Last week, the World Health Organization (WHO) published data from its SOLIDARITY trial on a preprint server. The SOLIDARITY trial is a global, pragmatic, adaptive, master protocol trial investigating 4 therapies for hospitalized COVID-19 patients, including remdesivir. Disappointing findings for remdesivir in the SOLIDARITY trial elicited a statement from Gilead Sciences, questioning the validity of SOLIDARITY, and emphasizing its ACTT-1 trial as the “gold standard” regarding remdesivir’s value for COVID-19.
Of the hundreds of agents being tested, inDemic.org selects the drugs most likely to have a significant impact on patients with COVID-19. The Watchlist is dynamic, with new drugs added and current drugs dropping off whenever new data prompts the changes. Selection for the Watchlist is based primarily on clinical trial data, but also on compelling mechanisms of action, signals of efficacy in compassionate use programs, and practical considerations such as manufacturing and distribution capacity to meet worldwide demand. Nominations for the Watchlist or other comments can be sent anytime to [email protected].
As part of an ongoing series of “Expert Perspectives”, Dr. Leon Henderson-MacLennan, Medical Advisor to inDemic Foundation and inThought Research, discusses the role of thromboembolic disease in COVID-19, and its implications for developmental therapeutics. Dr. Leon Henderson-MacLennan describes the rationale for conducting randomized, placebo-controlled trials on anticoagulants and anticomplement agents for COVID-19 associated thromboembolic disease, and highlights several agents and mechanisms of action to watch closely.
“It was the best of times; It was the worst of times”
COVID-19 has forced a re-think of clinical trial design, enrollment, and execution. Among the challenges of clinical trial investigators are the ethical principles of compassionate (“off-label”) use of investigational therapies vs. randomized, placebo-controlled trials [1-2], as well as the logistical challenges of manufacture and distribution of investigational therapies .
Here, we discuss a peculiar and paradoxical challenge of clinical trials accrual in a pandemic. For any clinical trial – whether it be for cancer, Alzheimer’s disease, or diabetes – identifying and enrolling patients is a well-known challenge. For example, targeted therapies for cancers may enroll patients with rare mutations, who may be difficult to identify and to enroll onto a clinical trial at a limited number of cancer centers . It is peculiar that, as millions of patients are infected by SARS-CoV-2, that there are insufficient patients for clinical trials, whose accrual goals are typically a few hundreds of patients.