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Platform adaptive trial of novel antivirals for early treatment of COVID-19 In the community (PANORAMIC): protocol for a randomised, controlled, open-label, adaptive platform trial of community novel antiviral treatment of COVID-19 in people at increased risk of more severe disease

Platform adaptive trial of novel antivirals for early treatment of COVID-19 In the community (PANORAMIC): protocol for a randomised, controlled, open-label, adaptive platform trial of community novel antiviral treatment of COVID-19 in people at increased risk of more severe disease
Platform adaptive trial of novel antivirals for early treatment of COVID-19 In the community (PANORAMIC): protocol for a randomised, controlled, open-label, adaptive platform trial of community novel antiviral treatment of COVID-19 in people at increased risk of more severe disease

Introduction: there is an urgent need to determine the safety, effectiveness and cost-effectiveness of novel antiviral treatments for COVID-19 in vaccinated patients in the community at increased risk of morbidity and mortality from COVID-19.

Methods and analysis: PANORAMIC is a UK-wide, open-label, prospective, adaptive, multiarm platform, randomised clinical trial that evaluates antiviral treatments for COVID-19 in the community. A master protocol governs the addition of new antiviral treatments as they become available, and the introduction and cessation of existing interventions via interim analyses. The first two interventions to be evaluated are molnupiravir (Lagevrio) and nirmatrelvir/ritonavir (Paxlovid).

Eligibility criteria: community-dwelling within 5 days of onset of symptomatic COVID-19 (confirmed by PCR or lateral flow test), and either (1) aged 50 years and over, or (2) aged 18-49 years with qualifying comorbidities. Registration occurs via the trial website and by telephone. Recruitment occurs remotely through the central trial team, or in person through clinical sites. Participants are randomised to receive either usual care or a trial drug plus usual care. Outcomes are collected via a participant-completed daily electronic symptom diary for 28 days post randomisation. Participants and/or their Trial Partner are contacted by the research team after days 7, 14 and 28 if the diary is not completed, or if the participant is unable to access the diary. The primary efficacy endpoint is all-cause, non-elective hospitalisation and/or death within 28 days of randomisation. Multiple prespecified interim analyses allow interventions to be stopped for futility or superiority based on prespecified decision criteria. A prospective economic evaluation is embedded within the trial.

Ethics and dissemination: ethical approval granted by South Central-Berkshire REC number: 21/SC/0393; IRAS project ID: 1004274. Results will be presented to policymakers and at conferences, and published in peer-reviewed journals.

Trial registration number: ISRCTN30448031; EudraCT number: 2021-005748-31.

COVID-19, SARS-CoV-2, aged, antiviral agents, humans, middle Aged, prospective studies, randomized controlled trials as Topic, treatment outcome, therapeutics, virology, primary care, clinical trials
2044-6055
e069176
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Allen, Julie
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Gbinigie, Oghenekome, Ogburn, Emma, Allen, Julie, Dorward, Jienchi, Dobson, Melissa, Madden, Tracie-Ann, Yu, Ly-Mee, Lowe, David M., Rahman, Najib, Petrou, Stavros, Richards, Duncan, Hood, Kerenza, Patel, Mahendra, Saville, Benjamin R., Marion, Joe, Holmes, Jane, Png, May Ee, Hayward, Gail, Lown, Mark, Harris, Victoria, Jani, Bhautesh, Hart, Nigel, Khoo, Saye, Rutter, Heather, Chalk, Jem, Standing, Joseph F., Breuer, Judith, Lavallee, Layla, Hadley, Elizabeth, Cureton, Lucy, Benysek, Magdalena, Andersson, Monique I., Francis, Nick, Thomas, Nicholas P.B., Evans, Philip, van Hecke, Oliver, Koshkouei, Mona, Coates, Maria, Barrett, Sarah, Bateman, Clare, Davies, Jennifer, Raymundo-Wood, Ivy, Ustianowski, Andrew, Nguyen-Van-Tam, Jonathan, Carson-Stevens, Andrew, Hobbs, Richard, Little, Paul and Butler, Christopher C. (2023) Platform adaptive trial of novel antivirals for early treatment of COVID-19 In the community (PANORAMIC): protocol for a randomised, controlled, open-label, adaptive platform trial of community novel antiviral treatment of COVID-19 in people at increased risk of more severe disease. BMJ Open, 13 (8), e069176, [e069176]. (doi:10.1136/bmjopen-2022-069176).

Record type: Article

Abstract

Introduction: there is an urgent need to determine the safety, effectiveness and cost-effectiveness of novel antiviral treatments for COVID-19 in vaccinated patients in the community at increased risk of morbidity and mortality from COVID-19.

Methods and analysis: PANORAMIC is a UK-wide, open-label, prospective, adaptive, multiarm platform, randomised clinical trial that evaluates antiviral treatments for COVID-19 in the community. A master protocol governs the addition of new antiviral treatments as they become available, and the introduction and cessation of existing interventions via interim analyses. The first two interventions to be evaluated are molnupiravir (Lagevrio) and nirmatrelvir/ritonavir (Paxlovid).

Eligibility criteria: community-dwelling within 5 days of onset of symptomatic COVID-19 (confirmed by PCR or lateral flow test), and either (1) aged 50 years and over, or (2) aged 18-49 years with qualifying comorbidities. Registration occurs via the trial website and by telephone. Recruitment occurs remotely through the central trial team, or in person through clinical sites. Participants are randomised to receive either usual care or a trial drug plus usual care. Outcomes are collected via a participant-completed daily electronic symptom diary for 28 days post randomisation. Participants and/or their Trial Partner are contacted by the research team after days 7, 14 and 28 if the diary is not completed, or if the participant is unable to access the diary. The primary efficacy endpoint is all-cause, non-elective hospitalisation and/or death within 28 days of randomisation. Multiple prespecified interim analyses allow interventions to be stopped for futility or superiority based on prespecified decision criteria. A prospective economic evaluation is embedded within the trial.

Ethics and dissemination: ethical approval granted by South Central-Berkshire REC number: 21/SC/0393; IRAS project ID: 1004274. Results will be presented to policymakers and at conferences, and published in peer-reviewed journals.

Trial registration number: ISRCTN30448031; EudraCT number: 2021-005748-31.

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Accepted/In Press date: 3 July 2023
Published date: 7 August 2023
Additional Information: Funding Information: The trial is implemented by the University of Oxford Primary Care and Vaccines Collaborative Clinical Trials Unit (PCV-CTU) with further support from the Oxford Respiratory Trials Unit and the Centre for Trials Research, Cardiff University, supported by the National Institute of Health and Care Research Clinical Research Network, the National Institute of Health and Care Research and the Department of Health and Social Care (and equivalents in devolved administrations). Funding Information: The authors would like to especially thank all participants in the study and acknowledge the work and support of all participating general practices, NHS COVID-19 treatment services and other health and social care organisations supporting the trial. We would also like to thank our PPI contributors, the Trial Steering Committee, the Data Monitoring and Safety Committee, primary care and other colleagues in the National Institute of Health and Care Research Clinical Research Network, and the National Institute of Health and Care Research. CCB acknowledges part support as senior investigator of the National Institute of Health and Care Research, the NIHR Community Healthcare Medtech and In-Vitro Diagnostics Co-operative (MIC), and the NIHR Health Protection Research Unit on Health Care Associated Infections and Antimicrobial Resistance. RH acknowledges his part-funding from the NIHR Applied Research Collaboration (ARC OxTV) and the NIHR Community Healthcare Medtech and In-Vitro Diagnostics Co-operative (MIC). GH is funded by and NIHR Advanced Fellowship and by the NIHR Community Healthcare Medtech and In-Vitro Diagnostics Co-operative (MIC). JD is funded by the Wellcome Trust PhD Programme for Primary Care Clinicians (216421/Z/19/Z). SP receives support as an NIHR Senior Investigator (NF-SI-0616-10103) and from the UK NIHR Applied Research Collaboration Oxford and Thames Valley. OvH is supported by an NIHR Development and Skills Enhancement Award. KH receives support as an HCRW Senior Research Leader and the Centre for Trials Research receives infrastructure funding from Health & Care Research Wales and Cancer Research UK. OG is funded by ECRAID-Prime (grant number 101046109). Data Monitoring and Safety Committee Independent members: Professor Deborah Ashby (Chair), Professor Benjamin Fisher, Professor Simon Gates, Professor Gordon Taylor, Professor Martin Underwood. Trial Steering Committee Independent members: Philip Hannaford (Chair), Corina Cheeks, Professor Ranjit Lall, Professor Alastair Hay, Professor William Hollingworth, Professor Matthew Sydes: Independent observer, Professor Mike Moore: Independent observer. Funding Information: This work is supported by the UKRI/NIHR, Grant number NIHR135366. Virology team members are partly supported by an MRC COVID modelling grant, Grant number MR/W015560/1. JD is funded by the Wellcome Trust PhD Programme for Primary Care Clinicians (216421/Z/19/Z). For the purpose of Open Access, the author has applied a CC BY public copyright license to any Author Accepted Manuscript version arising from this submission. NH was funded by the Northern Ireland Clinical Research Network, Public Health Agency. OG is funded by ECRAID-Prime (grant number 101046109). Publisher Copyright: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
Keywords: COVID-19, SARS-CoV-2, aged, antiviral agents, humans, middle Aged, prospective studies, randomized controlled trials as Topic, treatment outcome, therapeutics, virology, primary care, clinical trials

Identifiers

Local EPrints ID: 481215
URI: http://eprints.soton.ac.uk/id/eprint/481215
ISSN: 2044-6055
PURE UUID: 1337e07f-2298-4d7c-9a50-1da6f42ddff3
ORCID for Mark Lown: ORCID iD orcid.org/0000-0001-8309-568X
ORCID for Nick Francis: ORCID iD orcid.org/0000-0001-8939-7312
ORCID for Paul Little: ORCID iD orcid.org/0000-0003-3664-1873

Catalogue record

Date deposited: 18 Aug 2023 16:51
Last modified: 12 Jul 2024 02:05

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Contributors

Author: Oghenekome Gbinigie
Author: Emma Ogburn
Author: Julie Allen
Author: Jienchi Dorward
Author: Melissa Dobson
Author: Tracie-Ann Madden
Author: Ly-Mee Yu
Author: David M. Lowe
Author: Najib Rahman
Author: Stavros Petrou
Author: Duncan Richards
Author: Kerenza Hood
Author: Mahendra Patel
Author: Benjamin R. Saville
Author: Joe Marion
Author: Jane Holmes
Author: May Ee Png
Author: Gail Hayward
Author: Mark Lown ORCID iD
Author: Victoria Harris
Author: Bhautesh Jani
Author: Nigel Hart
Author: Saye Khoo
Author: Heather Rutter
Author: Jem Chalk
Author: Joseph F. Standing
Author: Judith Breuer
Author: Layla Lavallee
Author: Elizabeth Hadley
Author: Lucy Cureton
Author: Magdalena Benysek
Author: Monique I. Andersson
Author: Nick Francis ORCID iD
Author: Nicholas P.B. Thomas
Author: Philip Evans
Author: Oliver van Hecke
Author: Mona Koshkouei
Author: Maria Coates
Author: Sarah Barrett
Author: Clare Bateman
Author: Jennifer Davies
Author: Ivy Raymundo-Wood
Author: Andrew Ustianowski
Author: Jonathan Nguyen-Van-Tam
Author: Andrew Carson-Stevens
Author: Richard Hobbs
Author: Paul Little ORCID iD
Author: Christopher C. Butler

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