A UK COVID-19 drugs trial – testing whether low-risk treatment in the community can help people at higher risk of complications from COVID-19 to get better quicker, reducing the need for hospital admission – is today announcing that older people who have had coronavirus symptoms for 15 days or less can now also screen for the trial online.
More than 500 GP surgeries are already recruiting people aged 50–64 with a pre-existing illness, or aged 65 and over, into the trial.
It is the first trial of COVID-19 treatments to take place in primary care, one of the UK Government’s four national priority platform trials on the disease, and is funded by the UK Research and Innovation (UKRI) and National Institute for Health Research (NIHR) COVID-19 rapid response.
Led by an Oxford University team, the Platform Randomised trial of Interventions against COVID-19 in older peoPLE (PRINCIPLE) trial is testing pre-existing drugs for older patients in the community who show signs of the disease.
From this week, the trial is now also screening participants online. This means that regardless of which GP surgery they are registered with, older people with coronavirus symptoms can now pre-screen for the trial at home via an online questionnaire to see whether they can be included.
PRINCIPLE is trialling a number of low-risk treatments recommended by an expert panel advising the Chief Medical Officer for England. The effectiveness of these treatments will be compared to the current best available care.
In the first phase, the trial is evaluating whether a seven-day course of hydroxychloroquine, a well-known drug used for acute malaria and certain types of arthritis, can reduce the severity of symptoms in vulnerable groups and help avoid hospital admission. The antibiotic azithromycin will soon be added to the trial.
Professor Chris Butler, from Oxford University, who is leading the trial, said: “The PRINCIPLE trial platform is enabling us to rapidly evaluate potential treatments for COVID-19 in older people who are most at risk of serious complications from the illness. With enough people recruited, this trial will give us the vital information we need to understand whether existing drugs can help people recover sooner and at home, without needing to be admitted to hospital – a significant milestone in the course of this pandemic.
“As soon as we find that any one of the drugs in our trial is making a critical difference to people’s health, we want it to be part of clinical practice as soon as it can be introduced.”
Dr Rebecca Clark, a Blackpool-based GP whose practice are contacting patients eligible to join the trial, said: “PRINCIPLE is a hugely important community trial, particularly in areas where health systems are under pressure and prevalence of disease puts many of our older patients at increased risk from COVID-19. That’s why it is vital that we urgently identify treatments that can help people to get better more quickly and keep them out of hospital. As a practice running the trial locally, I have been amazed at how straightforward the enrolment process has been for our patients.”
Chief Medical Officer, Professor Chris Whitty said: “The Government is working with researchers to find proven, effective treatments for COVID-19. This PRINCIPLE trial is a vital part of this research effort and it’s being scaled up by GP surgeries across the country.
“I would urge anyone who is contacted to take part in this trial to do so and contribute to helping our world class scientists find a treatment that will save lives.”
Participants will be closely monitored for the first 28 days of the trial, with a health record notes review taking place for up to three months to understand the longer-term effects of the illness on their health.
Integration of the trial with the Royal College of General Practitioners (RCGP) Research and Surveillance Centre, a rapidly expanding network of over 1100 GP practices, is enabling this extended follow-up to take place. As well as recruiting patients into the PRINCIPLE trial, GP practices in the network continuously monitor and report on the prevalence of infections and diseases in the community through swab testing, including COVID-19.
Professor Richard Hobbs, from Oxford University, who is co-leading the trial, said: “The challenges in developing PRINCIPLE were unprecedented in terms of speed in finalising design, seeking permissions, and then operationalising this key platform trial. It has required months of work to be completed in just a matter of days and weeks.
“We could not have achieved this without extraordinary levels of support from our digital partners at EMIS, TPP and NHS-X, our research delivery partners in the National Institute for Health Research and the RCGP, and the many practices agreeing to support the trial. In particular, our thanks go to the patients who are falling ill and are yet agreeing to join this study.”
The PRINCIPLE trial platform has received £1.7m from UKRI and the Department of Health and Social Care through the NIHR. It is part of a wider £24.6m rapid research response investment by the UK Government to support looking at ways to tackle the coronavirus outbreak.
Professor Fiona Watt, Executive Chair of the Medical Research Council, said: “This trial is very important. It is focused on older people and those with co-morbidities, who are much more likely to be hospitalised with COVID-19. We need more people to join the trial to see if we can identify a drug that helps prevent people reaching hospital and speeds up their recovery.”
For details of participating GP surgeries, and a link to the online screening questionnaire, visit the PRINCIPLE trial website. PRINCIPLE is led from the Primary Care Clinical Trials Unit at the University of Oxford.