PANORAMIC: Exploring new COVID-19 treatments

The UK wide PANORAMIC (Platform Adaptive trial of Novel antiviRals for eArly treatment of COVID-19 In the Community) trial is being sponsored by Oxford University and will be used to study the efficacy of managing COVID-19 in around 10,000 vaccinated or unvaccinated individuals throughout the community, via treatment with antivirals.

PANORAMIC aims to help those who have tested positive for COVID-19 manage their symptoms and recover more quickly, whilst assessing the efficacy of new COVID-19 treatments, with the current focus on the antivirals Molnupiravir. Priority for inclusion in this trial will be given to those at highest risk of developing severe COVID.

Why is PANORAMIC being run?

PANORAMIC will be crucial in allowing UK scientists gather data on how antivirals work in a largely vaccinated population. Currently only Molnupiravir is being assessed, however new COVID-19 treatments are likely to be added to the trial scope in the coming months. It is anticipated that the first publications resulting from this trial will be available in early 2022.

Who can take part in PANORAMIC?

To be involved in PANORAMIC and potentially receive at home COVID-19 treatments, there are a few conditions that must be met. Participants’ must:

• Feel unwell with COVID-19 symptoms that started within the last 5 days
• AND have a positive PCR test for COVID-19
• AND be over 50
• OR be over 18 with an underlying medical condition that can increase the chance of severe COVID-19.

Underlying medical conditions include: people on immunosuppression due to certain medical conditions , those with a long term lung disease, those with a long term kidney disease and those with a long term liver disease. When signing up to PANORAMIC individuals can also specify ‘other long term health condition which puts you at greater risk from COVID-19’

How do I sign up?

If you are eligible to take part you may be contacted by one of the 60 GP hubs organising the PANORAMIC study, or the study team to consider enrolling in the study. Alternatively, if you believe you are eligible and you meet the criteria outlined in ‘Who can take part in PANORAMIC’ you can also sign up online.

What will this trial involve?

Trial participants will be split into two groups, each of whom will be offered standard NHS COVID-19 care, with one group also receiving the treatment being tested. Currently (December 2021) this treatment is the antiviral Molnupiravir.

Allocation into one group or another will largely be randomised however individuals with the most severe health risks from COVID-19 who are least likely to benefit from vaccination, are exceptions and rather than being randomly assigned treatment they will be offered the antiviral.

Once involved in the trial, participants will be asked to either complete a daily diary for the 28 days of treatment, or alternatively to receive a phone call on days 7, 14 and 28 from the trial teams to discuss your symptoms.

What does this mean for those at higher risk?

For those at the highest risk from COVID-19, Molnupiravir will be accessible even if they are not taking part in PANORAMIC. A second COVID-19 treatment called Ronapreve will also be available to these individuals from the 16^th December.

A ‘pre-notification’ letter will be sent from GP’s to those who fall into this category – providing them with a PCR test to be kept at home and used if they become symptomatic. This will support rapid testing and therefore rapid treatment.

Patients who are eligible for these new COVID-19 treatments outside of the PANORAMIC study include those with ‘certain inflammatory disorders’ and ‘patients with a primary immune deficiency which is either genetic or the result of disease treatment.’

What are the treatments being tested?

Lageviro (or Molunpiravir), is an oral antiviral, given in the form of a tablet which should be taken twice a day. This treatment reduces the risk of hospitalisation or death in non-hospitalised and at risk adults by at least 30%, and works by introducing mistakes into the viruses genetic code which ultimately kill it.

Ronapreve is also being used in this winter’s COVID-19 strategy. It uses monoclonal antibodies to target the COVID-19 virus, preventing it from entering body cells and therefore minimising the damage caused by the virus. It will be provided to individuals most at risk by the COVID Medicines Delivery Unit (CMDU). Currently just used in hospitals it is administered as an intravenous infusion by a medical professional and can reduce the risk of hospitalisation or death by 70%.

As more treatments are added to the PANORAMIC trial, and become available to those who are most at risk from the virus, and least protected by the vaccine, SRUK will keep updating our COVID-19 information with the latest news.