12 March 2021
On February 25, the REMAP-CAP paper: “Interleukin-6 Receptor Antagonists in Critically Ill Patients with COVID-19” was published in the New England Journal of Medicine. It shows the results of the use of tocilizumab and sarilumab in patients with severe COVID-19. Adult patients with COVID-19 who received organ support in the intensive care unit within 24 hours, were randomly assigned to receive tocilizumab, sarilumab, or standard care. 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 outcomes, including survival.
The pragmatic, international design of REMAP-CAP means that the results are probably generalizable to the wider critically ill patient population with COVID-19, although the standard of care may vary in other ICUs and over time, and other populations may include different high-risk patients. Read the full publication.
Results discussed in live stream and podcast
The publication in The New England Journal was simultaneous accompanied by a livestream of Critical Care Review. Prof Derek Angus (Pittsburgh, USA) & Dr Liz Lorenzi (Berry Consultants, Austin, USA), set the scene with talks on the adaptive platform design of REMAP-CAP, and its underlying Bayesian framework, respectively. Coordinating investigator Dr. Lennie Derde (UMC Utrecht, The Netherlands) presented the latest results on the IL-6 Receptor Antagonist Domain and followed by a panel discussion on what this means for clinical practice. The full-recorded livestream is available here.
The results were also discussed during the first ERS respiratory channel podcast hosted by Professor Daiana Stolz. Together with Dr. Lennie Derde, they not only discussed the results but also looked at the learning objectives. For example, to determine who the potential candidates for tocilizumab are. Listen to the podcast by clicking here.
What is REMAP-CAP?
REMAP-CAP was designed to be adapted in the event of a pandemic. This is one of the specific goals of the PREPARE funding under which REMAP-CAP was initiated. REMAP-CAP is a Randomized, Embedded, Multifactorial, Adaptive Platform trial. The broad objective is to, over time, determine and continuously update the optimal set of treatments for community-acquired pneumonia. The purpose of the novel and innovative adaptive trial design is to evaluate a number of treatment options simultaneously and efficiently. The innovative design enabled REMAP-CAP to rapidly adapt to the COVID19 pandemic.