Oxford patients, clinicians and researchers have contributed important data to new global research which shows that corticosteroids can significantly improve outcomes for severely ill patients with COVID-19. Four research papers published today in the Journal of the American Medical Association (JAMA) reinforce evidence that these inexpensive and widely available drugs improve outcomes for the most critically ill patients with the disease. One paper suggests the risk of death can be reduced by up to 20%. The papers include findings from the international REMAP-CAP study, which is supported by the NIHR Oxford Biomedical Research Centre. Working closely together to help deliver rapid recruitment, NHS trusts, the NIHR’s Clinical Research Network (NIHR CRN) and partner research institutes from devolved nations recruited 71% of all global study participants. This included 10 patients recruited at Oxford’s John Radcliffe Hospital, run by Oxford University Hospitals NHS Foundation Trust. The results from the REMAP-CAP trial show a high probability that among critically ill patients with COVID-19, treatment with a seven-day course of hydrocortisone improved outcomes such as survival and more rapid recovery, compared with no hydrocortisone treatment.
An additional paper, coordinated by the World Health Organisation and led by researchers at the University of Bristol and the NIHR’s Bristol Biomedical Research Centre, provides a meta-analysis of global steroid use across seven randomised controlled trials in 12 countries spanning five continents. It also included data drawn from REMAP-CAP and the NIHR-funded RECOVERY trial, which has already shown that the steroid dexamethasone can be successfully used in treatment of moderate to severe Covid-19. It concludes that corticosteroids can reduce the risk of death in the most ill patients by up to 20%.
Dr Matt Rowland, the principal investigator for the study at the John Radcliffe, said: “We’re proud to have participated in the REMAP-CAP study to help improve outcomes in the most critically unwell patients with COVID. This once again shows the benefit of the collaborative approach to COVID research we’ve seen across the UK.” Professor Jonathan Van-Tam, Deputy Chief Medical Officer, said: “These findings offer further evidence that corticosteroids can be an important part of COVID-19 treatment for severe patients. Both the REMAP-CAP and the Bristol University papers show the important work that has been done here in the UK by researchers in making further major contributions towards the international evidence. “It is impressive to see so many UK participants willing to take part in studies, and able to volunteer due to the rapid recruitment response of the NIHR’s Clinical Research Network. Research such as this, will make the difference in controlling this virus.”
REMAP-CAP (A Randomised, Embedded, Multi-factorial, Adaptive Platform Trial for Community-Acquired Pneumonia) is a nationally prioritised adaptive platform study investigating community-acquired pneumonia (CAP) a syndrome where people develop an acute infection of the lungs before being admitted to hospital. Bacterial and viral infections – like COVID-19 – are responsible for the vast majority of CAP. The study is being carried out at more than 246 sites across 15 countries, including 143 hospitals in the UK. Across the globe a total of 1,471 patients have been randomised into the study and 852 of those participants are COVID-19 patients.
Today’s results from REMAP-CAP show that the steroid hydrocortisone led to improved survival rates and less need for intensive care support, including mechanical ventilation and blood pressure support, for seriously ill patients with COVID-19. However, the trial was stopped early, precluding definitive conclusions from this trial alone.