PANORAMIC trial explained

PANORAMIC
Study Type:platform trial
Dates:Dec 2021 - ongoing
Locations:United Kingdom
Lead Researcher:Chris Butler, Paul Little
Funding:National Institute for Health and Care Research (NIHR)

The PANORAMIC trial (short for Platform Adaptive Trial of Novel Antivirals for Early Treatment of COVID-19 in the Community) is a clinical trial in the United Kingdom testing the effectiveness of new antiviral drugs at the early stages of COVID-19 infections.[1] [2] [3] The study aims to find out if antivirals can prevent death and hospitalisation and help faster recovery for people aged over 50 and those at higher risk due to underlying health conditions.[4] The trial was launched in December 2021,[5] and had nearly 30,000 people enrolled as participants.[6]

Overview

PANORAMIC is a platform trial[7] that compares two groups who are having symptoms of COVID: one receives standard care (same as in the NHS) and the other one receives standard care plus antiviral treatment. Participants take part from home online or via phone and the antivirals are delivered to them.[8]

Participants

People could enroll in the study if they had symptoms of COVID (confirmed by a test) less than 5 days prior to enrolling. They had to be either aged 50 or over, or have a preexisting health condition.

Treatments

The antivirals tested in the study were molnupiravir (Lagevrio)[7] and nirmatrelvir/ritonavir (Paxlovid).[9]

Results

Molnupiravir

Results from the trial showed that for higher risk, vaccinated adults molnupiravir does not reduce the chances of hospitalisation and death. However it leads to faster recovery and reduces the amount of virus in the body (viral load).[10] [11]

Even though molnupiravir reduced the amount of virus after a 5-day treatment, the virus was still present and infectious in some of the participants. Furthermore those taking the medicine had fewer antibodies compared to those who did not which is a potential issue for boosting immunity.[12]

After a 6-month follow-up, the PANORAMIC study showed that people who took the antiviral felt better, had fewer and less severe COVID-19 symptoms, took less time off and needed healthcare services less compared to those who received standard care. However, differences between the two groups were small and were evident only if a large number of people received molnupiravir.[13]

Nirmatrelvir/ritonavir

As of November 2024, the results of PANORAMIC regarding nirmatrelvir/ritonavir (Paxlovid) are still being analysed.[14]

Significance

According to a paper reviewing how the PANORAMIC trial was delivered, learnings from the trial could be useful in preparing for future pandemics and for health research in general. The main recommendation of the review was that research conducted in primary care settings (as opposed to hospitals) should play a central role in future pandemics to help prevent the worsening of symptoms and hospitalisation. Further recommendations included the use of the platform study format, focusing on recruiting participants in care homes, and working on ways to rapidly deliver medicine to participants. The review also stressed the importance of building trust with diverse communities so that participation and involvement in research can be inclusive.[15] [16]

Leadership and funding

The trial is led by Chris Butler (University of Oxford) and Paul Little (University of Southampton).[17] PANORAMIC is sponsored by the University of Oxford and funded and delivered by the National Institute for Health and Care Research (NIHR).[18]

Awards

The PANORAMIC trial received the Prix Galien Best Public Sector Innovation Award in 2024.[19] [20]

See also

Notes and References

  1. Web site: PANORAMIC . 16 March 2022 . www.panoramictrial.org.
  2. News: 25 January 2022 . Thousands needed to try a new Covid antiviral treatment . BBC News . 16 March 2022.
  3. Web site: Public urged to sign up to world-first COVID-19 antiviral study . 16 March 2022 . GOV.UK .
  4. Web site: 21 February 2022 . Covid cost-cutting will put blinkers on our best Covid research . 16 March 2022 . the Guardian .
  5. Web site: Pinching . John . 22 February 2022 . PANORAMIC view of World's largest COVID study . 16 March 2022 . PharmaTimes.
  6. Web site: Homepage . 2024-11-04 . www.panoramictrial.org . en.
  7. Web site: Over ten thousand participants enrol in world's largest COVID-19 antiviral study . 16 March 2022 . www.nihr.ac.uk .
  8. Web site: Participant Information — PANORAMIC . 16 March 2022 . www.panoramictrial.org.
  9. Web site: Second ground-breaking antiviral to be deployed to country's most vulnerable . 16 March 2022 . GOV.UK .
  10. Butler . Christopher C . Hobbs . F D Richard . Gbinigie . Oghenekome A . Rahman . Najib M . Hayward . Gail . Richards . Duncan B . Dorward . Jienchi . Lowe . David M . Standing . Joseph F . Breuer . Judith . Khoo . Saye . Petrou . Stavros . Hood . Kerenza . Nguyen-Van-Tam . Jonathan S . Patel . Mahendra G . 2022-12-22 . Molnupiravir plus usual care versus usual care alone as early treatment for adults with COVID-19 at increased risk of adverse outcomes (PANORAMIC): an open-label, platform-adaptive randomised controlled trial . The Lancet . en . 401 . 10373 . 281–293 . 10.1016/S0140-6736(22)02597-1 . 9779781 . 36566761.
  11. Web site: 2022-12-22 . Pill for Covid does not reduce risk of hospitalisation or death, UK study finds . 2022-12-29 . The Guardian . en.
  12. Standing . Joseph F. . Buggiotti . Laura . Guerra-Assuncao . Jose Afonso . Woodall . Maximillian . Ellis . Samuel . Agyeman . Akosua A. . Miller . Charles . Okechukwu . Mercy . Kirkpatrick . Emily . Jacobs . Amy I. . Williams . Charlotte A. . Roy . Sunando . Martin-Bernal . Luz M. . Williams . Rachel . Smith . Claire M. . 2024-02-23 . Randomized controlled trial of molnupiravir SARS-CoV-2 viral and antibody response in at-risk adult outpatients . Nature Communications . en . 15 . 1 . 10.1038/s41467-024-45641-0 . 2041-1723 . 10891158 . 38396069.
  13. Harris . Victoria . Holmes . Jane . Gbinigie-Thompson . Oghenekome . Rahman . Najib M . Richards . Duncan B . Hayward . Gail . Dorward . Jienchi . Lowe . David M . Standing . Joseph F . Breuer . Judith . Khoo . Saye . Petrou . Stavros . Hood . Kerenza . Ahmed . Haroon . Carson-Stevens . Andrew . 2024-09-09 . Health outcomes 3 months and 6 months after molnupiravir treatment for COVID-19 for people at higher risk in the community (PANORAMIC): a randomised controlled trial . The Lancet Infectious Diseases . en . 10.1016/S1473-3099(24)00431-6. 39265595 . free .
  14. Web site: Results . 2024-11-04 . www.panoramictrial.org . en.
  15. Web site: 2024-10-29 . PANORAMIC study learnings are key to pandemic preparedness . 2024-11-04 . National Institute for Health and Care Research . en.
  16. The PANORAMIC study of COVID-19 treatments in primary care: a review and learning exercise . Evans . Philip . Tonner . Emma . 2024-08-08 . 10.3310/nihropenres.1115237.1 . en . Williamson . James . Dolman . Mark . Chambers . Emma . Crawshaw . Sarah Elizabeth . Yu . Ly-Mee. free .
  17. Web site: COVID-19 drug reduces recovery time but not hospitalisations . 2024-11-04 . Health Research Southampton . en.
  18. Web site: NIHR funds community COVID-19 antiviral trial . 16 March 2022 . National Institute for Health and Care Research.
  19. Web site: Prix Galien UK . 2024-11-04 . www.galienfoundation.org . en.
  20. Web site: 2024-10-29 . PANORAMIC study learnings are key to pandemic preparedness . 2024-11-04 . National Institute for Health and Care Research . en.

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