ASCOT ADAPT study of COVID-19 therapeutics in hospitalised patients: An international multicentre adaptive platform trial

on behalf of the ASCOT ADAPT investigators

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Background: SARS-CoV-2 infection is associated with a significant risk of hospitalisation, death, and prolonged impact on quality of life. Evaluation of new treatment options and optimising therapeutic management of people hospitalised with SARS-CoV-2 infection remains essential, but rapid changes in pandemic conditions and potential therapies have limited the utility of traditional approaches to randomised controlled trials. Methods: ASCOT ADAPT is an international, investigator-initiated, adaptive platform, randomised controlled trial of therapeutics for non-critically ill patients hospitalised with COVID-19. The study design is open label and pragmatic. Potential participants are hospitalised adults with PCR confirmed, symptomatic, SARS-CoV-2 infection, within 14 days of symptom onset. Domains include antiviral, antibody and anticoagulant interventions, with a composite primary outcome of 28-day mortality or progression to intensive-care level respiratory or haemodynamic support. Initial interventions include intravenous nafamostat and variable dose anticoagulation. A range of secondary endpoints, and substudies for specific domains and interventions are outlined. Discussion: This paper presents the trial protocol and management structure, including international governance, remote site monitoring and biobanking activities and provides commentary on ethical and pragmatic considerations in establishing the ASCOT ADAPT trial under pandemic conditions. Trial registration: Australian and New Zealand Clinical Trials Registry (ACTRN12620000445976) and (NCT04483960).

Original languageEnglish
Article number1014
Pages (from-to)1-11
Number of pages11
Issue number1
Publication statusPublished - Dec 2022

Bibliographical note

Funding Information:
Biological specimens collected for ASCOT ADAPT are stored in participating biobank facilities, with a central ‘virtual biobank’ catalogue of samples and consent. Samples are collected, processed and stored according to central laboratory procedures. Access to samples for ethics-approved protocols is considered through a central biobank committee, where guiding principles for access are equity and maximising scientific value. Storage of specimens is provided by the ASCOT ADAPT study, with retrieval and transport costs funded by external researchers accessing specimens.

Publisher Copyright:
© 2022, The Author(s).


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