Innovative methods of recruitment through the NIHR Clinical Research Network (CRN) into large-scale pandemic trials in primary care: the PANORAMIC trial experience

BACKGROUND: In the summer of 2021, after 18 months of the COVID-19 pandemic, there were still no clear evidence-based interventions for COVID-19 infection in the community. Recruiting large numbers at pace was a challenge to urgently generate the evidence needed to inform care within the pandemic. AIM: To develop efficient, user-friendly recruitment methods to offer large numbers of acutely unwell, infectious people with COVID-19 UK the opportunity to participate in a priority trial and test the clinical and cost-effectiveness of molnupiravir. METHOD: PANORAMIC was an adaptive platform clinical trial with participants randomised to either a novel antiviral or usual care. Participants needed to start antiviral medication within 5 days of symptom onset. Innovative methods of identifying positive individuals within general practice were developed, as well as online research procedures for delivery and follow-up, including through www.panoramictrial.org. RESULTS: Novel methods of recruitment were developed in collaboration between the study team and the NIHR Clinical Research Network (CRN), and continually adapted during the study. These included virtual recruitment through the study website combined with GP recruitment via hub and spoke models: this was supported by data, stakeholder, and workforce infrastructure across devolved administration. PANORAMIC was the fastest recruiting study ever delivered by primary care in the NIHR CRN. There were 26 411 participants recruited. Final molnupiravir results will also be presented. CONCLUSION: Large-scale, at-pace recruitment supported by the English CRN and equivalent networks across the UK, is achievable in a pandemic situation, producing potentially game-changing results of national and international importance.