03 Sep 2020
Greater Manchester NHS patients contribute key data to practice-changing corticosteroids COVID-19 study
Patients, NHS trusts and local research teams across the Greater Manchester region 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 Greater Manchester enrolled a total of 34 participants to this vital, practice-changing study at NHS hospitals across the region.
The local recruiting hospitals were North Manchester General Hospital, Salford Royal, Royal Oldham Hospital, Royal Blackburn Hospital, Manchester Royal Infirmary, Wythenshawe Hospital and Stepping Hill Hospital.
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%.
Tim Felton, Specialty Lead for Critical Care at NIHR CRN Greater Manchester and Clinical Lead for COVID-19 research at Manchester University NHS Foundation Trust (MFT) which runs Manchester Royal Infirmary and Wythenshawe Hospital, said: “Seven of our local Greater Manchester and East Lancashire hospitals, based across five different NHS trusts, have recruited patients on to the REMAP-CAP study and played a vital role in generating the data which has led to these practice-changing findings. The speed at which the study was set-up and delivered by teams across our region is testament to how effectively urgent COVID-19 research is being carried out during the pandemic. We are extremely grateful to all patients who have taken part.
“MFT is at the cutting-edge of research and innovation, and we are now utilising our expertise to address the urgent priorities for research as part of a global, coordinated effort to enhance understanding and develop potential treatments for COVID-19. To date, 32 COVID-19 research studies have opened at MFT, with more than 4,600 participants recruited.”
Wiesia Woodyatt, Research and Innovation Manager for Stockport NHS Foundation Trust which runs Stepping Hill Hospital, said: “The REMAP-CAP study is vital research in helping our health services develop the best treatments we can for those suffering from severe symptoms of COVID-19. We are pleased to have been able to contribute to this study and are very grateful to our patients who have taken part.”
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.”
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.”