In an international collaboration, the REMAP-CAP study group is testing known agents in the treatment of COVID-19. Their results, now published in the New England Journal of Medicine, demonstrate the benefit of monoclonal antibodies in addition to cortisone drugs for severely ill patients.
The REMAP-CAP study group is an association of intensive care units in 14 countries in Europe, Canada, USA, Australia, New Zealand and Saudi Arabia, established by intensive care physicians and infectiologists. In this unique global collaboration, the group is conducting randomized clinical trials in an ongoing international multifactorial adaptive platform study to evaluate the efficacy of known drugs in the COVID-19 pandemic. The study participation in Germany, currently consisting of 25 intensive care units, is coordinated at the Center for Clinical Studies of the University Hospital Jena (UKJ).
In a paper now published in the New England Journal of Medicine, physicians report a study that tested the use of monoclonal antibodies in COVID-19 disease with a very severe course. The active ingredients tocilizumab and sarilumab have been used for years in rheumatoid arthritis. They block the receptor for interleukin-6, a pro-inflammatory immune messenger. In this way, the study hypothesized, the organ-damaging inflammatory response could be mitigated. This assumption was confirmed by the randomized controlled trial with 800 intensive care patients, 70% of whom received artificial respiration.
Half of the patients received the study drugs within one day after organ function support became necessary. “As a result, these patients required ten fewer days of organ support than the control group, and the risk of dying was also reduced by a quarter,” says Frank Brunkhorst, summarizing the results. The head of the study center and professor of clinical sepsis research at UKJ is a member of the global steering group and is jointly responsible for the design and protocols of the REMAP-CAP studies. “In addition to corticosteroids, this gives us a second well-established and safe group of agents whose use has been shown to be effective in treating severe COVID-19 courses.” The results of the British RECOVERY study group, recently published as a preprint, have impressively confirmed the benefit of tocilizumab even in less severely ill hospitalized patients.
Original publication:
REMAP-CAP Investigators: Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19, February 25, 2021, N Engl J Med 2021; DOI: 10.1056/NEJMoa2100433.
