Journal Article

STIMULATE-ICP: A pragmatic, multi-centre, cluster randomised trial of an integrated care pathway with a nested, Phase III, open label, adaptive platform randomised drug trial in individuals with Long COVID: A structured protocol

Wall, Emma C., Crooks, Michael G., Green, Angela, Prescott, Gordon, Strain, William D., Watkins, Caroline, Banerjee, Rajarshi, Dehbi, Hakim-Moulay, Robson, Chris, Hismeh, Lyth, Forshaw, Denise, Attree, Emily, Heightman, Melissa, Banerjee, Amitava, Lorgelly, Paula

2023

Overview

Long COVID (LC), the persistent symptoms ≥12 weeks following acute COVID-19, presents major threats to individual and public health across countries, affecting over 1.5 million people in the UK alone. Evidence-based interventions are urgently required and an integrated care pathway approach in pragmatic trials, which include investigations, treatments and rehabilitation for LC, could provide scalable and generalisable solutions at pace. This is a pragmatic, multi-centre, cluster-randomised clinical trial of two components of an integrated care pathway (Coverscan™, a multi-organ MRI, and Living with COVID Recovery™, a digitally enabled rehabilitation platform) with a nested, Phase III, open label, platform randomised drug trial in individuals with LC. Cluster randomisation is at level of primary care networks so that integrated care pathway interventions are delivered as \"standard of care\" in that area. The drug trial randomisation is at individual level and initial arms are rivaroxaban, colchicine, famotidine/loratadine, compared with no drugs, with potential to add in further drug arms. The trial is being carried out in 6-10 LC clinics in the UK and is evaluating the effectiveness of a pathway of care for adults with LC in reducing fatigue and other physical, psychological and functional outcomes at 3 months. The trial also includes an economic evaluation which will be described separately. The protocol was reviewed by South Central-Berkshire Research Ethics Committee (reference: 21/SC/0416). All participating sites obtained local approvals prior to recruitment. Coverscan™ has UK certification (UKCA 752965). All participants will provide written consent to take part in the trial. The first participant was recruited in July 2022 and interim/final results will be disseminated in 2023, in a plan co-developed with public and patient representatives. The results will be presented at national and international conferences, published in peer reviewed medical journals, and shared via media (mainstream and social) and patient support organisations. ISRCTN10665760.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Biology and Life Sciences / Buffers / Clinical decision making / Clinical trials / Clinical Trials, Phase III as Topic / Clinics / Clusters / Colchicine / Consent / COVID-19 / Data collection / Delivery of Health Care, Integrated / Disease / Drug dosages / Drugs / Ethics / Evaluation / Evidence-based medicine / Famotidine / Fatigue / Health care / Humans / Integrated delivery systems / Labeling / Long COVID / Medical research / Medicine and Health Sciences / Multicenter Studies as Topic / Pandemics / Patient advocacy / Patients / Post-Acute COVID-19 Syndrome / Pragmatic Clinical Trials as Topic / Primary care / Product development / Public health / Randomization / Randomized Controlled Trials as Topic / Rehabilitation / Research and Analysis Methods / Research ethics / Rivaroxaban / SARS-CoV-2 / Study Protocol / Treatment Outcome