Share this page!

MRC-NIHR Trials Methodology Research Partnership Profile picture
Twitter logo
26 Feb, 6 tweets, 5 min read
A number of COVID-19 trials use a platform structure and we will look at a few examples in the later stages of development in this thread. #adaptivedesigns
(1/6)
The first treatment to be shown to benefit COVID-19 patients was identified within the ACTT trial. The platform allows to stop the evaluation for benefit and lack thereof as well as adding additional treatments.

nejm.org/doi/full/10.10…

@NIAIDNews
The RECOVERY trial (recoverytrial.net) is with 38,000 patients to date the largest COVID trial. This has allowed several questions to be answered including dexamethasone as an effective treatment for severe disease.
@PeterHorby @MartinLandray @RichardHaynes3 (3/6)
REMAP-CAP (remapcap.org) has added investigations into COVID to an existing trial platform even further increasing the efficiency of platforms. A response-adaptive approach is taken - see for a discussion.

@remap_cap
(4/6)
The next platform to include is the @WHO SOLIDARITY Trial, a phenomenal example of cross-country to find answers that matter to the whole world.

who.int/emergencies/di…

(5/6)
The final platform, called PROTECT-CH (protect-trial.net) is just about to get going and is investigating potential prophylactic treatments and is undertaking investigations within care homes. @ProtectTrial @adamgordon1978

(6/6)

• • •

Missing some Tweet in this thread? You can try to force a refresh
　

Keep Current with MRC-NIHR Trials Methodology Research Partnership

MRC-NIHR Trials Methodology Research Partnership Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @MRCNIHRTMRP

MRC-NIHR Trials Methodology Research Partnership Profile picture
26 Feb
While platform trials are clearly more prominent in COVID-19 than they were before the pandemic, many other COVID-19 trials use adaptive features. Some examples to follow. #adaptivedesigns

(1/4)
The MATIS trial (NCT04581954) is a multi-arm multi-stage trial with early stopping for lack of benefit which seeks to evaluate treatments to prevent more severe disease. @JMSWason

(2/4)
Similarly, the RECOVERY-Respiratory Support trial (ISRCTN16912075) seeks to identify optimal respiratory support using a multi-arm multi-stage structure. More details are here:

warwick.ac.uk/fac/sci/med/re…

@recovery_rs @WarwickCTU

(3/4)
Read 4 tweets
MRC-NIHR Trials Methodology Research Partnership Profile picture
26 Feb
Throughout this week we have made the case that adaptive designs can be useful to improve efficiency and discussed practical challenges. Two recent papers have made the case that trials that are adaptive can be particularly helpful in the of COVID-19. #adaptivedesigns (1/4)
Different types of adaptations and their utility for studies of COVID-19 treatments have been reviewed in

tandfonline.com/doi/full/10.10…
(2/4)
But the utility of adaptive designs is not limited to studies of COVID-19 treatments. They can also be useful for trials that are impacted by COVID-19 as argued here.

tandfonline.com/doi/full/10.10…
(3/4)
Read 4 tweets
MRC-NIHR Trials Methodology Research Partnership Profile picture
25 Feb
The TAIloR trial (ISRCTN: 51069819) was a multi-arm multi-stage clinical trial that investigated the utility of different doses of telmisartan to reduce insulin resistance in HIV-positive individuals. @thomas_jaki (1/n).
The trial had one interim analysis during which doses that were deemed insufficiently promising were dropped from the study and in the study two of the initial three doses were dropped at this point. (2/n)
Due to the ability to eliminate insufficiently promising doses, fewer patients were exposed to doses that did not provide benefit to patients. (3/n)
Read 4 tweets
MRC-NIHR Trials Methodology Research Partnership Profile picture
25 Feb
The NOTACS trial (ISRCTN: 14092678) an adaptive, multicentre, parallel group, randomised controlled trial comparing the efficacy, cost-effectiveness and safety of 2 types of oxygen therapy in patients at high risk of post-operative pulmonary complication after cardiac surgery 1/n
The trial has an embedded interim sample size re-estimation, which is a type of adaptive trial design. This is joint work by @RoyalPapworth, @MRC_BSU (inc. @SofiaSVillar1, @SarahNDawson) (2/n)
After a pre-defined number of patients have been recruited and completed follow-up, we will use the data accumulated so far to re-estimate the nuisance parameters and use these to repeat the sample size calculation. (3/n)
Read 4 tweets
MRC-NIHR Trials Methodology Research Partnership Profile picture
24 Feb
Adaptive designs, and other innovative approaches, provide great benefits but are also more complex to run. In 2019, the Adaptive Designs Working Group started investigating what extra resource Clinical Trials Units (CTUs) might need to support #adaptivedesigns. (1/7)
Funded by the @NIHRresearch @UKCTUNetwork CTU Support Fund and led by Newcastle CTU, the “Costing Adaptive Trials (CAT)’ project set about answering this question. Step 1 was a snazzy logo. (2/7) Image
We then did a mock costing exercise. Seven CTUs agreed to cost five trial scenarios - each based on a real trial. For each, we outlined a non-adaptive and adaptive version. CTUs returned the staff resource and other costs that they’d put in a funding application. (3/7)
Read 7 tweets
MRC-NIHR Trials Methodology Research Partnership Profile picture
24 Feb
We’re now passing over to @DrGWheeler to walk us through software for adaptive designs!
Sorry, attempt 2 (@JMSWason not too experienced with adding gifs!)
In 2020 Michael Grayling @UniofNewcastle & @DrGWheeler @ucl published a review of software for #AdaptiveDesigns in clinical trials.

Lack of available software is a known barrier to using better trial designs in practice. Q: “How bad is this problem?” 1/9
journals.sagepub.com/doi/full/10.11…
Our research questions were:

1. How many articles proposing new adaptive designs included code with the paper, or a link to code available elsewhere?

2. Which adaptive design approaches and features are well supported by current software, and (importantly), which are not? 2/9
Read 10 tweets

Did Thread Reader help you today?

Support us! We are indie developers!

This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Too expensive? Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal Become our Patreon

Thank you for your support!

Follow Us on Twitter!

Like this author's thread?

Get emails when @MRCNIHRTMRP has new unrolls!

Check out other threads from @MRCNIHRTMRP!

Read all threads by @MRCNIHRTMRP