Africa’s largest Covid treatment clinical trial launched by 13-country network

A network of 13 African countries has joined forces with global researchers to launch the largest clinical trial of potential Covid-19 treatments on the continent.

The Anticov study, involving Antwerp’s Institute of Tropical Medicine and international research institutions, aims to identify treatments that can be used to treat mild and moderate cases of Covid-19 early and prevent spikes in hospitalisation that could overwhelm fragile and already overburdened health systems in Africa.

The clinical trial will be carried out at 19 sites in 13 countries and led by doctors from African countries. The initiative emerged after calls for responses to the coronavirus better tailored to the developing world and the challenges of often underfunded healthcare systems.

“There is a need for large clinical trials in Africa for Covid-19 to answer research questions that are specific to an African context,” said Dr John Nkengasong, director of the Africa Centres for Disease Control and Prevention.

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“African countries have mounted an impressive response so far to Covid-19 and now is the time to prepare for future waves of the disease. It will help answer one of our most pressing questions: with limited intensive care facilities in Africa – can we treat people for Covid-19 earlier and stop our hospitals from being overwhelmed?”

The study will test the efficacy of treatments in 2,000 to 3,000 mild-to-moderate patients in Burkina Faso, Cameroon, Ivory Coast, the Democratic Republic of the Congo, Equatorial Guinea, Ethiopia, Ghana, Guinea, Kenya, Mali, Mozambique, Sudan, and Uganda, with the aim of identifying treatments that can prevent progression of coronavirus to severe disease and also limit transmission.

The study will be an adaptive platform trial, an innovative type of clinical trial pioneered for cancer drugs that allows for several treatments to be simultaneously tested. Adaptive platform trials enable rapid decisions to be made, including adding, continuing, or stopping treatment arms based on ongoing analysis of results.

“The Institute of Tropical Medicine in Antwerp, Belgium, has been working closely with its partners in Ethiopia for many years now,” said Prof Dr Johan Van Griensven, from the institute.

“Together with more than 10 other African countries, we are able to investigate whether Covid-19 patients with mild symptoms who receive early treatment experience less serious complications,” he said. “This strategy is necessary in order not to overburden the fragile health system, as hospitals with sufficient staff and intensive care units are sparse in African countries.”

New treatments will be added to the trial as evidence of their potential for mild-to-moderate cases emerges.

Initially, Anticov will focus on drugs where large-scale randomised clinical trials could provide missing efficacy data in mild-to-moderate patients. The trial will begin testing, against a control arm, the HIV antiretroviral combination lopinavir-ritonavir and the malaria drug hydroxychloroquine, which remains the standard of care for Covid-19 today in numerous African countries.