A REMAP trial attempts to work beyond the limitations of a traditional clinical trial. In a REMAP trial, participants can receive multiple treatments in combination with each other. “When you’re testing several things simultaneously, the total number of combinations gets huge rapidly,” says Derek Angus, MD, MPH, chief health care innovation officer at UPMC, and professor and chair, Department of Critical Care Medicine at the University of Pittsburgh and UPMC. The REMAP design allows for an evaluation of all these combinations simultaneously and in a manner where the vast majority of patients receive at least one form of active therapy. Few patients are in the “placebo” or control-only part of the trial. REMAP trials also are adaptive. As the study continues, if a treatment combination appears to be more effective, more participants receive that combination in the future. If a treatment combination isn’t showing results, its use can be reduced or eliminated.