Trials and tribulations: so many potential treatments, so few answers
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INVITED PAPERS
Trials and tribulations: so many potential treatments, so few answers Aaron Gazendam 1 Mohit Bhandari 1,3
&
Nicholas Nucci 2 & Seper Ekhtiari 1 & Chetan Gohal 1 & Meng Zhu 3 & Abbey Payne 3 &
Received: 1 May 2020 / Accepted: 12 May 2020 # SICOT aisbl 2020
Abstract Purpose The purpose of this review is to quantify the landscape of current clinical trials ongoing for therapies in the treatment of COVID-19. A secondary purpose is to examine the relationship between public and scientific interests in potential therapies for COVID-19. Methods A systematic search of clinicaltrials.gov was undertaken on April 22, 2020, to identify all currently registered clinical trials investigating potential therapies for patients with COVID-19. Public interest in the various therapies was quantified utilizing Google Trends. Public interest in hydroxychloroquine and chloroquine was plotted against the cumulative number of active clinical trials evaluating antimalarials as potential COVID-19 therapies over time. Results There were 341 interventional studies and 208 different therapies actively registered on clinicaltrials.gov whose primary aim is the treatment of COVID-19. The median sample size was 120 patients (range 4–6000) with 154 (45%) trials reporting a planned sample size of 100 patients or less. There was a strong positive correlation (r = 0.76, p = 0.01) between the number of registered clinical trials and the public interest in the top ten proposed therapies. Following the spike in public interest, the average number of new trials increased tenfold with respect to antimalarial therapies. Conclusions The relatively small sample sizes and the number of independent trials investigating similar therapies are concerning. Resources may not be being allocated based on scientific merit and may be driven by public consciousness and speculation. Moving forward, a concerted effort focused on implementing large, well-coordinated and carefully designed multiarmed clinical trials will help to ensure that the most promising therapeutic options are rigorously studied and clinically meaningful results produced. Keywords COVID-19 . Clinical trials . Resource allocation . Google Trends
Introduction The current global landscape created by the COVID-19 pandemic has led to a rapid and concerted effort of researchers around the globe to determine the utility and efficacy of pharmaceutical treatments for COVID-19. This pandemic has
* Aaron Gazendam [email protected] 1
Division of Orthopaedic Surgery, Center for Evidence Based Orthopaedics, McMaster University, Hamilton, Ontario, Canada
2
Northern Ontario School of Medicine, Lakehead University, Thunder Bay, Canada
3
OrthoEvidence, Burlington, Ontario, Canada
created an explosion of clinical trials in attempts to reach any promising treatment for this virus. Potential treatments are varied; ranging from antimalarials and antivirals to natural honey. Scientists have collaborated across institution and country lines in an unprecedented fashion, to evaluate potential C
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