The Randomized Embedded Multifactorial Adaptive Platform Trial in Community-acquired Pneumonia (REMAP-CAP): Building an International Research Response to Variant COVID-19

Information about the best treatments for patients with COVID-19 is being generated at a record pace. Large international clinical trials have been central to this process. REMAP-CAP - the Randomized Embedded Multifactorial Adaptive Platform Trial in Community-Acquired Pneumonia - is one such trial; it focuses on the care of the sickest patients, those who are ill enough to need organ support in an intensive care unit (ICU). REMAP-CAP is currently active in 310 sites on 5 continents. It has recruited more than 6150 COVID-19 patients, and identified three treatments that improve patient outcomes - treatment with corticosteroids, inhibition of a protein called IL-6, and blood thinners in some, but not all patients. As COVID-19 continues in Canada and around the world, new variants have become the most common causes. These are infecting younger patients and resulting in more ICU admissions. REMAP-CAP in Canada has exhausted its initial funding; we seek to maintain our leadership role in the international effort to overcome COVID-19. We will direct our attention to understanding treatments for these new variants in three ways. First, we will focus on treatments that seem to be more effective in patients with severe disease, and in particular, on treatments that interfere with interactions between the virus and a protein called ACE2 that the virus uses to enter cells. Second, we will use international variability in rates of variant disease to determine whether the effectiveness of treatment is influenced by the infecting variant. Finally we will work to expand out network of 34 recruiting sites to ensure that we are enrolling patients from across the country, and in particular where rates of infection are highest. In partnership with clinical researchers around the world, we will collaborate to understand how best to care for the sickest Canadians with COVID-19.