 at 11:30.

What is this study about?

REMAP-CAP is an international (15 countries) adaptive platform trial in community acquired pneumonia, that was specifically designed to be employed in a pandemic to evaluate multiple interventions simultaneously in critically ill patients. In addition to recruiting patients with community acquired pneumonia who have been admitted to critical care, we are also recruiting patients with COVID-19 to understand optimal treatment strategies.

The trial is modular so that new domains (groups of similar treatment options) can be added over time.

COVID-19 treatment domains:

Ward and ICU

  • Antiplatelet
    Three interventions: (1) No antiplatelet; (2) Asprin; (3) P2Y12 inhibitor (clopidogrel, prasugrel or ticagrelor)
  • Therapeutic anticoagulation
    Two interventions: (1) local standard venous thromboprophylaxis; (2) therapeutic anticoagulation with intravenous unfractionated heparin or subcutaneous low molecular weight heparin - no longer open for recruitment (ATTACC, ACTIV-4a & REMAP-CAP Multiplatform RCT: Results of Interim Analysis)

ICU only

  • Immunomodulation
    Five interventions: (1) no immune modulation; (2) interferon beta 1a; (3) interleukin 1 receptor antagonist [anakinra]; (4 and 5) interleukin 6 inhibition [tocilizumab and sarilumab] - No immune modulation no longer open for recruitment (see (1) NEJM publication - Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19)
  • Immunoglobulin therapy
    Two interventions: (1) no immunoglobulin; (2) convalescent plasma – no longer open for recruitment
  • Vitamin C
    Two interventions: (1) no vitamin C; (2) vitamin C
  • Statin therapy
    Two interventions: (1) no statin therapy; (2) simvastatin
  • Corticosteroids (three interventions: (1) no steroids; (2) steroids for 7 days (3) steroids if shock present) – no longer open for recruitment
  • Antivirals Four interventions: (1) no antiviral; (2) lopinavir/ritonavir; (3) hydroxychloroquine; (4) lopinavir/ritonavir and hydroxychloroquine combination – no longer open for recruitment (response to the Lancet article regarding the use of hydroxychloroquine)


Community Acquired Pneumonia treatment domains:

  • Antibiotics
    Five interventions: (1) Ceftriaxone + Macrolide; (2) Moxifloxacin or Levofloxacin; (3) Piperacillin-tazobactam + Macrolide (4) Ceftaroline + Macrolide (5) Amoxicillin-clavulanate + Macrolide
  • Macrolide duration
    Two interventions: (1) standard course (3-5 days); (2) extended course (14 days)
  • Corticosteroids
    Three interventions: (1) no steroids; (2) steroids for 7 days (3) steroids if shock present
  • Antivirals (influenza)
    Three interventions: (1) no antiviral for influenza; (2) Oseltamivir (5 days); (3) Oseltamivir (10 days)
  • Vitamin C
    Two interventions: (1) no vitamin C; (2) vitamin C

 Further information can be found on the global REMAP-CAP website https://www.remapcap.org

 

Information for sites

Information is available for participating sites on set-up, randomisation, pharmacy arrangements and FAQs.

Chief Medical Officers' letter of support

REMAP-CAP has been named as one of the three national randomised trials in COVID-19. Please find the letter of support encouraging participation of all hospitals into these studies.

COVID-19 Newsletter 

See REMAP-CAPs recent Pandemic Newsletter (No. 2) 

Registration

REMAP-CAP is registered at NCT02735707
EudraCT number: 2015-002340-14

Funding and support

European Commission FP7: Platform foR European Preparedness Against (Re-)emerging Epidemics
Prioritised by the National Institute For Health Research as a COVID19 study

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