15 May 2020
On Wednesday 13 May 2020, the Global Health Network hosted a webinar entitled ‘REMAP-CAP and Why we need Platform Trials in a Pandemic’. The goal of the webinar was to introduce REMAP-CAP and the concept of adaptive platform trials more broadly, as well as discuss the upsides and challenges of such trials in a pandemic.
REMAP-CAP is a randomised, embedded, multi-factorial, adaptive platform trial for community-acquired pneumonia. It is different than a standard clinical trial as it allows for multiple treatments to be tested simontaniously. The platform trial is designed to be adapted in the event of a pandemic to evaluate the most relevant treatment options. REMAP-CAP is part of PREPARE, an EU funded network for harmonized large-scale clinical research studies on infectious diseases, prepared to rapidly respond to any severe outbreak.
Prof. Srinivas Murthy of the University of British Columbia introduced the concept of adaptive platform trials and the challenges of research during a pandemic. Currently, over a 1000 clinical trials are taking place globally on treatments for COVID-19, yet many of them have small sample sizes and are investigating the same substances. Platform trials are suited for a pandemic because they can be implemented rapidly enabling multiple interventions to be tested in order to inform a public health response. However, setting up adactive clinical trials takes time. This is why it is key to leverage structures established pre-pandemic, such as REMAP-CAP.
Prof. John Marshal of the University of Toronto futher explained the REMAP-CAP pandemic response. The trial was commenced as a result of 2009 H1N1 pandemic, as scientists begin to realise the challenges of conducting clinical trials during a pandemic. REMAP-CAP was designed as a sleeper trial ready to be activated during a pandemic outbreak. The pandemic appendix protocol has recently been activated in response to the COVID-19 outbreak. Since the activation of the pandemic protocol the trial has randomised 926 patients at 173 active sites on 4 continents, with further plans for expansion. The pandemic has allowed for new models of collaboration, larger sample sizes, new models of reporting and data sharing, all with a goal to produce results as rapidly as possible to inform patient care.
Prof. Fernando Zampieri of the University of South Denmark talked about the challenges of running collaborative interantional clinical trials in low and middle income countries using the example of Brazil. Low and middle income countries face scarcity of funding, regional inequalities, and difficulty to obtain public funding for global vs local initiatives. Furthermore, ethic committes and regulatory agencies in these countries often lack experience with external collaboration and adaptive trials. Aditional issues include unique logistic challenges and difficulty to demonstrate the impact of these trials on the local healthcare systems.
Prof. Trudie Lang of the Universiy of Oxford, the meeting Chair, concluded the webinar by thanking everyone for their participation and reiterating the importance of adaptive platform trials during the pandemic.
Watch the full webinar here.