Design aspects of COVID-19 treatment trials: Improving probability and time of favorable events

Biom J. 2022 Mar;64(3):440-460. doi: 10.1002/bimj.202000359. Epub 2021 Oct 22.


As a reaction to the pandemic of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a multitude of clinical trials for the treatment of SARS-CoV-2 or the resulting corona disease 2019 (COVID-19) are globally at various stages from planning to completion. Although some attempts were made to standardize study designs, this was hindered by the ferocity of the pandemic and the need to set up clinical trials quickly. We take the view that a successful treatment of COVID-19 patients (i) increases the probability of a recovery or improvement within a certain time interval, say 28 days; (ii) aims to expedite favorable events within this time frame; and (iii) does not increase mortality over this time period. On this background, we discuss the choice of endpoint and its analysis. Furthermore, we consider consequences of this choice for other design aspects including sample size and power and provide some guidance on the application of adaptive designs in this particular context.

Keywords: COVID-19; SARS-CoV-2; clinical trials; competing events; outcomes.

MeSH terms

  • COVID-19 Drug Treatment*
  • Humans
  • Pandemics
  • Probability
  • SARS-CoV-2