International trial demonstrates a common steroid improves recovery and survival of COVID-19 ICU patients
A paper was published today in The Journal of the American Medical Association (JAMA) on a global trial which demonstrates that delivering intravenous hydrocortisone, a corticosteroid, improves recovery and survival for critically ill COVID-19 patients.
The findings were made through the “Randomised Embedded Multifactorial Adaptive Platform Community Acquired Pneumonia” (REMAP-CAP) trial and are reported today in the JAMA as part of a four-article package. The World Health Organisation is updating its COVID-19 treatment guidance as a result. Between March and June, the REMAP-CAP corticosteroid trial randomized 403 adult COVID-19 patients admitted to an intensive care unit to receive the steroid hydrocortisone or no steroids at all. The trial found a 93% probability that giving patients a seven-day intravenous course of hydrocortisone would result in better outcomes than not giving the steroid. The results were consistent across age, race and sex.
The Health Research Board helped fund the Irish arm of this trial which was set up by a group of intensive care specialists from around the world in response to the H1N1 pandemic in 2009. It is led in Ireland by Professor Alistair Nichol, SVUH and University College Dublin. Irish hospitals and patients participated in this important trial. Irish hospitals and patients participated in this important trial.
According to Prof Nichol, an author of the paper, 'The REMAP CAP Trial was designed to be able to quickly recruit patients in response to emerging pandemics such as COVID-19. So, in March 2020 our team of investigators began randomising patients with COVID-19 to alternative hydrocortisone dosing strategies and compared their outcomes with patients who received no corticosteroid.
The study involved 384 adult participants globally, and the research found a 93 per cent probability that giving this common steroid to patients improved their recovery and survival.
These results build on the success of existing evidence that dexamethasone, another corticosteroid, also improves outcomes for COVID 19 patients, confirming that this class of anti-inflammatory drugs can make a real difference in the fight against COVID-19.
Data from REMAP-CAP also contributed by combining data with other corticosteroid trials to confirm these results. Overall, this is an important extension of current knowledge that gives clinicians an alternative corticosteroid to use in case of shortages in availability of dexamethasone'.
Dr Mairead O'Driscoll, Chief Executive at the HRB added,
'This rapid response to address critical cases of COVID-19 is possible because of a long term investment by the Health Research Board in the Irish Critical Care Clinical Trials Network based at the UCD Clinical Research Centre, and in clinic research facilities and infrastructures across in Ireland. Since 2007, the HRB has invested more than €160 million in Ireland's clinical research ecosystem. It is good to see that by having this infrastructure in place, we can help deliver such timely and relevant outcomes for patients’.
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