NHS patients across the West Midlands contribute to practice-changing COVID-19 study

West Midlands COVID-19 research participants have contributed to improving outcomes for severely ill patients.

Patients, NHS trusts and local research teams across the region have taken part in new global research which shows that corticosteroids can significantly improve outcomes for severely ill patients with COVID-19.

Research papers published in the Journal of the American Medical Association (JAMA) today reinforce evidence that these inexpensive and widely available drugs improve outcomes for the most critically ill patients with the disease. One paper suggests the risk of death can be reduced by up to 20%.

The papers include findings from the National Institute for Health Research (NIHR) supported REMAP-CAP study, which is being conducted across 15 countries around the world and led in the UK from the NIHR Imperial Biomedical Research Centre.

Working closely together to help deliver rapid recruitment, NHS trusts and the NIHR’s Clinical Research Network (NIHR CRN), and research institutes from the devolved nations helped recruit 71% of all global study participants from right across the UK. Local participants to this vital, practice-changing study are at nine NHS hospitals across the region, which have recruited 46 of the participants.

The results from the REMAP-CAP trial show a high probability that among critically ill patients with COVID-19, treatment with a seven-day course of hydrocortisone improved outcomes such as survival and more rapid recovery, compared with no hydrocortisone treatment.

An additional paper, co-ordinated by the World Health Organisation (WHO) and led by researchers at the University of Bristol and the NIHR’s Bristol Biomedical Research Centre, provides a meta-analysis (evidence summary) of global steroid use across seven randomised controlled trials (RCTs) in 12 countries spanning five continents.

It also included data drawn from REMAP-CAP and the NIHR-funded RECOVERY trial, which has already shown that the steroid dexamethasone can be successfully used in treatment of moderate to severe Covid-19. It concludes that corticosteroids can reduce the risk of death in the most ill patients by up to 20%.

Professor Jeremy Kirk, Clinical Director of the NIHR Clinical Research Network West Midlands says: ‘This result provides another vital step forward in increasing survival for critically ill people with COVID-19. The breakthroughs we have made so far are testament to our NHS teams’ unwavering determination to help patients, who are always central to our clinical focus.

‘There are still more questions to be answered in relation to this virus, but with the efforts of our country's unique NIHR community, along with those who participate in research, we're in the best possible position to succeed.’

NHS chief executive, Sir Simon Stevens said: “One of the distinctive benefits of having our NHS is that we've been able to mobilise quickly and at scale to help researchers test and develop proven coronavirus treatments. Just as we did with dexamethasone, the NHS will now take immediate action to ensure that patients who could benefit from treatment with hydrocortisone do so, adding a further weapon in the armoury in the worldwide fight against Covid-19.”

ENDS

For more information contact:

Claire Hall, NIHR Clinical Research Network Communications Lead, West Midlands
T: 07775 800227
E: claire.hall@nihr.ac.uk

About the research: REMAP-CAP

REMAP-CAP (A Randomised, Embedded, Multi-factorial, Adaptive Platform Trial for Community-Acquired Pneumonia) is a nationally prioritised adaptive platform study investigating community-acquired pneumonia (CAP) a syndrome where people develop an acute infection of the lungs before being admitted to hospital. Bacterial and viral infections – like COVID-19 - are responsible for the vast majority of CAP.

The study is being carried out at more than 246 sites across 15 countries, including 143 hospitals in the UK. Across the globe a total of 1,471 patients have been randomised into the study and 852 of those participants are COVID-19 patients. NIHR’s Clinical Research Network (CRN) recruited 520 COVID-19 participants.

Today’s results from REMAP-CAP show that the steroid hydrocortisone led to improved survival rates and less need for intensive care support, including mechanical ventilation and blood pressure support, for seriously ill patients with COVID-19. However, the trial was stopped early, precluding definitive conclusions from this trial alone.

Meta-analysis

The meta analysis looked at mortality over a 28-day period after the start of treatment. It showedThey found that giving corticosteroids led to an estimated 20 per cent reduction in the risk of death. This is equivalent to around 68 per cent of patients surviving after treatment with corticosteroids, compared to around 60 per cent surviving in the absence of them.

The seven RCTs recruited 1,703 critically ill patients in total, spanning five continents and including some of the countries hardest hit by coronavirus such as China, Brazil, Spain, the UK and the USA.

There was evidence of benefit from corticosteroids regardless of whether patients were receiving invasive mechanical ventilation at the time they started treatment. The benefit appeared greater among patients who were not so sick that they needed medicine to support their blood pressure, although the results were not definitive in this regard. The effect of corticosteroids appeared similar regardless of age, sex or how long patients had been ill.