Complementary Kānuka

A unique pharmacy-backed, three-year MRINZ trial shows that a medical-grade honey formulation derived from the kānuka tree is just as effective in healing cold sores as the standard pharmaceutical anti-viral treatment, aciclovir cream. The largest randomised controlled trial of its kind ever undertaken in New Zealand, these findings present patients with an evidence-based, alternative option.

MRINZ research also shows the benefits of kānuka honey for the treatment of rosacea, a chronic skin condition mainly affecting the face. MRINZ teams are now looking at the use of medicinal kānuka oil for a range of other skin conditions.

A landmark eczema trial, led by the MRINZ, and conducted in partnership with New Zealand enterprises Hikurangi Bioactives Limited Partnership (HBLP) and TRG Natural Pharmaceuticals, offered strong evidence of the safety and effectiveness of kānuka oil cream as treatment. HBLP is a social enterprise committed to creating jobs and economic development for Māori communities in the Tairāwhiti region, working in partnership with the indigenous guardians of natural resources. Tauranga-based TRG Natural Pharmaceuticals, develops innovative and scientifically proven products from natural sources.

Through these trials the MRINZ has developed the Pharmacy Research Network (PRN), a national community pharmacy collaboration centralised at the MRINZ with support from the Pharmacy Guild of New Zealand. The PRN has given the MRINZ a future-focused, cost-effective, efficient, collaborative and high-quality platform to ascertain the efficacy/safety profile of both novel and commonly used over-thecounter treatments. The globally unique PRN provides the underpinning system by which to assess pharmaceutical and nutraceutical products derived from New Zealand’s flora and fauna.

DEPUTY DIRECTOR

Complementary & Alternative Medicine, Emerging Therapeutics, and Pharmacy Programmes Lead Education co-Lead

It is extraordinary that REMAP-CAP was able to randomise patients to receive novel treatments for COVID-19 before the WHO declared a world-wide pandemic. The MRINZ REMAP-CAP team has played an important role in this global study involving over 1,000 researchers in 24 countries, including low-and middle-income nations, all collaborating to identify treatments which improve outcomes and reduce the burden of COVID-19.

COVID-19

The Randomised, Embedded, Multi-factorial, Adaptive Platform Trial for CommunityAcquired Pneumonia (REMAP-CAP) study was conceptualised in 2015 as part of international pandemic preparedness planning, driven by the collective experiences of the 2009 influenza outbreak (‘swine flu’). Initial funding permitted the design and preparation of a trial that would swing into action once another major respiratory pandemic event began. This remarkable foresight enabled mobilisation to patient recruitment within weeks of the start of the current COVID-19 pandemic. Led by intensive care clinician-researchers, this study investigated treatment interventions for the most seriously ill COVID-19 patients — those receiving critical care in ICU.

The study features a novel trial design that allows faster generation of high-quality medical evidence. As a platform study, multiple interventions can be tested at the same time, adapting further as evidence accumulates, with findings incrementally translated into clinical practice globally.

The award-winning global trial has to date evaluated 35 distinct treatment interventions, including numerous drug therapies, blood plasma from recovered patients (convalescent plasma) and mechanical ventilation strategies.

Among these, it has demonstrated the effectiveness of several treatments including corticosteroids and the IL-6 inhibitors tocilizumab and sarilumab, and more intense early treatment to prevent blood clots in non-critically ill patients. Importantly, the study also demonstrated the ineffectiveness and risks associated with other treatments, including hydroxychloroquine either taken alone or together with the combination of lopinavir-ritonavir.

We knew it was possible to exercise patients on life support, and, despite very limited evidence from small studies, some clinicians have argued that this kind of exercise should be adopted as early as possible for ICU patients. In fact, such exercise significantly increases complications including abnormal heart rhythms and low oxygen levels compared to usual care. This study will help change ICU physiotherapy practices and patient outcomes worldwide.

— PROFESSOR CAROL HODGSON, MONASH UNIVERSITY, MELBOURNE, AUSTRALIA