The scientific programme for the Critical Care Reviews Meeting 12th to 14th June 2024 includes 11 major trial results, several systematic reviews & meta analyses, reviews of 3 of the most interesting trials of the past year.
Simvastatin, a widely available and inexpensive drug that is included on the WHO list of essential medicines, was shown to have a high probability (96%) of improving outcomes (a combination of survival and length of time patients need support in an intensive care unit) when started as a treatment for critically ill patients with COVID-19, and a 92% chance of improving survival at 3 months. This equates to one life saved for every 33 patients treated with simvastatin. 2,684 critically ill patients were included at 141 hospitals across 13 countries.
Vitamin C is widely available around the world and was used in some settings for the treatment of COVID-19. Through harmonising two clinical trials – REMAP-CAP and LOVIT-COVID – over 2,500 patients in 20 countries took part, including both critically ill and non-critically ill patients with COVID-19 in hospital. It was shown that high-dose vitamin C did not improve outcomes for patients. This is the largest trial examining high-dose vitamin C in COVID-19 and provides evidence that high-dose vitamin C is not beneficial and suggests a high probability that it may be harmful.
In this letter we show that in patients who became critically ill while receiving therapeutic-dose heparin initiated when non-critically ill, continuation of therapeutic-dose compared with the lower doses confers no clinical benefit and appears harmful.
In this randomized clinical trial that included 779 patients, initiation of an ACE inhibitor or ARB did not improve organ support–free days. Among critically ill patients, there was a 95% probability that treatments worsened this outcome.
Among critically ill patients with COVID-19 randomized to receive one or more therapeutic interventions, treatment with an IL-6 receptor antagonist had a greater than 99.9% probability of improved 180-day mortality compared with the control group. Treatment with an antiplatelet had a 95.0% probability of improved 180-day mortality.
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.
Among critically ill adults with confirmed COVID-19, treatment with convalescent plasma had a low likelihood of providing improvement in organ support–free days.
University Medical Center Utrecht
Heidelberglaan 100
3584 CX Utrecht
The Netherlands
Email:
EU.remapcap@umcutrecht.nl
REMAP-CAP ClinicalTrials.gov registration NCT02735707
REMAP-CAP EU Clinical Trials Register EUCT number: 2023-507889-89
REMAP-CAP is supported by the ECRAID-Base project which has received funding from the EU Horizon 2020 research and innovation programme (grant number 965313).
Inseparable to the design of this trial, platform conclusions are generated through frequent adaptive analyses as data accrues. To date, REMAP-CAP has contributed to the knowledge about the best treatment of COVID-19 with several results:
ACE2 RAS DOMAIN (27 Feb 2022)
Antiplatelet DOMAIN (23 Jun 2021)
CORTICOSTEROID DOMAIN
COVID-19 IMMUNE MODULATION DOMAIN
COVID-19 ANTI-COAGULATION DOMAIN
COVID-19 IMMUNOGLOBULIN DOMAIN
COVID-19 ANTIVIRAL DOMAIN
