St. Michael’s could be the ‘catalyst’ for global collaboration on COVID-19 clinical research

By Ana Gajic

A clinical trial set up to enable a rapid response to future pandemics now has even broader reach as it has aligned with a global research response to understand treatments for COVID-19.

Led by St. Michael’s Hospital’s Dr. John Marshall, scientist at the Keenan Research Centre for Biomedical Science and critical care doctor, the Canadian arm of the study, REMAP-CAP, has aligned its goals with a worldwide clinical trial led by the World Health Organization (WHO), called SOLIDARITY.

The SOLIDARITY Trial is examining four potential treatments for COVID-19: a drug previously tested for Ebola, MERS and SARS (Remdesivir); a treatment used for HIV (Lopinavir/Ritonavir); a treatment used currently for Multiple Sclerosis (Interferon beta-1a) and medications used for malaria and rheumatology conditions (chloroquine and hydroxychloroquine respectively). While REMAP-CAP is studying some of the same interventions as the WHO’s SOLIDARITY, it is also studying interventions relevant to the most critically ill patients around the world.

REMAP-CAP, which stands for Randomised, Embedded, Multifactorial, Adaptive Platform for Community Acquired Pneumonia, is an adaptive trial. Instead of traditional clinical trials that test one treatment at a time, adaptive trials allow scientists to test multiple treatments simultaneously in the same patient groups and randomize patients to receive the treatments that seem to be faring the best, giving them the best opportunity to be treated.

“We set up REMAP-CAP precisely to prepare us for the next pandemic,” said Dr. Marshall. “And as COVID-19 has swept across the world, we have looked to position our trial to support the global effort.”

REMAP-CAP is recruiting patients on four continents. Its Canadian arm is led by St. Michael’s, in close collaboration and coordination with SOLIDARITY/CATCO – led by Dr. Srinivas Murthy, an infectious diseases and critical care physician at BC Children’s Hospital and a clinical associate professor in the University of British Columbia’s department of pediatrics in Vancouver.

The trial is looking to expand to 80 Canadian ICUs, as the more centres and patients are enrolled, the faster the generation of evidence will be.

“This scale of collaboration is unprecedented,” said Dr. Marshall. As a critical care doctor, Dr. Marshall has seen pandemics – from SARS to H1N1. This level of dedication to research is unique to COVID-19.

“This time around there is a collective understanding that good research is what’s going to help our patients through this pandemic,” Dr. Marshall said.

As Canada’s premier critical care hospital, Dr. Marshall sees St. Michael’s as a catalyst in the Canadian arm of this global work. In his work as a co-lead of the WHO Clinical Characterization and Management Working Group, Dr. Marshall works with global peers to make sure centres are tracking similar outcomes so that the WHO will be able to compare research across centres.

“This is something that’s very special to critical care,” he said. “There’s a sense of collegiality that doesn’t always exist in other fields. There was an appetite to collaborate during H1N1 – now, with COVID-19, we’re delivering on it.”

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.