适应性平台试验在新型冠状病毒感染大流行中的应用:以RECOVERY为例的方法学反思与未来展望OA

During the early stage of the COVID-19 pandemic,the decision-making regarding the treatment of hospitalized patients was marked by an urgent clinical requirement but a lack of high-quality evidence.The Ran-domised Evaluation of COVID-19 Therapy(RECOVERY)trial,leveraging its adaptive multi-arm platform design,quickly assessed multiple candidate therapies within a unified framework.It confirmed the clinical efficacy of dexamethasone,tocilizumab,and baricitinib in specific hospitalized patients,while disproving the effectiveness of several interventions such as hydroxychloroquine,azithromycin,and lopinavir/ritonavir with strong randomized evidence.Using RECOVERY as the core framework,this review explores how the trial transformed the treatment of hospitalized COVID-19 patients from widespread empirical use to stratified decision-making based on disease stage,inflammatory phenotype,host immune status,and treatment timing.It also outlines RECOVERY'S methodological,clinical,and evidentiary contributions for future emerging infectious diseases.We contend that the significant contribution of RECOVERY lies not only in identifying effective therapies but also in demonstrating that embedded platform trials can rapidly generate evidence that can change clinical practice and support the development of dynamically updated treatment strategies during public health emergencies.