Callum and Sam Spence are twins, but the way COVID-19 affected them was very different. Callum ended up on a ventilator in the ICU fighting for his life, while Sam was at home with aches and pains. Their dramatic experience, chronicled in the Irish Independent, led them to the REMAP-CAP trial.
In this trial, antiplatelet therapy met the prespecified criterion for futility in critically ill patients based on very similar outcomes for organ support–free days compared with control.
To be better prepared for the next pandemic, leading scientists from the Netherlands, Belgium and the United Kingdom are advocating some radical innovations. They propose the creation of a European authority for clinical research on pandemics to coordinate clinical research in this area thereby avoiding fragmentation of studies.
The Randomised, Embedded, Multifactorial Adaptive Platform (REMAP-CAP) trial is the largest randomized clinical trial in critically ill patients with COVID-19 to report the effects of lopinavir-ritonavir, hydroxychloroquine and combination therapy of lopinavir-ritonavir and hydroxychloroquine compared with no antiviral therapy. We found that, among critically ill patients with COVID-19, lopinavirritonavir, hydroxychloroquine and combination therapy reduced organ support-free days and survival compared to no COVID-19 antiviral therapy.