The NIHR is playing a vital role in funding, enabling and delivering research into COVID-19. The prioritised urgent public health research is helping to inform national policy and enable new diagnostics and treatments to be developed and tested. At the forefront of this is critical care research.
The NIHR Critical Care Specialty have helped deliver a number of urgent public health studies, including:
REMAP CAP
Randomised Embedded Multifactorial Adaptive Platform study in Community-Acquired Pneumonia (REMAP CAP) is the international randomised controlled study of critically ill patients with COVID 19.
Community-acquired pneumonia (CAP) is 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. If severe enough, this condition will require admission to an Intensive Care Unit (ICU) and may present a substantial risk of death.
REMAP-CAP is part of a suite of nationally-prioritised COVID-19 studies supported by the NIHR. The trial, which uses an adaptive platform design, aims to provide answers about the best treatment options for those patients who develop severe CAP.
The UK has recruited the largest proportion of patients with the study open in over 150 UK ICUs. The NIHR’s network of research active ICUs, regional research leads and Clinical Research Network (CRN) supported research nurses allowed a rapid adoption of the study in the UK.
REMAP CAP has published data supporting the use of steroid therapy and IL-6 monoclonal antibody antagonists in severe COVID 19. The novel study design allows for the efficient enrichment of study domains to facilitate rapid evaluation of new therapies. Other treatments currently being trialled include anticoagulation, anti-platelets, immunomodulatory therapies, statins, vitamin-C and ACE inhibitors.
Find out more about the NIHR’s impact in our REMAP CAP case study.
ADAPT Sepsis
The ADAPT-Sepsis study, started in 2017, aimed to make antibiotic prescribing for critically ill patients with suspected sepsis more effective and targeted.
Now given urgent public health research status, the study has been revised to respond to the requirements of clinical teams treating COVID 19.
Including COVID-19 patients in their work is particularly important for severe infections caused by coronavirus, because there is no evidence that antibiotics are effective at treating viral infections.
The study is an example in how effective national coordination, funding and delivery of research can facilitate swift alternation to study protocols and implementation to meet urgent needs of patients.
GenOMICC
Since 2016 the GenOMICC study has been researching what genetic factors affect whether people become severely ill from an infection.
The team were able to set up the emerging infections element of GenOMICC to recruit patients with coronavirus infection, studying genes from hundreds of very unwell patients to help understand what treatments might help tackle COVID-19.
With the help of the NIHR's CRN they were able to rapidly double recruitment to more than 200 ICUs, almost all units in the country. The GenOMICC study has already recruited more than 11,600 participants with COVID-19 in over 200 ICUs across the UK (as of 3 March 2021), with researchers aiming to recruit around 20,000 COVID-19 patients in total.
In December 2020, the study reported its first findings, identifying five genes associated with whether someone is susceptible to severe COVID-19.
Find out more about the NIHR’s impact in our GenOMICC case study.