ECRAID-Prime Trains for Third Treatment in Adaptive Platform Trial

The ECRAID-Prime trial operations team and primary care national teams prepare for the addition of a third treatment to the ongoing adaptive platform trial – a significant project milestone and proof of ability.

The Ecraid operations team in Utrecht organised an online training session on 1 September 2025 with the primary care national coordinating teams (NCTs), to prepare for the introduction of the third treatment to the trial and site activation in October.

Building on the ongoing adaptive platform randomised trial currently investigating two potential treatments for COVID-19 and COVID-like illness, the new LTX-109 nasal spray treatment will be introduced at 10 primary care sites across five participating countries: Belgium, Georgia, Ireland, Poland and Spain. This addition brings the total number of treatments being evaluated in the trial to three, all of which will be assessed in parallel – an important advantage of the adaptive platform trial design, enabling rapid and responsive assessment of new treatments, particularly in health crises when time is critical.

Now Live: Acute Viral Respiratory infections/COVID-like-illness adaptive platform trial

The EU-funded study began recruiting patients in October 2024 and is Europe’s first and only adaptive platform trial evaluating potential treatments for COVID-19 and COVID-like illness in the community. The study is currently assessing the efficacy of nitric oxide nasal spray and saline spray in improving outcomes for people suffering from acute viral respiratory infections.

The strength of the adaptive platform design is that it allows us to seamlessly add and compare new and potential treatments in real-world primary care settings, explains Alike van der Velden, who is the project’s co-coordinating investigator and trial lead, based at the University Medical Centre in Utrecht, the Netherlands.

“The goal of our training and regular meetings is to ensure that our national teams are well prepared for a smooth integration of the third treatment into our trial later this year. In addition, maintaining a regular feedback loop with our national coordinators has been essential. Their valuable input helped simplify trial procedures, particularly around patient recruitment and engagement, and these changes were quickly approved, improving recruitment and overall trial efficiency,” shares Alike van der Velden, ECRAID-Prime's Coordinating Investigator and Trial Lead.

“With the addition of a third treatment and site activation planned for October, ECRAID-Prime continues to expand its capacity to rapidly evaluate promising treatments when needed and deliver evidence that can help shape future outbreak response.”

Major trial accomplishment

To the consortium, this milestone marks a significant achievement and demonstration of progress. The project’s co-coordinator, Chris Butler, from the University of Oxford, remarks, “We are particularly excited to be introducing LTX-109 into ECRAID-Prime because this demonstrates the ability of our adaptive platform trial – with pandemic research readiness – to incorporate new treatments for evaluation even after the trial has been set up. This avoids having to start up a whole new trial from scratch every time a promising treatment emerges that requires rigorous testing in a trial.”

What makes this development particularly exciting is the potential of LTX-109 itself.

“LTX-109 is a broad spectrum anti-viral agent with little or no risks of driving antiviral resistance. The molecule originates from Tromsø University and is based on properties of certain proteins found in milk that helps protect the young from infections. So it represents a gentle, but rapidly acting approach that disrupts viruses – an innovation inspired by the best solutions found in nature itself!”

- Chris Butler, ECRAID-Prime Coordinating Investigator

Building a European primary care research infrastructure

ECRAID-Prime is one of six projects funded by the European Commission's Horizon Europe programme to drive therapeutic and vaccines clinical trials to boost COVID-19 and COVID-like illness treatment and prevention.

Since the project started in December 2021, the six-partner ECRAID-Prime consortium has implemented Europe's first adaptive platform trial on COVID-19 therapeutics in the primary care setting.