Simvastatin in Critically Ill Patients with Covid-19

This international randomized platform trial (REMAP-CAP) evaluated simvastatin (80 mg daily) in critically ill Covid-19 patients not previously on statins. Among 2684 patients, simvastatin modestly improved the median number of organ support-free days (11 vs. 7) and showed a 95.9% posterior probability of superiority, just below the 99% stopping threshold. Simvastatin also showed high probabilities of benefit in secondary outcomes such as respiratory support-free days and hospital stay. However, serious adverse events (e.g., elevated liver enzymes, creatine kinase) occurred more frequently with simvastatin. The trial was closed early due to reduced Covid-19 cases, and although results favored simvastatin, superiority criteria were not statistically met.

This international randomized platform trial (REMAP-CAP) evaluated simvastatin (80 mg daily) in critically ill Covid-19 patients not previously on statins. Among 2684 patients, simvastatin modestly improved the median number of organ support-free days (11 vs. 7) and showed a 95.9% posterior probability of superiority, just below the 99% stopping threshold. Simvastatin also showed high probabilities of benefit in secondary outcomes such as respiratory support-free days and hospital stay. However, serious adverse events (e.g., elevated liver enzymes, creatine kinase) occurred more frequently with simvastatin. The trial was closed early due to reduced Covid-19 cases, and although results favored simvastatin, superiority criteria were not statistically met.