Ziauddin University

What is REMAP CAP study?

REMAP-CAP (Randomised, Embedded, Multifactorial, Adaptive Platform for Community-Acquired Pneumonia) is a large international research project. It helps find the best treatments for patients with severe chest infections who are critically ill and need care in an intensive care unit (ICU).

This research project is designed to look at several treatments at the same time instead of testing one treatment at a time, like traditional trials. The goal is to learn faster which treatments work best for different types of patients. 

What happens in the study?

Patients in this research project do not necessarily receive all treatments. Each patient is only offered the treatments that are available at their hospital, approved by their treating doctor, and suitable for their specific health condition. Once offered, the patient or their relative is asked to give consent for those treatments. No treatment is given without permission.

Some treatments that are currently being tested as part of the research project include:

  1. Corticosteroids: Medicines used to reduce inflammation that may help patients recover more quickly and improve survival.
  2. Antivirals (Oseltamivir): Medicines used for flu that may help fight viruses in the lungs and reduce the severity of chest infections.
  3. Antibiotics: Medications used to treat bacterial infections, which are the most common types of severe chest infections.
  4. Mechanical Ventilation: When patients can’t breathe on their own, a machine helps them. We are testing the safest and most effective ways to use this support.

Treatments that have been tested as part of the research project in the past:

  1. Vitamin C: An antioxidant that may help protect the body’s organs by reducing harmful stress when given in high doses.
  2. Ivermectin: A medicine usually used for parasitic infections that may have benefits against viral infections like COVID-19.
  3. Statins: Medication used to lower cholesterol, and also reduce inflammation and protect organs.

These are all widely used, safe treatments in standard medical practice. REMAP-CAP is studying how to use them most effectively and in which patients they work best.

Why does this study matter?

REMAP-CAP is designed to find out which treatments help patients the most. The study can adjust in real time based on what is working well, while stopping less effective options sooner. Thanks to its special design, REMAP-CAP can test several treatments more quickly and effectively than traditional studies, but always in a careful, controlled, and safe way. 

What We Think Will Happen:

Based on previous research and clinical experience, researchers hope that:

  • Certain treatments (like corticosteroids) may improve survival by reducing harmful inflammation.
  • Antiviral therapies (like oseltamivir or ivermectin) may reduce the amount of virus in the body and help prevent progression to severe disease.
  • Vitamin C might help protect organs by reducing the damaging effects of critical illness.

Each treatment is carefully chosen by experts to find out which patients benefit most from each treatment, while ensuring patient safety throughout the study. 

An open letter regarding the operationalisation of the REMAP-CAP trial in Pakistan and other Asian countries has been published in Wellcome Open Research by the PI and co-investigators: https://doi.org/10.12688/wellcomeopenres.16486.1.

An original article regarding the REMAP-CAP Vitamin C domain was published online in JAMA on behalf of The LOVIT-COVID Investigators, and the REMAP-CAP Investigators: https://doi.org/10.1001/jama.2023.21407.

An original article on the efficacy of the REMAP-CAP Statin domain was published in NEJM on behalf of the REMAP-CAP Investigators: https://www.nejm.org/doi/full/10.1056/NEJMoa2309995

Name: Prof Madiha Hashmi
Designation: Principal Investigator
Email: [email protected]
Contact No: 021 35862937, Ext. 4460