title: A response adaptive randomization platform trial for efficient evaluation of Ebola virus treatments: A model for pandemic response.
abstract: The outbreak of Ebola virus disease in West Africa is the largest ever recorded. Numerous treatment alternatives for Ebola have been considered, including widely available repurposed drugs, but initiation of enrollment into clinical trials has been limited. The proposed trial is an adaptive platform design. Multiple agents and combinations will be investigated simultaneously. Additionally, new agents may enter the trial as they become available, and failing agents may be removed. In order to accommodate the many possible agents and combinations, a critical feature of this design is the use of response adaptive randomization to assign treatment regimens. As the trial progresses, the randomization ratio evolves to favor the arms that are performing better, making the design also suitable for all-cause pandemic preparedness planning. The study was approved by US and Sierra Leone ethics committees, and reviewed by the US Food and Drug Administration. Additionally, data management, drug supply lines, and local sites were prepared. However, in response to the declining epidemic seen in February 2015, the trial was not initiated. Sierra Leone remains ready to rapidly activate the protocol as an emergency response trial in the event of a resurgence of Ebola. (ClinicalTrials.gov Identifier: NCT02380625.) In summary, we have designed a single controlled trial capable of efficiently identifying highly effective or failing regimens among a rapidly evolving list of proposed therapeutic alternatives for Ebola virus disease and to treat the patients within the trial effectively based on accruing data. Provision of these regimens, if found safe and effective, would have a major impact on future epidemics by providing effective treatment options.
authors.affiliation: Berry Consultants LLC, Austin, TX, USA University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Berry
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Petzold
authors.affiliation: Bill & Melinda Gates Foundation, Seattle, WA, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Dull
authors.affiliation: Duke Global Health Institute, Duke University, Durham, NC, USA.
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Thielman
authors.affiliation: Duke University School of Medicine, Durham, NC, USA.
authors.forename: Coleen K
authors.initials: CK
authors.lastname: Cunningham
authors.affiliation: Duke Global Health Institute, Duke University, Durham, NC, USA.
authors.forename: G Ralph
authors.initials: GR
authors.lastname: Corey
authors.affiliation: Duke University School of Medicine, Durham, NC, USA.
authors.forename: Micah T
authors.initials: MT
authors.lastname: McClain
authors.affiliation: Clinical Research Management, Inc., Hinckley, OH, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: Hoover
authors.affiliation: Connaught Hospital, Freetown, Sierra Leone.
authors.forename: James
authors.initials: J
authors.lastname: Russell
authors.affiliation: Clinical Research Management, Inc., Hinckley, OH, USA.
authors.forename: J McLeod
authors.initials: JM
authors.lastname: Griffiss
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA Duke Global Health Institute, Duke University, Durham, NC, USA Duke University School of Medicine, Durham, NC, USA Chris.woods@duke.edu.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Woods
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D002985:Clinical Protocols; D019142:Hemorrhagic Fever, Ebola / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D058873:Pandemics; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012107:Research Design; D012807:Sierra Leone / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents
keywords: Ebola virus disease; response adaptive randomization; therapeutics platform trial