Randomised Evaluation of COVID-19 Therapy (RECOVERY)
|The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.|
|ClinicalTrials.gov Identifier: NCT04381936|
Recruitment Status : Recruiting
First Posted : May 11, 2020
Last Update Posted : May 5, 2021
|First Submitted Date ICMJE||May 7, 2020|
|First Posted Date ICMJE||May 11, 2020|
|Last Update Posted Date||May 5, 2021|
|Actual Study Start Date ICMJE||March 19, 2020|
|Estimated Primary Completion Date||December 2021 (Final data collection date for primary outcome measure)|
|Current Primary Outcome Measures ICMJE
||All-cause mortality [ Time Frame: Within 28 days after randomisation ]
For each pairwise comparison with the 'no additional treatment' arm, the primary objective is to provide reliable estimates of the effect of study treatments on all-cause mortality.
|Original Primary Outcome Measures ICMJE||Same as current|
|Current Secondary Outcome Measures ICMJE
|Original Secondary Outcome Measures ICMJE
|Current Other Pre-specified Outcome Measures
|Original Other Pre-specified Outcome Measures||Not Provided|
|Brief Title ICMJE||Randomised Evaluation of COVID-19 Therapy|
|Official Title ICMJE||Randomised Evaluation of COVID-19 Therapy|
|Brief Summary||RECOVERY is a randomised trial investigating whether treatment with Lopinavir-Ritonavir, Hydroxychloroquine, Corticosteroids, Azithromycin, Colchicine, IV Immunoglobulin (children only), Convalescent plasma, Synthetic neutralizing antibodies (REGN-COV2), Tocilizumab, Aspirin, Baricitinib, Infliximab or Anakinra (children only) prevents death in patients with COVID-19.|
The RECOVERY trial has already shown that dexamethasone (a type of steroid) & tocilizumab reduce the risk of dying for patients hospitalised with COVID-19 receiving oxygen. The trial also concluded that there is no beneficial effect of hydroxychloroquine, lopinavir-ritonavir or azithromycin in patients hospitalised with COVID-19, and these arms have been closed to recruitment.
BACKGROUND: In early 2020, as this protocol was being developed, there were no approved treatments for COVID-19, a disease induced by the novel coronavirus SARSCoV-2 that emerged in China in late 2019. The UK New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) advised that several possible treatments should be evaluated, including Lopinavir-Ritonavir, low-dose corticosteroids, and Hydroxychloroquine (which has now been done). A World Health Organization (WHO) expert group issued broadly similar advice. These groups also advised that other treatments will soon emerge that require evaluation.
ELIGIBILITY AND RANDOMISATION: This protocol describes a randomised trial among patients hospitalised for COVID-19. All eligible patients are randomly allocated between several treatment arms, each to be given in addition to the usual standard of care in the participating hospital: No additional treatment vs corticosteroids (children only) vs intravenous immunoglobulin (children only) (main randomisation part A). In a factorial design (in the UK alone), eligible patients are allocated simultaneously to no additional treatment vs synthetic neutralising antibodies (REGN-COV2) (part B). Separately, all participants aged 18 years or older will be allocated to baricitinib (UK only) vs infliximab (excluding UK [ex-UK] vs no additional treatment (part D [part C was discontinued in V15.0], UK only). Separately, all participants aged 18 years or older with hypoxia will be allocated to either high-dose corticosteroids vs no additional treatment (part E, ex-UK only). The study allows a subsequent randomisation for children with PIMS-TS (hyper-inflammatory state associated with COVID-19): No additional treatment vs tocilizumab vs anakinra. For patients for whom not all the trial arms are appropriate or at locations where not all are available, randomisation will be between fewer arms.
RECOVERY will also assess interventions for which additional information is required to determine whether they are considered for large-scale assessment as their potential to improve outcomes in COVID-19 is uncertain. Hence, for some patients the main randomisation part A will include an Early Phase Assessment arm in which patients may be randomised to receive dimethyl fumarate and additional information on efficacy and safety collected.
ADAPTIVE DESIGN: The interim trial results will be monitored by an independent Data Monitoring Committee (DMC). The most important task for the DMC will be to assess whether the randomised comparisons in the study have provided evidence on mortality that is strong enough (with a range of uncertainty around the results that is narrow enough) to affect national and global treatment strategies. In such a circumstance, the DMC will inform the Trial Steering Committee who will make the results available to the public and amend the trial arms accordingly. New trial arms can be added as evidence emerges that other candidate therapeutics should be evaluated.
OUTCOMES: The main outcomes will be death, discharge, need for ventilation and need for renal replacement therapy. For the main analyses, follow-up will be censored at 28 days after randomisation. Additional information on longer term outcomes may be collected through review of medical records or linkage to medical databases where available (such as those managed by NHS Digital and equivalent organisations in the devolved nations).
SIMPLICITY OF PROCEDURES: To facilitate collaboration, even in hospitals that suddenly become overloaded, patient enrolment (via the internet) and all other trial procedures are greatly streamlined. Informed consent is simple and data entry is minimal. Randomisation via the internet is simple and quick, at the end of which the allocated treatment is displayed on the screen and can be printed or downloaded. Key follow-up information is recorded at a single timepoint and may be ascertained by contacting participants in person, by phone or electronically, or by review of medical records and databases.
DATA TO BE RECORDED: At randomisation, information will be collected on the identity of the randomising clinician and of the patient, age, sex, major co-morbidity, pregnancy, COVID-19 onset date and severity, and any contraindications to the study treatments. The main outcomes will be death (with date and probable cause), discharge (with date), need for ventilation (with number of days recorded) and need for renal replacement therapy. Reminders will be sent if outcome data have not been recorded by 28 days after randomisation. Suspected Unexpected Serious Adverse Reactions (SUSARs) to one of the study medication (eg, Stevens-Johnson syndrome, anaphylaxis, aplastic anaemia) will be collected and reported in an expedited fashion. Other adverse events will not be recorded but may be available through linkage to medical databases.
NUMBERS TO BE RANDOMISED: The larger the number randomised the more accurate the results will be, but the numbers that can be randomised will depend critically on how large the epidemic becomes. If substantial numbers are hospitalised in the participating centres then it may be possible to randomise several thousand with mild disease and a few thousand with severe disease, but realistic, appropriate sample sizes could not be estimated at the start of the trial.
HETEROGENEITY BETWEEN POPULATIONS: If sufficient numbers are studied, it may be possible to generate reliable evidence in certain patient groups (e.g. those with major comorbidity or who are older). To this end, data from this study may be combined with data from other trials of treatments for COVID-19, such as those being planned by the WHO.
ADD-ON STUDIES: Particular countries or groups of hospitals, may well want to collaborate in adding further measurements or observations, such as serial virology, serial blood gases or chemistry, serial lung imaging, or serial documentation of other aspects of disease status. While well-organised additional research studies of the natural history of the disease or of the effects of the trial treatments could well be valuable (although the lack of placebo control may bias the assessment of subjective side-effects, such as gastrointestinal problems), they are not core requirements.
|Study Type ICMJE||Interventional|
|Study Phase ICMJE||Phase 2
|Study Design ICMJE||Allocation: Randomized
Intervention Model: Factorial Assignment
Intervention Model Description:
Masking: None (Open Label)
RECOVERY includes multiple options for the Main Randomisation (Parts A to E), that can be undertaken simultaneously, as appropriate, plus a subsequent randomisation for a subset of participants. Not all treatments are available in all countries.
Part A: randomisation between no additional treatment, dimethyl fumarate (UK adults only; early phase assessment), corticosteroids (children only) or intravenous immunoglobulin (children only).
Part B: randomisation between no additional treatment or synthetic neutralizing antibodies (REGN-COV2)
Part C: randomisation to no additional treatment vrs aspirin has finished recruitment
Part D: randomisation between no additional treatment vs baricitinib vs infliximab
Part E: randomisation between no additional treatment vs high dose corticosteroids
Subsequent randomisation: Children with PIMS-TS (hyper-inflammatory state associated with COVID-19) can be randomised to no additional treatment vs tocilizumab vs anakinra.
Primary Purpose: Treatment
|Condition ICMJE||Severe Acute Respiratory Syndrome|
|Study Arms ICMJE||
* Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
|Recruitment Status ICMJE||Recruiting|
|Estimated Enrollment ICMJE
|Original Estimated Enrollment ICMJE
|Estimated Study Completion Date ICMJE||December 2031|
|Estimated Primary Completion Date||December 2021 (Final data collection date for primary outcome measure)|
|Eligibility Criteria ICMJE||
|Ages ICMJE||Child, Adult, Older Adult|
|Accepts Healthy Volunteers ICMJE||No|
|Listed Location Countries ICMJE||Indonesia, Nepal, United Kingdom|
|Removed Location Countries|
|NCT Number ICMJE||NCT04381936|
|Other Study ID Numbers ICMJE||NDPHRECOVERY
2020-001113-21 ( EudraCT Number )
ISRCTN50189673 ( Registry Identifier: ISRCTN )
|Has Data Monitoring Committee||Yes|
|U.S. FDA-regulated Product||
|IPD Sharing Statement ICMJE||
|Responsible Party||University of Oxford|
|Study Sponsor ICMJE||University of Oxford|
|PRS Account||University of Oxford|
|Verification Date||April 2021|
ICMJE Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP