title: Feasibility of a randomized controlled trial to assess treatment of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection in Saudi Arabia: a survey of physicians.
abstract: The Middle East Respiratory Syndrome coronavirus (MERS-CoV) is an emerging respiratory pathogen with a high mortality rate and no specific treatments available to date. The purpose of this study was to determine the feasibility of conducting a randomized controlled trial (RCT) of convalescent plasma therapy for MERS-CoV-infected patients by using MERS-CoV-specific convalescent plasma obtained from previously recovered patients.
  
  
  
  A survey was adapted from validated questionnaire originally aimed to measure network capacities and capabilities within the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC). The questionnaire was modified for this study to include 26 items that were divided into three main domains of interest: (1) the ability to care for critically ill MERS-CoV patients; (2) laboratory capacity to diagnose MERS-CoV and blood bank ability to prepare convalescent plasma; and (3), research capacity to conduct randomized controlled trials. The questionnaire was emailed to physicians.
  
  
  
  Of 582 physicians who were invited to the survey, 327 responded (56.2 %). The professional focus of the majority of respondents was critical care (106/249 (43 %)), pediatrics (59/249, (24 %)) or internal medicine (52/249 (21 %)) but none was blood banking. Nearly all respondents (251/263 (95 %)) reported to have access to ICU facilities within their institutions. Most respondents (219/270 (81 %)) reported that intensivists were the most physician group responsible for treatment decisions about critically ill SARI patients. While 125/165 respondents (76 %) reported that they conduct research in ICUs, and 80/161 (49.7 %) had been involved in the conduct of RCTs, including using a placebo comparison (60/161 (37 %)), only 49/226 (21 %) of respondents regularly participated in research networks.
  
  
  
  Our survey indicated that in the Kingdom of Saudi Arabia (KSA), ICUs are the most likely clinical locations for conducting a clinical trial of convalescent plasma therapy for MERS-CoV, and that most ICUs have experience with such research designs.
authors.affiliation: Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, PO Box 22490, Riyadh, 11426, Saudi Arabia. arabi@ngha.med.sa.
authors.forename: Yaseen M
authors.initials: YM
authors.lastname: Arabi
authors.affiliation: Intensive Care Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, PO Box 22490, Riyadh, 11426, Saudi Arabia.
authors.forename: Farhan
authors.initials: F
authors.lastname: Al-Enezi
authors.affiliation: University of Oxford Centre for Tropical Medicine (CCVTM), Churchill Hospital Old Road, Headington, Oxford, OX3 7LE, UK.|International Severe Acute Respiratory & emerging Infection Consortium (ISARIC), Old Road Campus, Headington, OX3 7FZ, UK.
authors.forename: Kajsa-Stina
authors.initials: KS
authors.lastname: Longuere
authors.affiliation: Infection Control Department, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
authors.forename: Hanan H
authors.initials: HH
authors.lastname: Balkhy
authors.affiliation: Emergency & Critical Care Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Al-Sultan
authors.affiliation: AlFaisal University, Riyadh, Saudi Arabia.
authors.forename: Awad
authors.initials: A
authors.lastname: Al-Omari
authors.affiliation: Critical Care & Pulmonary Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, Saudi Arabia.
authors.forename: Fahad M
authors.initials: FM
authors.lastname: Al-Hameed
authors.affiliation: University of Oxford Centre for Tropical Medicine (CCVTM), Churchill Hospital Old Road, Headington, Oxford, OX3 7LE, UK.|International Severe Acute Respiratory & emerging Infection Consortium (ISARIC), Old Road Campus, Headington, OX3 7FZ, UK.
authors.forename: Gail
authors.initials: G
authors.lastname: Carson
authors.affiliation: Pandemic and Epidemic Diseases Department, World Health Organization, Geneva, Switzerland.
authors.forename: Nahoko
authors.initials: N
authors.lastname: Shindo
authors.affiliation: Department of Medicine and Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada.|Department of Medicine and Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Fowler
mesh_terms: D001291:Attitude of Health Personnel; D018352:Coronavirus Infections / Q000097:blood* / Q000628:therapy* / Q000821:virology; D003422:Critical Care / Q000706:statistics & numerical data; D005240:Feasibility Studies; D006801:Humans; D065207:Middle East Respiratory Syndrome Coronavirus; D010820:Physicians / Q000523:psychology*; D010951:Plasma Exchange; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D012529:Saudi Arabia; D011795:Surveys and Questionnaires
keywords: Convalescent plasma; Middle East respiratory syndrome coronavirus (MERS-CoV); Randomized controlled trial