The Randomized, Embedded, Multifactorial Adaptive Platform trial for Community-Acquired Pneumonia (REMAP-CAP) was conceived after the 2009 Influenza AH1N1 (“Swine flu”) outbreak. During that pandemic, and previous pandemics, the research response has been largely absent. REMAP-CAP was set up as an Adaptive Platform Trial, embedded in clinical care and allowing multiple therapies to be evaluated at the same time (multifactorial).
The inter-pandemic focus was on finding the best treatment CAP, the disease most likely to resemble a pandemic disease with major effects on hospitalized patients, including the most critically ill. REMAP-CAP was designed to adapt to a future pandemic since its inception.
In 2014, with seed funding from the European Commission through the PREPARE FP7 grant (grant number 602525), REMAP-CAP was initiated. Additional regions were added as a result of the combined effort from the world’s leading ICU trial networks, experts in infectious disease, immunology, critical care, emergency medicine, Bayesian statistics, and clinical trial execution. The first patient was included in the University Medical Center Utrecht in April 2018, and the first COVID-19 patient on March 9th 2020, less than 6 weeks after the World Health Organization declared COVID-19 a Public Health Emergency of International Concern, and 2 days before declaring it a pandemic. The REMAP-CAP network currently spans eight global regions with over 300 participating centers and continues to grow. The study is conducted by a broad range of hospitals and research centers across the globe.
The treatments investigated in the trial are organized in what we refer to as “domains”, within which alternative interventions are compared. As such, patients are assigned to regimens consisting of specific interventions within one or more domains. Patients can be eligible for random assignment in some domains even if ineligible for participation in other domains.