This story is a sidebar to a main story about findings from the earliest clinical trials launched during the COVID pandemic. To read the full story, click here.
Clinical trial networks developed during the COVID-19 pandemic are now being leveraged to study treatments for other respiratory diseases, including influenza.
Both the U.S. ACTIV program and the U.K. RECOVERY program have pivoted, in part with the goal of keeping the networks active should another pandemic occur.
"It was so laborious to put together, not only the networks within the U.S., but globally," said Stacey Adam, PhD, a vice president of science partnerships at the Foundation for the National Institutes of Health, which managed the ACTIV portfolio.
"It took time -- time that patients didn't have," Adam told MedPage Today. "So if we can avoid having to go through that again, and have networks that stay active, we think that will be beneficial."
As the inpatient trials in ACTIV were winding down, they were merged into a cohesive network, which is now called STRIVE: Strategies and Treatments for Respiratory Infections and Viral Emergencies, Adam said.
"We merged all of these together and we now have a master protocol that covers all respiratory infectious disease, so it has the potential for testing therapies," Adam said. Indeed, the network is ramping up an observational study in influenza, she added.
One objective is to make sure the network stays "warm," she said, otherwise it won't be ready to test treatments in the event of another pandemic. That includes talking with private sector collaborators "to come in and use the network," she said. "Because if the network isn't used, it won't stay active."
"Maintaining something that size is just very hard if it's not being actively used," Adam said. "The physicians have lots of other things they could be doing with their time, if they're not conducting trials for it."
The U.K.'s RECOVERY trial, which recently hit an enrollment of 50,000 people and includes sites across Europe, Asia, and Africa, switched from studying COVID when its funding for that disease ran out in 2024. It's now researching influenza, according to co-lead investigator Martin Landray, MBChB, PhD, of the University of Oxford in England.
"The issues are the same, we have the same sorts of patients with the same sorts of problems, and the same questions arise about how you treat severe influenza in hospitals," Landray told MedPage Today.
There are plenty of unanswered questions in seasonal influenza, he noted, including the fact that "we don't actually have good data on whether [oseltamivir (Tamiflu)] reduces or improves severe influenza pneumonia in hospitals."
"That evidence isn't there at the moment, even though it's very widely used," Landray said. "So that reminds you of hydroxychloroquine and an awful lot of other things."
Having such a network ready to go would also be critical should H5N1 avian influenza mutate to cause a human pandemic, he added.
James Lawler, MD, MPH, of the University of Nebraska Medical Center's Global Center for Health Security in Omaha, noted that while RECOVERY's findings were important, they didn't arrive until late May and June of 2020, after the first wave of the COVID pandemic in the U.S. had receded.
"It took a while for these trials to get up and running, and it took us a while to get data out of them," Lawler said.
Going forward, Lawler said, the research community "should think about these things before emergencies start and set up systems to initiate and conduct research more quickly."
"The plural of anecdote is not data," he said, "and we really need to make sure that we are conducting rigorous scientific investigations to understand what works and what doesn't."
Landray agreed: "You need to generate the evidence, not guess what the answers will be."