■快速确定在大流行期间在社区中使用的有效治疗方法对于个人的福祉以及医疗保健系统和社会的可持续性至关重要。此外,确定无效的治疗方法减少了研究浪费,避免人们不必要的副作用,使购买和储存药物的成本合理化,并减少不适当的药物使用。然而,只有一小部分针对SARS-CoV-2感染的治疗试验已经在初级保健中进行:大多数开放为时已晚,努力招募,很少产生可操作的结果。参与研究通常受到一个人居住或接受医疗保健的限制,和试验参与者可能不代表那些治疗的目的。
■ALIC4E,原理和正在进行的全景试验已经随机分配了超过40,500名COVID-19患者。这种个人观点描述了这些试验是如何创新的:试验设计(通过使用新颖的自适应平台设计);试验交付(通过补充传统的基于地点的招募(“患者来研究”)与机制,使病人,有传染性的人参加而不必离开家(“把研究带给人民”),通过解决“反向研究参与法”,这凸显了那些贡献最大的人所面临的不成比例的障碍,并从中受益,研究,并通过评估9种药物来改变证据基础,以支持全球范围内针对COVID-19的指南和护理决策,并为抗菌药物管理做出贡献。
■原则和全景试验代表了创新和包容性的模式,并举例说明初级保健在应对紧迫的全球卫生挑战方面的潜力。
自适应平台试验可以有效地并行评估几种治疗方法,并依次“将研究带给人们”可以通过使病人,使参与民主化。有传染性的人从家里做出贡献,在全国范围内,原则和全景试验在试验设计和交付方面进行了创新,为社区中的9种COVID-19治疗提供了证据。
UNASSIGNED: Rapid identification of effective treatments for use in the community during a pandemic is vital for the well-being of individuals and the sustainability of healthcare systems and society. Furthermore, identifying treatments that do not work reduces research wastage, spares people unnecessary side effects, rationalises the cost of purchasing and stockpiling medication, and reduces inappropriate medication use. Nevertheless, only a small minority of therapeutic trials for SARS-CoV-2 infections have been in primary care: most opened too late, struggled to recruit, and few produced actionable results. Participation in research is often limited by where one lives or receives health care, and trial participants may not represent those for whom the treatments are intended.
UNASSIGNED: The ALIC4E, PRINCIPLE and the ongoing PANORAMIC trial have randomised over 40,500 people with COVID-19. This personal view describes how these trials have innovated in: trial design (by using novel adaptive platform designs); trial delivery (by complementing traditional site-based recruitment (\'the patient comes to the research\') with mechanisms to enable sick, infectious people to participate without having to leave home (\'taking research to the people\'), and by addressing the \'inverse research participation law,\' which highlights disproportionate barriers faced by those who have the most to contribute, and benefit from, research, and; in transforming the evidence base by evaluating nine medicines to support guidelines and care decisions world-wide for COVID-19 and contribute to antimicrobial stewardship.
UNASSIGNED: The PRINCIPLE and PANORAMIC trials represent models of innovation and inclusivity, and exemplify the potential of primary care to lead the way in addressing pressing global health challenges.
Adaptive platform trials can efficiently evaluate several treatments in parallel and sequentially‘Taking research to people’ can democratise participation by enabling sick, contagious people to contribute from home, country-wideThe PRINCIPLE and PANORAMIC Trials innovated in trial design and delivery to produce evidence on nine treatments for COVID-19 in the community.