ASCOT ADAPT study of COVID-19 therapeutics in hospitalised patients: an international multicentre adaptive platform trial

Full description

Abstract Background SARS-CoV-2 infection is associated with a significant risk of hospitalisation, death, and prolonged impact on quality of life. Evaluation of new treatment options and optimising therapeutic management of people hospitalised with SARS-CoV-2 infection remains essential, but rapid changes in pandemic conditions and potential therapies have limited the utility of traditional approaches to randomised controlled trials. Methods ASCOT ADAPT is an international, investigator-initiated, adaptive platform, randomised controlled trial of therapeutics for non-critically ill patients hospitalised with COVID-19. The study design is open label and pragmatic. Potential participants are hospitalised adults with PCR confirmed, symptomatic, SARS-CoV-2 infection, within 14 days of symptom onset. Domains include antiviral, antibody and anticoagulant interventions, with a composite primary outcome of 28-day mortality or progression to intensive-care level respiratory or haemodynamic support. Initial interventions include intravenous nafamostat and variable dose anticoagulation. A range of secondary endpoints, and substudies for specific domains and interventions are outlined. Discussion This paper presents the trial protocol and management structure, including international governance, remote site monitoring and biobanking activities and provides commentary on ethical and pragmatic considerations in establishing the ASCOT ADAPT trial under pandemic conditions. Trial registration Australian and New Zealand Clinical Trials Registry (ACTRN12620000445976) and ClinicalTrials.gov (NCT04483960).

Notes

External Organisations
Royal Melbourne Hospital; The George Institute for Global Health; John Hunter Hospital; University of Melbourne; Monash University; Department of Health (New South Wales); Royal Brisbane and Women's Hospital; University of Sydney; Middlemore Hospital, Auckland

Associated Persons
Naomi E. Hammond (Contributor); David Paterson (Contributor); David Price (Contributor); Mark Jones (Contributor)Justin T. Denholm (Contributor); Balasubramanian Venkatesh (Contributor); Joshua Davis (Contributor); Vivekanand Jha (Contributor); Grace McPhee (Contributor); Zoe McQuilten (Contributor); Matthew V. N. O’Sullivan (Contributor); Megan Rees (Contributor); Jason Roberts (Contributor); James Totterdell (Contributor); Nanette Trask (Contributor); Susan Morpeth (Contributor); Steven YC Tong (Contributor)