GPs to recruit patients for COVID-19 antiviral trial as new treatments deployed

The PANORAMIC study, run by the University of Oxford, will see GP practices and other healthcare providers recruit up to 10,600 patients aged over 50, or aged 18 to 49 and at risk of serious illness from COVID-19, to take molnupiravir (Lagevrio) at home after receiving a positive PCR test.

GPs do not need to prescribe the drug but are being asked to identify potential participants, invite them to take part and support their participation. Participants will be asked to complete a daily diary for 28 days, or have weekly calls to discuss their symptoms.

Outside of the trial, patients at the highest risk from COVID-19, including the immunocompromised, people with cancer or those with Down’s syndrome, will be able to access either molnupiravir or the new monoclonal antibody combination casirivimab/imdevimab (Ronapreve) from 16 December.

Deployment of the treatments is intended to help protect people most at risk from the virus over the winter months - including those with compromised immune systems for whom the vaccines can be less effective - thus reducing the number of hospitalisations and easing pressures on the NHS. 

In previous trials molnupiravir reduced the risk of hospitalisation or death for at-risk, non-hospitalised adults with mild to moderate COVID-19 by 30% and casirivimab/imdevimab reduced the risk by 70%.

Early intervention

Patients contacted by the PANORAMIC study are urged to enroll urgently to ensure that they have the opportunity to access antiviral treatment within the first five days of COVID-19 symptoms following a positive PCR test, when the drug is most effective.

Professor Chris Butler, co-chief investigator of PANORAMIC and professor of primary care at the University of Oxford’s Nuffield Department of Primary Care Health Sciences, said: ‘It is early on in the illness, when people are still being cared for in the community, that treatments for COVID-19 could have their greatest benefit.

‘So far, a lot of the research has focussed on finding out if well-known drugs can be repurposed to treat COVID-19. This new trial will test whether exciting, new antiviral treatments that are more specific to COVID-19 help people in the community recover faster and reduce the need for treatment in hospital.

‘All community health and social care providers will be able to link people with the trial; everyone who is eligible across the UK will be able to join PANORAMIC, and many will be able to do so from their own homes by participating online with support from their GPs and study team, with medicines sent directly to them at home.’

Studies of antivirals to date have focused on unvaccinated populations but the PANORAMIC study will gather data on the potential benefits of the drugs for vaccinated patients, to inform wider rollout plans next year. Results of the trial are anticipated in early 2022.

Assessment

People receiving molnupiravir or casirivimab/imdevimab outside of the PANORAMIC trial will be assessed over the phone by an expert clinician from an NHS COVID Medicines Delivery Unit (CMDU), who will review and discuss with the patient what the most appropriate treatment would be for them.

Those being prescribed a monoclonal antibody treatment will be invited to attend the CMDU, while those receiving molnupiravir, which is supplied as oral capsules, can have someone collect it for them or have it delivered to their home.

A second COVID-19 antibody treatment sotrovimab (Xevudy) was approved by the MHRA on 2 December, after trials found it reduced the risk of hospitalisation and death by 79% in high-risk adults with symptomatic COVID-19 infection.

The injectable antiviral remdesivir (Veklury) was approved last year to treat COVID-19 in patients with pneumonia requiring supplemental oxygen.