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Plazy M, Doucet MH, Timbo Songbono C, Sanon A, Issiaka B, Martin C, Da I, L'hostellier A, Marcy O, Malvy D, Poda A, Delamou A, Berthé A, Orne-Gliemann J. Acceptability and feasibility of home and hospital follow-up in Burkina Faso and Guinea: A mixed-method study among patients of the COVID-19 Coverage-Africa clinical trial. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001545. [PMID: 37437024 DOI: 10.1371/journal.pgph.0001545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/18/2023] [Indexed: 07/14/2023]
Abstract
Patient experiences and perspectives on trial participation and follow-up may influence their compliance with research procedures or negatively impact their well-being. We aimed to explore the acceptability and feasibility of home-based and hospital-based follow-up modalities among COVID-19 patients enrolled in the ANTICOV ANRS COV33 Coverage-Africa trial in Burkina Faso and Guinea. The trial (2021-2022) evaluated the efficacy of treatments to prevent clinical worsening among COVID-19 patients with mild to moderate symptoms. Patients were either based at home or hospitalized, as per national recommendations, and followed-up through face-to-face visits and phone calls. We conducted a mixed-methods sub-study administering a questionnaire to all consenting participants and individually interviewing purposively selected participants. We performed descriptive analyses of Likert scale questions for the questionnaires and thematic analysis for the interviews. We conducted framework analysis and interpretation. Of the 400 trial patients, 220 completed the questionnaire (n = 182 in Burkina Faso, n = 38 in Guinea) and 24 were interviewed (n = 16 and n = 8, respectively). Participants were mostly followed-up at home in Burkina Faso; all patients from Guinea were first hospitalized, then followed-up at home. Over 90% of participants were satisfied with follow-up. Home follow-up was considered acceptable if (i) participants perceived they were not severely ill, (ii) it was combined with telemedicine, and (iii) the risk of stigma could be avoided. Hospital-based follow-up was viewed as a way to prevent contamination of family members, but could be badly experienced when mandatory and conflicting with family responsibilities and commitments. Phone calls were seen as reassuring and as a way to ensure continuity of care. These overall positive findings support the development of home-based follow-up for mildly ill patients in West-Africa, provided that both emotional and cognitive factors at individual, familial/inter-relational, healthcare and national levels be addressed when planning the implementation of a trial, or developing any public health strategy.
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Affiliation(s)
- Mélanie Plazy
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
| | - Marie-Hélène Doucet
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
| | - Christine Timbo Songbono
- African Centre of Excellence in the Prevention and Control of Communicable Diseases (CEA-PCMT), Faculty of Sciences and Health Techniques, Gamal Abdel Nasser University, Conakry, Republic of Guinea
- The Alliance for International Medical Action (ALIMA), Conakry, Republic of Guinea
| | - Anselme Sanon
- Muraz Centre, Department of Public Health, Bobo-Dioulasso, Burkina Faso
| | - Bamba Issiaka
- Muraz Centre, Department of Public Health, Bobo-Dioulasso, Burkina Faso
| | - Caroline Martin
- The Alliance for International Medical Action (ALIMA), Conakry, Republic of Guinea
| | - Inès Da
- Muraz Centre, Department of Public Health, Bobo-Dioulasso, Burkina Faso
| | - Anthony L'hostellier
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
| | - Olivier Marcy
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
| | - Denis Malvy
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
- Division of Tropical Medicine and Clinical International Health, Department of Infectious Diseases and Tropical Medicine, CHU Pellegrin, Bordeaux, France
| | - Armel Poda
- Superior Institute of Health Sciences, Nazi Boni University, CHU Sourô Sanou, Bobo Dioulasso, Burkina Faso
| | - Alexandre Delamou
- African Centre of Excellence in the Prevention and Control of Communicable Diseases (CEA-PCMT), Faculty of Sciences and Health Techniques, Gamal Abdel Nasser University, Conakry, Republic of Guinea
| | - Abdramane Berthé
- Muraz Centre, Department of Public Health, Bobo-Dioulasso, Burkina Faso
| | - Joanna Orne-Gliemann
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Research Centre, Bordeaux, France
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Grenier C, Loniewski M, Plazy M, Onaisi R, Doucet MH, Joseph JP, Duvignaud A, Malvy D, Anglaret X, Orne-Gliemann J. Implementing an outpatient clinical trial on COVID-19 treatment in an emergency epidemic context: a mixed methods study among operational and research stakeholders within the Coverage trial, Bordeaux (France). Arch Public Health 2022; 80:245. [PMID: 36463300 PMCID: PMC9719237 DOI: 10.1186/s13690-022-00999-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The emergency set-up and implementation of outpatient clinical trials on epidemic emerging infectious diseases such as COVID-19 raise many issues in terms of research structuration, regulations, and health systems organization. We aimed to describe the experience and points of view of different stakeholders involved in a French home-based outpatient trial on COVID-19 and to identify the early barriers and facilitators to the trial implementation. METHODS We conducted a mixed-methods study in July 2020. A self-administered questionnaire was emailed to 213 clinical, operational and research stakeholders involved in the Coverage trial; individual semi-directed interviews were conducted among 14 stakeholders. Questionnaire data and written interview notes are presented together by key theme. RESULTS One hundred fifty six stakeholders responded to the questionnaire. 53.4% did not have prior experience in clinical research. The motivation of most stakeholders to participate in the Coverage trial was to feel useful during the pandemic. 87.9% agreed that the trial had an unusual set-up timeframe, and many regretted a certain lack of regulatory flexibility. Mobile medical teams and specific professional skills were perceived as instrumental for outpatient research. CONCLUSIONS The implementation of a home-based outpatient clinical trial on COVID-19 was perceived as relevant and innovative although requiring important adaptations of usual professional responsibilities and standard research procedures. Lessons learned from the Coverage trial underline the need for improved networks between hospital and community medicine, and call for a dedicated and reactive outpatient research platform on emerging or threatening infectious diseases.
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Affiliation(s)
- Carine Grenier
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France
| | - Macha Loniewski
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France
| | - Mélanie Plazy
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France
| | - Racha Onaisi
- grid.412041.20000 0001 2106 639XDepartment of General Practice, University of Bordeaux, Bordeaux, France
| | - Marie-Hélène Doucet
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France
| | - Jean-Philippe Joseph
- grid.412041.20000 0001 2106 639XDepartment of General Practice, University of Bordeaux, Bordeaux, France
| | - Alexandre Duvignaud
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France ,grid.42399.350000 0004 0593 7118Department of Infectious Diseases and Tropical Medicine, Division of Tropical Medicine and Clinical International Health, CHU Bordeaux, Bordeaux, France
| | - Denis Malvy
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France ,grid.42399.350000 0004 0593 7118Department of Infectious Diseases and Tropical Medicine, Division of Tropical Medicine and Clinical International Health, CHU Bordeaux, Bordeaux, France
| | - Xavier Anglaret
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France
| | - Joanna Orne-Gliemann
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France
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Oxman AD, Chalmers I, Dahlgren A. Key concepts for informed health choices. 1.1: assumptions that treatments are safe or effective can be misleading. J R Soc Med 2022; 115:354-359. [PMID: 36321676 PMCID: PMC9634226 DOI: 10.1177/01410768221120491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- A D Oxman
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, 0213 Oslo, Norway
| | - I Chalmers
- Centre for Evidence-Based Medicine, University of Oxford, OX2 6GG, UK
| | - A Dahlgren
- Centre for Evidence-Based Medicine, University of Oxford, OX2 6GG, UK
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Duvignaud A, Lhomme E, Onaisi R, Sitta R, Gelley A, Chastang J, Piroth L, Binquet C, Dupouy J, Makinson A, Lefèvre B, Naccache JM, Roussillon C, Landman R, Wallet C, Karcher S, Journot V, Nguyen D, Pistone T, Bouchet S, Lafon ME, Molimard M, Thiébaut R, de Lamballerie X, Joseph JP, Richert L, Saint-Lary O, Djabarouti S, Wittkop L, Anglaret X, Malvy D. Inhaled ciclesonide for outpatient treatment of COVID-19 in adults at risk of adverse outcomes: a randomised controlled trial (COVERAGE). Clin Microbiol Infect 2022; 28:1010-1016. [PMID: 35304280 PMCID: PMC8920965 DOI: 10.1016/j.cmi.2022.02.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/08/2022] [Accepted: 02/20/2022] [Indexed: 12/23/2022]
Abstract
Objectives To assess the efficacy of inhaled ciclesonide in reducing the risk of adverse outcomes in COVID-19 outpatients at risk of developing severe illness. Methods COVERAGE is an open-label, randomized controlled trial. Outpatients with documented COVID-19, risk factors for aggravation, symptoms for ≤7 days, and absence of criteria for hospitalization are randomly allocated to either a control arm or one of several experimental arms, including inhaled ciclesonide. The primary efficacy endpoint is COVID-19 worsening (hospitalization, oxygen therapy at home, or death) by Day 14. Other endpoints are adverse events, maximal follow-up score on the WHO Ordinal Scale for Clinical Improvement, sustained alleviation of symptoms, cure, and RT-PCR and blood parameter evolution at Day 7. The trial's Safety Monitoring Board reviewed the first interim analysis of the ciclesonide arm and recommended halting it for futility. The results of this analysis are reported here. Results The analysis involved 217 participants (control 107, ciclesonide 110), including 111 women and 106 men. Their median age was 63 years (interquartile range 59–68), and 157 of 217 (72.4%) had at least one comorbidity. The median time since first symptom was 4 days (interquartile range 3–5). During the 28-day follow-up, 2 participants died (control 2/107 [1.9%], ciclesonide 0), 4 received oxygen therapy at home and were not hospitalized (control 2/107 [1.9%], ciclesonide 2/110 [1.8%]), and 24 were hospitalized (control 10/107 [9.3%], ciclesonide 14/110 [12.7%]). In intent-to-treat analysis of observed data, 26 participants reached the composite primary endpoint by Day 14, including 12 of 106 (11.3%, 95% CI: 6.0%–18.9%) in the control arm and 14 of 106 (13.2%; 95% CI: 7.4–21.2%) in the ciclesonide arm. Secondary outcomes were similar for both arms. Discussion Our findings are consistent with the European Medicines Agency's COVID-19 task force statement that there is currently insufficient evidence that inhaled corticosteroids are beneficial for patients with COVID-19.
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Affiliation(s)
- Alexandre Duvignaud
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France; Department of Infectious Diseases and Tropical Medicine, CHU Bordeaux, Bordeaux, France; IRD 271, Bordeaux, France
| | - Edouard Lhomme
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France; CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, Bordeaux, France; Inria SISTM, Bordeaux, France; Department of Public Health, CHU Bordeaux, Bordeaux, France
| | - Racha Onaisi
- Department of General Practice, Bordeaux University, Bordeaux, France
| | - Rémi Sitta
- CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, Bordeaux, France; Department of Public Health, CHU Bordeaux, Bordeaux, France
| | - Ambre Gelley
- CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, Bordeaux, France
| | - Julie Chastang
- Département de Médecine Générale, Sorbonne Université, France; Inserm 1136 IPLESP, Sorbonne Université, Paris, France
| | - Lionel Piroth
- Département d'infectiologie, CHU de Dijon, Dijon, France; Module Épidémiologie Clinique, Université de Bourgogne, CIC Inserm 1432, Dijon, France
| | - Christine Binquet
- Module Épidémiologie Clinique, Université de Bourgogne, CIC Inserm 1432, Dijon, France
| | - Julie Dupouy
- Inserm 1295 CERPOP, Université Toulouse III Paul Sabatier, Toulouse, France; Département universitaire de médecine générale, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Alain Makinson
- Université. de Montpellier, Inserm 1175, CIC 1411, Montpellier, France; Département des Maladies Infectieuses, CHU de Montpellier, Montpellier, France
| | - Benjamin Lefèvre
- Service des Maladies Infectieuses et Tropicales, CHRU Nancy, Nancy, France; Université de Lorraine, APEMAC, Nancy, France
| | - Jean-Marc Naccache
- Service de Pneumologie-Allergologie-Oncologie Thoracique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Caroline Roussillon
- Clinical Research and Innovation Department, Safety and Vigilance Unit, CHU Bordeaux, Bordeaux, France
| | - Roland Landman
- Inserm 1137 IAME, Université Paris Diderot, IMEA, Paris, France; Service de Maladies Infectieuses et Tropicales, AP-HP, CHU Bichat-Claude Bernard, Paris, France
| | - Cédrick Wallet
- CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, Bordeaux, France
| | - Sophie Karcher
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
| | - Valérie Journot
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
| | - Duc Nguyen
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France; Department of Infectious Diseases and Tropical Medicine, CHU Bordeaux, Bordeaux, France; IRD 271, Bordeaux, France
| | - Thierry Pistone
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France; Department of Infectious Diseases and Tropical Medicine, CHU Bordeaux, Bordeaux, France; IRD 271, Bordeaux, France
| | | | | | - Mathieu Molimard
- Clinical Research and Innovation Department, Safety and Vigilance Unit, CHU Bordeaux, Bordeaux, France
| | - Rodolphe Thiébaut
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France; CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, Bordeaux, France; Inria SISTM, Bordeaux, France; Department of Public Health, CHU Bordeaux, Bordeaux, France
| | - Xavier de Lamballerie
- Unité des Virus Émergents, IRD 190, Inserm 1207, Université Aix-Marseille, Marseille Cedex 05, France
| | | | - Laura Richert
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France; CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, Bordeaux, France; Inria SISTM, Bordeaux, France; Department of Public Health, CHU Bordeaux, Bordeaux, France
| | - Olivier Saint-Lary
- Centre for Research in Epidemiology and Population Health, Inserm 1018, Université Paris-Saclay Villejuif, Villejuif Cedex, France; Faculty of Health Sciences Simone Veil, Department of Family Medicine, Univ. Versailles Saint-Quentin en Yvelines, Montigny Le Bretonneux, France
| | - Sarah Djabarouti
- Pharmacy, CHU Bordeaux, Bordeaux, France; Inserm 1034, Université de Bordeaux, Bordeaux, France
| | - Linda Wittkop
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France; CIC 1401, EUCLID/F-CRIN Clinical Trials Platform, Bordeaux, France; Inria SISTM, Bordeaux, France; Department of Public Health, CHU Bordeaux, Bordeaux, France
| | - Xavier Anglaret
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France; IRD 271, Bordeaux, France.
| | - Denis Malvy
- Inserm 1219 Bordeaux Population Health, Université de Bordeaux, Bordeaux, France; Department of Infectious Diseases and Tropical Medicine, CHU Bordeaux, Bordeaux, France; IRD 271, Bordeaux, France
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Noor NM, Love SB, Isaacs T, Kaplan R, Parmar MKB, Sydes MR. Uptake of the multi-arm multi-stage (MAMS) adaptive platform approach: a trial-registry review of late-phase randomised clinical trials. BMJ Open 2022; 12:e055615. [PMID: 35273052 PMCID: PMC8915371 DOI: 10.1136/bmjopen-2021-055615] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND For medical conditions with numerous interventions worthy of investigation, there are many advantages of a multi-arm multi-stage (MAMS) platform trial approach. However, there is currently limited knowledge on uptake of the MAMS design, especially in the late-phase setting. We sought to examine uptake and characteristics of late-phase MAMS platform trials, to enable better planning for teams considering future use of this approach. DESIGN We examined uptake of registered, late-phase MAMS platforms in the EU clinical trials register, Australian New Zealand Clinical Trials Registry, International Standard Randomised Controlled Trial Number registry, Pan African Clinical Trials Registry, WHO International Clinical Trial Registry Platform and databases: PubMed, Medline, Cochrane Library, Global Health Library and EMBASE. Searching was performed and review data frozen on 1 April 2021. MAMS platforms were defined as requiring two or more comparison arms, with two or more trial stages, with an interim analysis allowing for stopping of recruitment to arms and typically the ability to add new intervention arms. RESULTS 62 late-phase clinical trials using an MAMS approach were included. Overall, the number of late-phase trials using the MAMS design has been increasing since 2001 and been accelerated by COVID-19. The majority of current MAMS platforms were either targeting infectious diseases (52%) or cancers (29%) and all identified trials were for treatment interventions. 89% (55/62) of MAMS platforms were evaluating medications, with 45% (28/62) of the MAMS platforms having at least one or more repurposed medication as a comparison arm. CONCLUSIONS Historically, late-phase trials have adhered to long-established standard (two-arm) designs. However, the number of late-phase MAMS platform trials is increasing, across a range of different disease areas. This study highlights the potential scope of MAMS platform trials and may assist research teams considering use of this approach in the late-phase randomised clinical trial setting. PROSPERO REGISTRATION NUMBER CRD42019153910.
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Affiliation(s)
| | | | - Talia Isaacs
- Institute of Education, University College London, London, UK
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Unfolding the Mild to Moderate Short-Term Side Effects of Four COVID-19 Vaccines Used in Bahrain: A Cross-Sectional Study. Vaccines (Basel) 2021; 9:vaccines9111369. [PMID: 34835300 PMCID: PMC8625915 DOI: 10.3390/vaccines9111369] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/18/2021] [Accepted: 11/09/2021] [Indexed: 12/23/2022] Open
Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) created a global pandemic (COVID-19) that has resulted in massive health and economic losses. The current unavailability of treatments leaves vaccination as the only way to control this disease. There are four vaccines (Sinopharm, Pfizer—BioNTech, Sputnik, and AstraZeneca) available in Bahrain. This project aimed to study the most common side effects resulting from the first and second doses of these four vaccines. Data were collected through an online questionnaire answered by 311 individuals who received both doses of one of these four vaccines. The results of this study revealed that regardless of the vaccine identity, participants experienced more side effects from the second dose. Among the different side effects, pain at the site of injection was primarily observed after the first dose of the Pfizer vaccine (43%), which was followed by the AstraZeneca vaccine (31%). Moreover, fever was observed in participants after the first dose of the Sputnik vaccine (37%), while headache was mainly observed after the first dose of the Pfizer vaccine (32%). It is important to note that fatigue was observed after the first dose of all four vaccines but was reported by the highest proportion of respondents in the Pfizer group (28%). Interestingly, there are some side effects, such as pain at the site of injection, that are correlated with fever (r = 0.909). Similarly, headache is correlated with fever (r = 0.801) and pain at the site of injection (r = 0.868). Overall, it was observed that recipients of the Sinopharm vaccine reported the mildest side effects among all four vaccines. The crucial finding of this study is that the first and second dosage post-vaccination side effects were modest and predictable with no occurrences of hospitalization; this information can assist in lessening vaccine apprehension.
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Reis G, Silva EADSM, Silva DCM, Thorlund K, Thabane L, Guyatt GH, Forrest JI, Glushchenko AV, Chernecki C, McKay P, Sprague S, Harari O, Ruton H, Rayner CR, Mills EJ. A multi-center, adaptive, randomized, platform trial to evaluate the effect of repurposed medicines in outpatients with early coronavirus disease 2019 (COVID-19) and high-risk for complications: the TOGETHER master trial protocol. Gates Open Res 2021. [DOI: 10.12688/gatesopenres.13304.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: There remains a need for an effective and affordable outpatient treatment for early COVID-19. Multiple repurposed drugs have shown promise in treating COVID-19. We describe a master protocol that will assess the efficacy of different repurposed drugs as treatments for early COVID-19 among outpatients at a high risk for severe complications. Methods: The TOGETHER Trial is a multi-center platform adaptive randomized, placebo-controlled, clinical trial. Patients are included if they are at least 18 years of age, have a positive antigen test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and have an indication for high risk of disease severity, including co-morbidities, older age, or high body mass index. Eligible patients are randomized with equal chance to an investigational product (IP) or to placebo.The primary endpoint is hospitalization defined as either retention in a COVID-19 emergency setting for greater than 6 hours or transfer to tertiary hospital due to COVID-19. Secondary outcomes include mortality, adverse events, adherence, and viral clearance. Scheduled interim analyses are conducted and reviewed by the Data and Safety Monitoring Committee (DSMC), who make recommendations on continuing or stopping each IP. The platform adaptive design go-no-go decision rules are extended to dynamically incorporate external evidence on COVID-19 interventions from ongoing independent randomized clinical trials. Discussion: Results from this trial will assist in the identification of therapeutics for the treatment of early diagnosed COVID-19. The novel methodological extension of the platform adaptive design to dynamically incorporate external evidence is one of the first of its kind and may provide highly valuable information for all COVID-19 trials going forward. Clinicaltrials.gov registration: NCT04727424 (27/01/2021)
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Reis G, Silva EADSM, Silva DCM, Thorlund K, Thabane L, Guyatt GH, Forrest JI, Glushchenko AV, Chernecki C, McKay P, Sprague S, Harari O, Ruton H, Rayner CR, Mills EJ. A multi-center, adaptive, randomized, platform trial to evaluate the effect of repurposed medicines in outpatients with early coronavirus disease 2019 (COVID-19) and high-risk for complications: the TOGETHER master trial protocol. Gates Open Res 2021. [DOI: 10.12688/gatesopenres.13304.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Although vaccines are currently available for coronavirus disease 2019 (COVID-19), there remains a need for an effective and affordable outpatient treatment for early COVID-19. Multiple repurposed drugs have shown promise in treating COVID-19. We describe a master protocol that will assess the efficacy of different repurposed drugs as treatments for early COVID-19 among outpatients at a high risk for severe complications. Methods: The TOGETHER Trial is an international (currently in Brazil and Africa), multi-center platform adaptive randomized, placebo-controlled, clinical trial. Patients are included if they are at least 18 years of age, have a positive antigen test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and have an indication for high risk of disease severity, including co-morbidities, older age, or high body mass index. Eligible patients are randomized with equal chance to an investigational product (IP) or to placebo. The primary endpoint is hospitalization due to clinical worsening of COVID-19 or emergency room required observation for more than 6 hours up to 28 days after randomization. Key secondary endpoints include viral clearance, clinical improvement, hospitalization for any cause, mortality for any cause, and safety and tolerability of each IP. Scheduled interim analyses are conducted and reviewed by the Data and Safety Monitoring Committee (DSMC), who make recommendations on continuing or stopping each IP. The platform adaptive design go-no-go decision rules are extended to dynamically incorporate external evidence on COVID-19 interventions from ongoing independent randomized clinical trials. Discussion: Results from this trial will assist in the identification of therapeutics for COVID-19 that can easily be scaled in low- and middle-income settings. The novel methodological extension of the platform adaptive design to dynamically incorporate external evidence is one of the first of its kind and may provide highly valuable information for all COVID-19 trials going forward. Clinicaltrials.gov registration: NCT04727424 (27/01/2021)
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Duvignaud A, Anglaret X. Research on COVID-19 therapy: Putting the cart alongside the horse. EBioMedicine 2021; 67:103342. [PMID: 33910124 PMCID: PMC8068774 DOI: 10.1016/j.ebiom.2021.103342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Alexandre Duvignaud
- Inserm 1219, Univ. Bordeaux, IRD, 146 Rue Léo Saignat, F-33076 Bordeaux, France; Department of Infectious Diseases and Tropical Medicine, Division of Tropical Medicine and Clinical International Health, CHU de Bordeaux, Hôpital Pellegrin, Place Amélie Raba Léon, F-33076 Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954, Abidjan 18, Côte d'Ivoire.
| | - Xavier Anglaret
- Inserm 1219, Univ. Bordeaux, IRD, 146 Rue Léo Saignat, F-33076 Bordeaux, France; Programme PAC-CI/ANRS Research Site, CHU de Treichville, 18 BP 1954, Abidjan 18, Côte d'Ivoire.
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