Angus on launch of ‘learning while doing’ clinical trial to fast-track testing of coronavirus therapies

PITTSBURGH – A novel clinical trial developed by Pitt researchers launched today at UPMC to address one of the most important debates during the COVID-19 pandemic: How should doctors decide between quickly adopting new therapies, such as the anti-malarial drug hydroxychloroquine, and waiting until they are tested in longer clinical trials? 
Derek Angus release“The solution is to find an optimal tradeoff between doing something now, such as prescribing a drug off-label, or waiting until traditional clinical trials are complete,” said alumnus Derek Angus (BCHS '92), professor of health policy and management and chair of Pitt's Department of Critical Care Medicine. “We’ve developed a way to do that with an adaptive clinical trial model that relies on a type of artificial intelligence known as reinforcement learning to identify the best, evidence-backed therapy for COVID-19 much faster than using the traditional scientific approach.”  
“By building this one-stop solution at the point-of-care, we are rolling out an approach that can assure that every patient admitted with COVID-19 can be enrolled in the program.”
Before COVID-19 emerged, Angus and a wide range of international collaborators had developed a platform, called REMAP-Community Acquired Pneumonia (REMAP-CAP), designed to find optimal treatments for severe pneumonia both in non-pandemic and pandemic settings. When COVID-19 began circulating, REMAP-CAP was rapidly adapted, as per its intent, to incorporate additional treatment regimens specifically targeting the SARS-CoV-2 virus. The international team describes the REMAP-CAP platform in a manuscript published today in the Annals of the American Thoracic Society (AnnalsATS).
REMAP (randomized, embedded, multi-factorial, adaptive platform) allows researchers to rapidly test multiple treatment approaches simultaneously at a lower cost and with fewer patients than traditional clinical trials. The REMAP design, first described by Angus in 2015 in the Journal of the American Medical Association (JAMA), is a flexible version of what are called “adaptive platform trials.” “Adaptive platform trials are rapidly being endorsed by the U.S. Food and Drug Administration, the Bill & Melinda Gates Foundation and others as a long-needed revolution in clinical trials,” said Angus, who holds the Mitchell P. Fink Endowed Chair at Pitt.


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