Launching a comparative effectiveness adaptive platform trial of monoclonal antibodies for COVID-19 in 21 days.

Launching a comparative effectiveness adaptive platform trial of monoclonal antibodies for COVID-19 in 21 days.
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DOI:
10.1016/j.cct.2021.106652
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发表时间:
2022-03
影响因子:
2.2
通讯作者:
Angus DC
Angus DC
中科院分区:
医学4区
文献类型:
--
作者:
McCreary EK;Bariola JR;Minnier T;Wadas RJ;Shovel JA;Albin D;Marroquin OC;Schmidhofer M;Wisniewski MK;Nace DA;Sullivan C;Axe M;Meyers R;Khadem T;Garrard W;Collins K;Wells A;Bart RD;Linstrum K;Montgomery SK;Haidar G;Snyder GM;McVerry BJ;Seymour CW;Yealy DM;Huang DT;Angus DC

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限制进展为严重 2019 冠状病毒病 (COVID-19) 的门诊治疗对于优化患者治疗结果和公共卫生至关重要。随机临床试验证明单克隆抗体 (mAb) 能够减少住院治疗。然而,单克隆抗体治疗存在许多障碍,例如患者获取和临床医生教育。没有数据比较现有单克隆抗体的功效或安全性。我们寻求快速启动适应性平台试验,其目标是提高治疗的可及性,无论地理位置和社会经济状况如何,并评估现有单克隆抗体的比较疗效和安全性。在产生想法后的 21 天内,我们为本次临床试验中的所有患者分配了 mAb 治疗。在 2 个月内,我们缩小了黑人和白人患者之间接受 mAb 的可能性的差距(以背景阳性率为条件)(黑人患者 0.238;白人患者 0.241)。我们描述了试验基础设施、经验教训以及边做边学文化的未来方向。
Outpatient treatments that limit progression to severe coronavirus disease 2019 (COVID-19) are of vital importance to optimise patient outcomes and public health. Monoclonal antibodies (mAb) demonstrated ability to decrease hospitalizations in randomized, clinical trials. However, there are many barriers to mAb treatment such as patient access and clinician education. There are no data comparing efficacy or safety of available mAbs. We sought to rapidly launch an adaptive platform trial with the goals of enhancing access to treatment, regardless of geography and socioeconomic status, and evaluating comparative efficacy and safety of available mAbs. Within 21 days from idea genesis, we allocated mAb treatment to all patients within the context of this clinical trial. Within 2 months, we closed the gap of the likelihood of receiving mAb, conditional on background positivity rate, between Black and White patients (Black patients 0.238; White patients 0.241). We describe trial infrastructure, lessons learned, and future directions for a culture of learning while doing.
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