Accelerating the identification of effective COVID-19 treatments through innovative trial design

The NIHR Birmingham Biomedical Research Centre (BRC) led the development and delivery of CATALYST, an innovative early-phase platform trial established during the COVID-19 pandemic to rapidly evaluate potential treatments for patients hospitalised with COVID-19.

CATALYST brought together expertise from across Birmingham’s clinical research infrastructure. Trial design and methodology were led by the Inflammation–Advanced and Cell Therapy Trials Team (I-ACT) within the Cancer Research UK Clinical Trials Unit (CRCTU), supported by funding from the Birmingham BRC, the Midlands–Wales Advanced Therapy Treatment Centre (MW-ATTC) and the Arthritis Therapy Acceleration Programme (A-TAP). Patient and public involvement was supported by the NIHR Surgical Reconstruction and Microbiology Research Centre (SRMRC), while delivery was facilitated across University Hospitals Birmingham NHS Foundation Trust, including the NIHR/Wellcome Clinical Research Facility.

As a national, multi-centre Urgent Public Health study operating across 12 sites, CATALYST developed new collaborations with researchers at the NIHR Biomedical Research Centres in Oxford, Imperial and UCL. Its adaptive platform design enabled promising treatments to be assessed quickly and efficiently, helping to identify which therapies should progress for further investigation.

Between June 2020 and February 2021, 146 patients were enrolled into the trial. CATALYST evaluated two anti-inflammatory therapies already used in other conditions: namilumab, which targets excessive immune responses linked to severe lung inflammation, and infliximab, a treatment widely used for inflammatory diseases.

Following review by independent trial oversight committees, namilumab was found to reduce inflammation in patients hospitalised with COVID-19 pneumonia and was recommended for prioritisation in future COVID-19 treatment studies. In contrast, infliximab did not demonstrate sufficient benefit and was not recommended for further investigation in this setting.

These findings provided crucial early evidence during the pandemic and helped inform national decisions about which treatments should be progressed into larger studies. The results directly contributed to the prioritisation of therapies for evaluation in major UK platform trials, including RECOVERY and REMAP-CAP, demonstrating the value of Birmingham BRC-supported research in accelerating the identification of effective treatments during a global health emergency.