West of England NHS patients contribute key data to practice-changing COVID-19 study

Patients, NHS trusts and local research teams across the West of England have contributed important data to new global research which shows that corticosteroids can significantly improve outcomes for severely ill patients with COVID-19.

The research papers published in the Journal of the American Medical Association (JAMA) 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. While the local NIHR Clinical Research Network for the West of England enrolled a total of 30 participants to this vital, practice-changing study - at NHS hospitals across the region.

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%.

Dr Matt Thomas, Principle Investigator for REMAP-CAP at North Bristol Trust said: “I would like to thank all the research staff in the West of England who have worked so hard to support the delivery of the REMAP-CAP study, which was open across five Trusts in the region. In addition, the support from clinical teams at each site has been greatly appreciated. 

“I’d also like to thank all the patients who took part in the study, and their families, for supporting NIHR research and making a valuable contribution to the care of patients in the future.

“The hard work and support of everyone involved has contributed to the announcement of further evidence that corticosteroids can be an important part of COVID-19 treatment for severe patients. It’s great that patients, NHS trusts and local research teams across the West of England have contributed to these important findings.” 

Charlotte Bradbury, Lead for the anticoagulation domain of REMAP-CAP said: “We’re delighted to see the REMAP-CAP corticosteroid data published with results showing that severely ill patients with COVID-19 are likely to benefit from corticosteroid treatment (hydrocortisone).  

“This trial continues to be a phenomenal worldwide collaboration to which the UK has been the leading country to recruit patients. This is thanks to the national, regional and local efforts from the NIHR and research teams, as well as the patients and their families willing to take part.”

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.”

Professor Jonathan Van-Tam, Deputy Chief Medical Officer said: “These findings offer further evidence that corticosteroids can be an important part of COVID-19 treatment for severe patients. Both the REMAP-CAP and the Bristol University papers show the important work that has been done here in the UK by researchers in making further major contributions towards the international evidence. It is impressive to see so many UK participants willing to take part in studies, and able to volunteer due to the rapid recruitment response of the NIHR’s Clinical Research Network. Research such as this, will make the difference in controlling this virus.”

Anthony Gordon, Professor of Anaesthesia and Critical Care at Imperial College London,  and the study’s Chief Investigator, said: “The UK has been able to deliver so well in this study because of the joined up research processes that we have in this country. The NIHR provides infrastructure support to ensure research can be delivered efficiently throughout the whole NHS. This system is the envy of our international colleagues.”