28 Apr 2020
ASCOT blog: Keeping up with COVID
Written by Associate Professor Justin Denholm, Medical Director of the Victorian Tuberculosis Program, Doherty Institute and ASCOT Coordinating Principal Investigator.
This article was first published by AustralaSian COVID-19 Trial (ASCOT).
At the outset of the COVID-19 pandemic, of course no established treatment existed for this newly emergent infection. The AustralaSian COVID-19 Trial (ASCOT) was formally launched on Tuesday, 21 April 2020, only 82 days after the World Health Organization (WHO) declared COVID-19 as a “Public Health Emergency of International Concern”. That is a very short time to get a randomised controlled trial running in multiple countries, but it’s critical to have ASCOT and other well-designed studies operating to ensure that treatment of SARS-CoV-2 infection is undertaken safely and built on strong evidence.
While these studies have started quickly, in recent weeks, a large number of potential treatments have been proposed or tried. Most of these have shown some evidence of controlling SARS-CoV-2 in laboratory studies, but none have yet shown to have clear benefit for sick people. ASCOT has launched with a focus on evaluating two medications with early suggestions of potential benefit in hospitalised patients with SARS-CoV-2; hydroxychloroquine and lopinavir/ritonavir. Both are repurposed medications, meaning that they have been used for other conditions before. That’s helpful because there is some existing information about how these medications can be used safely. As the trial gets underway, we’re constantly watching for evidence from other parts of the world about these and other treatments related to COVID-19, especially for any evidence about safety and effectiveness. We’re also watching out for other medications which might be effective, and thinking about how we can incorporate them into our studies in the future.
With so much information being released about possible treatments, we use a range of ways to keep on top of it all. To start with, the ASCOT steering committee includes infectious diseases and respiratory doctors, community members, statisticians and others with a wide range of backgrounds and experience, including medical research. We have existing networks of clinicians and researchers that we draw from, and are actively sent new information regularly. Although not exhaustive, members of our steering committee have also found several sources to be helpful for good commentary on emerging treatments. These include Derek Lowe’s In the pipeline commentary on drug discovery, Zenodo’s crowdsourced Statistical reviews for clinical trials testing treatments for COVID-19 and clinical trial registries such as clinicaltrials.gov and anzctr.org.au. We also spend time on Twitter ourselves, and have recently launched a trial twitter account @ascot_trial, which we hope others will use to connect with us as well.
Of course, we’ll see all of this information change frequently, as new studies come out and help to shape better outcomes for people with COVID-19. The ASCOT team looks forward to contributing new and reliable evidence from this trial into the field as soon as possible, and you can follow along with us here or via Twitter @ascot_trial.