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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

Aug 2023  
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PANORAMIC protocol paper, published over 9 months after publication of the molnupiravir arm Butler.
Concerns have been raised that the mutagenic mechanism of action may create dangerous variants or cause cancer Chamod, Gruber, Hadj Hassine, Huntsman, Marikawa, Swanstrom, Waters, Zhou, Zibat. Multiple analyses have identified variants potentially created by molnupiravir Fountain-Jones, Kosakovsky Pond, Sanderson, twitter.com.
Study covers molnupiravir and paxlovid.
Gbinigie et al., 7 Aug 2023, peer-reviewed, 48 authors, trial ISRCTN30448031.
This PaperMolnupiravirAll
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
Oghenekome Gbinigie, Emma Ogburn, Julie Allen, Jienchi Dorward, Melissa Dobson, Dr Tracie-Ann Madden, Ly-Mee Yu, Dr David M Lowe, Professor Najib Rahman, Stavros Petrou, Duncan Richards, Kerenza Hood, Professor Mahendra G Patel, Benjamin R Saville, Joe Marion, Jane Holmes, May Ee Png, Gail Hayward, Mark Lown, Victoria Harris, Dr Bhautesh Jani, Professor Nigel Hart, Professor Saye Khoo, Heather Rutter, Jem Chalk, Joseph F Standing, Professor Judith Breuer, Layla Lavallee, Elizabeth Hadley, Lucy Cureton, Magdalena Benysek, Monique I Andersson, Nick Francis, Nicholas P B Thomas, Philip Evans, Oliver Van Hecke, Mona Koshkouei, Maria Coates, Sarah Barrett, Clare Bateman, Jennifer Davies, Ivy Raymundo-Wood, Andrew Ustianowski, Jonathan Nguyen-Van-Tam, Andrew Carson-Stevens, Richard Hobbs, Paul Little, Professor Christopher C Butler
BMJ Open, doi:10.1136/bmjopen-2022-069176
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.
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Supplemental material placed on this supplemental material which has been supplied by the author(s)
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Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. FLCCC and WCH provide treatment protocols.
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