COVID-19: New treatment recommendations for intensive care units

The international REMAP-CAP study group is testing known agents for COVID-19 treatment. The results show the benefit of monoclonal antibodies in addition to cortisone preparations for severely ill patients.

Study group tests effect of monoclonal antibodies

In an international collaboration, the REMAP-CAP study group is testing known agents in the treatment of COVID-19. The results show the benefit of monoclonal antibodies in addition to cortisone preparations for severely ill patients.

The REMAP-CAP study group is an alliance of intensive care physicians and infectious disease specialists in 14 countries in Europe, the Americas and Australasia. Countries such as Canada, USA, Australia, New Zealand and Saudi Arabia are participating. In this unique global effort, the group is conducting randomised clinical trials in an ongoing international multifactorial adaptive study to assess the efficacy of known drugs to combat the COVID-19 pandemic. For the German side of the study, 25 intensive care units are participating and are coordinated by the Centre for Clinical Trials of the Jena University Hospital (In German: Universitätsklinikums Jena or UKJ).

In a paper now published in the New England Journal of Medicine, physicians report on a study that tested the use of monoclonal antibodies in COVID-19 diseases with a very severe trajectory. The drugs tocilizumab and sarilumab have been used for years in rheumatoid arthritis. They block the receptor for interleukin-6, an inflammation-promoting immune messenger. In this way, according to the study hypothesis, the organ-damaging inflammatory response could be alleviated. The randomised controlled trial with 800 intensive care patients, 70% of whom received artificial respiration, was able to confirm this assumption.

Less organ support and lower mortality risk

Half of the patients received the study drugs within one day after organ support had become necessary. "As a result, these patients required ten days less of organ support than the control group, and the risk of dying was also reduced by a quarter," summarized Frank Brunkhorst. Prof. Brunkhorst is the head of the study centre and professor for clinical sepsis research at the UKJ and is co-responsible for the design and protocols of the REMAP-CAP studies as a member of the global steering group. "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”, he added. The results of the UK RECOVERY study group, recently published as a preprint, have impressively confirmed the benefit of tocilizumab even in less severely ill hospitalised patients.

REMAP-CAP Investigators: Interleukin-6 Receptor Antagonists in Critically Ill Patients with Covid-19, February 25, 2021, N Engl J Med 2021.