Invited Speaker Australian and New Zealand Stroke Organisation Conference 2025

Review of adaptive platform trials in stroke. (122611)

Kate Hayward 1 2 , Bruce Campbell 1 , Natasha Lannin 3 , Mark Parsons 4 , Hannah Johns 1 , Leonid Churilov 1
  1. Medicine, University of Melbourne, Melbourne, Victoria, Australia
  2. Physiotherapy, University of Melbourne, Parkville, VIC, Australia
  3. Department of Neuroscience, School of Translational Medicine, Monash University , Melbourne, Victoria, Australia
  4. Medicine, University of New South Wales, Sydney, NSW, Australia

Background/aims: Adaptive platform trials (APT) can test multiple treatments within a single trial infrastructure to drive efficiency. Our aim was to describe current stroke-specific APTs.

Methods: PubMed and clinicaltrials.gov were searched for stroke-specific APTs. Their design features were extracted.

Results: Four APTs with distinct designs were identified: n=2 recruiting and n=2 not yet recruiting.

1. A Multi‐faCtorial, mulTi‐arm, Multi‐staGe, Randomised, gLOBal Adaptive pLatform Trial for Stroke (ACT‐GLOBAL:Canada/Australia) is a Phase III investigator-initiated multi-domain APT. The aim is to identify treatment/s associated with the highest chance of improving outcome in stroke patients using frequentist and Bayesian approaches. Primary outcome is modified Rankin Scale (mRS).

2. StrokeNet Thrombectomy Endovascular Platform (STEP:USA) aims to optimise care of patients with acute ischemic stroke due to large or medium vessel occlusions within a flexible Bayesian design. This is an investigator-initiated, factorial and randomised APT. Primary outcome is mRS.

3. StandardisEd Adaptive Multiphase pLatform for unmEt Stroke needS-Adaptive Pipeline-Platform Trial (SEAMLESS:Australia) focuses on unmet needs from prehospital-hospital-home. Uses basket and/or umbrella designs that can accomodate frequentist and Bayesian characteristics. This investigator-initiated platform enables progression from Phase I to III within a single trial infrastructure. Primary outcome is domain-specific.

4. Life After Stroke Platform (LEAP:UK) focuses on complex interventions to improve living with stroke. This is an investigator-initiated multi-arm, multi-stage, Phase III APT. Primary outcomes are mood and participation subscales of Stroke Impact Scale.

Conclusions: There is no single APT design. Platforms vary from a single treatment or stroke presentation focus to encompassing multiple treatments and presentations.