COVID-19 platform trials: insight and lessons in clinical trial design

The COVID-19 pandemic was an unprecedented healthcare event. With a novel pathogen and no proven treatments, it also represented an unprecedented challenge for clinical research, with an urgent need for life-saving treatments and vaccines. In the absence of outstanding candidate therapeutics, trial designs were required which could rapidly evaluate multiple therapies in heterogeneous patient populations. Adaptive platform trials (randomised trials with multiple treatment arms and a single control group) were ideal to deliver this. This approach was heavily used in fields such as oncology pre-pandemic, but was less common in respiratory medicine or infectious diseases. Trials such as RECOVERY and REMAP-CAP delivered dexamethasone, tociliuzumab, baricitinib and antibody therapies as effective treatments for hospitalised patients with COVID-19, while demonstrating lack of effectiveness for a number of drugs that were widely used empirically. The success of adaptive platform trials during COVID-19 has increased interest in their application to other diseases post-pandemic, which may be a lasting legacy of the pandemic for clinical research.