REMAP-CAP: Randomized, Embedded, Multifactorial Adaptive Platform trial for Community- Acquired Pneumonia (COVID-19)

REMAP-CAP is a randomised clinical trial, which has been specifically designed to be able to adapt in the event of a pandemic. Prior to COVID-19 REMAP-CAP was running in 12 countries worldwide and was recruiting patients admitted to an intensive care unit (ICU) with pneumonia which had developed in the community. Since the COVID-19 pandemic, REMAP-CAP has used its novel design, which enables it to adapt, to change to evaluate the most relevant treatment options in patients admitted to an ICU with severe COVID-19. This change includes, evaluating both new and existing interventions targeted at patients with COVID-19, and using different clinical outcomes to obtain an answer quicker. The design of REMAP-CAP allows it to assess different types of treatment at the same time to understand which are the best treatment strategies. The original treatment types being tested in REMAP-CAP are: 1) use of COVID-19 antiviral medication; 2) use of COVID-19 immune modulation; 3) choice of antibiotic; 4) duration of macrolide treatment; and 5) steroid treatment. REMAP-CAP also uses the results within the trial to allocate more patients to interventions that are more likely to be effective and can provide an efficient way of generating time-critical evidence to improve patient outcomes during a global pandemic.