Antiviral clinical trial design throughout the COVID pandemic: evolving endpoints and lessons learnt

Purpose of review Trial design during the novel coronavirus-19 (COVID-19) pandemic was stymied by significant uncertainty about the natural history of the virus, at-risk populations, and optimal patient care by investigators and clinicians alike. Recent findings Three main types of trial design were invoked to address both the variable clinical disease and the evolving viral landscape, and to fit the respective health systems deploying the trials. These included adaptive trial design, platform trials, and master protocols. Strengths and challenges faced with each are discussed in more detail in the main text. Summary Future pandemics will almost certainly continue to arise. Similarly, the landscape will continue to evolve alongside our understanding of the disease. Designing trials that remain scientifically rigorous and practical while still addressing the changing natural history of the disease continues to pose a challenge.