Sites open
Global: 359 UK: 143
Patients randomised (all)
Global: 11,122 UK: 5,632
Patients randomised (COVID-19)
Global: 9,772 UK: 5,513
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:
ICU only
- Vitamin C Two interventions: (1) No vitamin C; (2) Vitamin C
- Statin therapy Two interventions: (1) No statin therapy; (2) Simvastatin
- ACE-2 RAS Four interventions: (1) No RAS; (2) Angiotensin converting enzyme inhibitor (ACEi); (3) Angiotensin-II receptor blocker (ARB); (4) ARB in combination with DMX-200, a chemokine receptor-2 (CCR2) inhibitor
- Anticoagulation
- No prior therapeutic anticoagulation - Two interventions: (1) Conventional low dose thromboprophylaxis; (2) Intermediate dose thromboprophylaxis
- Prior therapeutic anticoagulation - Three interventions: (1) Conventional low dose thromboprophylaxis; (2) Intermediate dose thromboprophylaxis; (3) Continuation of therapeutic dose anticoagulation
- Cysteamine Two interventions: (1) No cysteamine; (2) Cysteamine
Domains closed/paused to recruitment:
- Corticosteroids (1) Letter to sites 13JUL2020; (2) JAMA publication – Effect of Hydrocortisone on Mortality and Organ Support in Patients with Severe COVID-19; (3) JAMA publication - Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis
- Antivirals (1) Letter to sites 13JUL2020; (2) Letter to sites 19NOV2020; (3) Nat Commun publication - Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials
- Immunoglobulin therapy (1) Letter to sites 07JAN2021
- Therapeutic anticoagulation (1)Letter to sites 19DEC2020; (2) Letter to sites 08JAN2021; (3) Letter to sites 22JAN2021; (4) ATTACC, ACTIV-4a & REMA-CAP Multiplatform RCT: Results of Interim Analysis; (4) Pre-print - Therapeutic Anticoagulation in Critically Ill Patients with Covid-19 – Preliminary Report, The REMAP-CAP, ACTIV-4a, and ATTACC Investigators; (5) Pre-print - Therapeutic Anticoagulation in Non-Critically Ill Patients with Covid-19, The ATTACC, ACTIV-4a, and REMAP-CAP Investigators
- Immune modulation (1) Press release 19NOV2020; (2) Letter to sites 07JAN2021; (3) NEJM publication - Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19; (4) Letter to sites 09APR2021; (5) Pre-print - Effectiveness of Tocilizumab, Sarilumab and Anakinra for Critically Ill Patients with Covid-19
- Antiplatelet (1) Letter to sites 23JUN2021; (2) Press release 30JUN2021
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
- Cysteamine Two interventions: (1) No cysteamine; (2) Cysteamine
Further information can be found on the global REMAP-CAP website https://www.remapcap.org
COVID-19 Summary of study results (19MAY2021)
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.
Registration
REMAP-CAP is registered: NCT02735707EudraCT number: 2015-002340-14
Funding and support
Prioritised by the NIHR as a COVID19 study