The COVID-19 pandemic has seen some extraordinary medical feats and achievements, which are being rightly celebrated. Researchers at Oxford University have been at the forefront of global efforts, including the first human trials of a COVID-19 vaccine, and the world’s biggest trial of potential COVID-19 treatments, RECOVERY.
The Randomised Evaluation of COVid-19 thERapY (RECOVERY) Trial has recruited more than 10,000 patients in 176 hospitals in just two months - truly incredible figures for that timescale, making it the fastest ever recruiting individually randomised controlled trial. From conception to launch took just nine days! The trial is being co-led by Professor Peter Horby (Nuffield Department of Medicine) and Professor Martin Landray (Nuffield Department of Population Health), and is testing existing drugs, all with well-known side effects and confirmed safety, on hospital inpatients with suspected or confirmed COVID-19.
Each participant is randomised via a secure 24/7 web-based system. Participants receive either the usual standard of hospital care, or one of four drugs - lopinavir-ritonavir, normally used to treat HIV, the steroid dexamethasone (or alternative corticosteroids), used in a wide range of conditions to reduce inflammation, hydroxychloroquine, which is mainly used as an anti-malarial drug and the antibiotic azithromycin. The study allows a second randomisation for patients with progressive COVID-19, who receive the usual standard of care or tocilizumab, an immunosuppressive drug. The researchers will be able to fairly compare each of the treatments with usual standard of care and work out which, if any, make a difference. The trial design is flexible and as new treatments are suggested or become available, it can be adapted to accommodate them. Indeed, azithromycin, tocilizumab and most recently, convalescent plasma (CP) arms were added after the trial began recruitment; CP is about to be offered on top of the main first line randomisation options.