Introduction Effective management of seasonal and pandemic influenza is a high priority internationally. Guidelines in many countries recommend antiviral treatment for older people and individuals with comorbidity at increased risk of complications. However, antivirals are not often prescribed in primary care in Europe, partly because its clinical and cost effectiveness has been insufficiently demonstrated by non-industry funded and pragmatic studies.
Methods and analysis Antivirals for influenza-Like Illness? An rCt of Clinical and Cost effectiveness in primary CarE is a European multinational, multicentre, open-labelled, non-industry funded, pragmatic, adaptive-platform, randomised controlled trial. Initial trial arms will be best usual primary care and best usual primary care plus treatment with oseltamivir for 5 days. We aim to recruit at least 2500 participants ≥1 year presenting with influenza-like illness (ILI), with symptom duration ≤72 hours in primary care over three consecutive periods of confirmed high influenza incidence. Participant outcomes will be followed up to 28 days by diary and telephone. The primary objective is to determine whether adding antiviral treatment to best usual primary care is effective in reducing time to return to usual daily activity with fever, headache and muscle ache reduced to minor severity or less. Secondary objectives include estimating cost-effectiveness, benefits in subgroups according to age (<12, 12–64 and >64 years), severity of symptoms at presentation (low, medium and high), comorbidity (yes/no), duration of symptoms (≤48 hours/>48–72 hours), complications (hospital admission and pneumonia), use of additional prescribed medication including antibiotics, use of over-the-counter medicines and self-management of ILI symptoms.
Ethics and dissemination Research ethics committee (REC) approval was granted by the NRES Committee South Central (Oxford B) and Clinical Trial Authority (CTA) approval by The Medicines and Healthcare products Regulatory Agency. All participating countries gained national REC and CTA approval as required. Dissemination of results will be through peer-reviewed scientific journals and conference presentations.
Trial registration number ISRCTN27908921; Pre-results.
- primary healthcare
- cost-benefit analysis
- adaptive clinical trial
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EB and AWV contributed equally.
Contributors CCB and TV are cochief investigators of this trial, act as guarantors of the study in its entirety and led the development of the research question, study design and obtaining the funding along with AWvdV, JC, PB, HG, MdJ and PL. EB, JC and AWvdV manage the trial and coordinate the operational delivery of the study protocol to the networks co-ordinating centres. BS and JH are the trial statisticians. PB provides health economics input. MI provides support with sampling and analysis. RMA, CB, SCh, SCo, AC, MD, MDP, ADS, NAF, DG, MG-ć, ML, FMT, AM, JP, MP, RR-J, P-DS, AT, PT and DV are representatives of the collaborating co-ordinating centres responsible for their networks participation in the trial. EB and AWvdV drafted the manuscript and supervised by CCB. All other authors provided critical review and final approval of the manuscript.
Funding This work was supported by the European Commission FP7 Programme grant no HEALTH-F3-2013-602525.
Competing interests None declared.
Patient consent Not required.
Ethics approval NRES Committee South Central (Oxford B)
Provenance and peer review Not commissioned; externally peer reviewed.
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