Communicable E63: Does oseltamivir harm critically ill patients? The REMAP-CAP results

Hello, and welcome to Breakpoints.

My name is Erin McCreery, and I'm the Senior Director of Infectious Diseases Strategy at UPMC and a Clinical Associate Professor at the University of Pittsburgh School of Medicine.

Today, we are bringing you the fourth collaboration podcast between Communicable and Breakpoints, the Society of Infectious Diseases Pharmacists podcast.

Hi and welcome back to Communicable, the podcast brought to you by CMI Communications, ESCMID's open access journal covering infectious diseases and clinical microbiology.

My name's Josh Davis and I'm one of the editors at CMI Communications and an infectious diseases physician at John Hunt Hospital in Newcastle in Australia and also head of the infection research program at Hunter Medical Research Institute at the Uni of Newcastle in Australia.

And it's great to be doing another one of these collaborations with Breakpoints.

It always really helps our listener numbers for Communicable, which is an infant compared to Breakpoints.

It's more of like a teenager.

We're so thrilled to do these collaborations, and today's fun because I think the best thing we do is get together and talk about trials.

I've been doing this for almost 10 years, which is insane to me, but unpacking the latest and greatest trials will never get old, especially with you gentlemen, which is such a pleasure.

So today we're going to discuss the results of a trial that is quite a hot topic right now, the oseltamivir for critically ill patients with influenza domain of the REMAP-CAP trial.

The trial was stopped by the DSMB on March 13th, 2026, stating the five-day and 10-day arms had met the trigger for inferiority for adults.

These results were presented at the Critical Care Reviews Conference in Belfast in June this year, and it's generated quite a bit of controversy and quite a bit of discussion, so we're excited to talk about it today.

The preprint

of the manuscript is available online with the Lancet, as is the video of the CCR presentation.

So I think this is in general just a very wonderful thing the critical care community does is you can go online for free public access and watch these presentations in real time.

So see not only the presentation by the authors, but also the audience dialogue and questions.

So we're lucky today to be joined by two guests who can take us behind the scenes and help us understand what these results mean for clinical practice.

So first, I'd like to introduce Professor Steve Webb.

I think this is Steve's communicable and breakpoints debut, so we're so excited to have you.

Steve is an intensive care specialist in Perth, Australia, and a professor of critical care medicine at Monash University in Melbourne.

Steve led the establishment of the RemapCap trial at the beginning, the whole infrastructure, and he continues to be a member of the International Steering Committee and a member of the design team.

Steve, welcome to Breakpoints and Communicable.

Thanks very much, Erin.

Wonderful to be doing the doubleheader.

And I'm pleased to introduce a friend of the show, or both shows, I guess, and a friend and colleague of mine, Professor Stephen Tong.

He goes by Steve, though, so it's going to be a bit confusing to have two Steves here.

Do you want us to call you Stephen, Stephen, or Steve, Steve?

Sometimes we do Steve W and Steve T, don't we?

Yeah.

Don't call me Steve and Josh.

My mum's the only person who ever did that.

Yeah, that's like me, Joshua.

It's the only one I'm in trouble with, my mum.

So Steve T is an infectious diseases physician at the Royal Melbourne Hospital in Melbourne, Australia, and he's a professor of infectious diseases at the University of Melbourne.

And Steve also co-leads the ASCOT trial, which we might hear a little bit about later, but is also about COVID and flu.

Hi everyone, great to be back.