A visual framework for classifying adaptive design clinical trials using the GATE frame and PICO terminology

An adaptive design of a clinical trial is a trial design that offers pre-planned opportunities to use accumulating trial data to modify aspects of an ongoing trial while preserving the validity and integrity of that trial. The Consolidated Standards Of Reporting Trials (CONSORT) 2025 statements show the minimum information that should be included in the reporting of trials to ensure that trial protocols and trials reports are clear and transparent. Pre-planned interim analysis of adaptive clinical trials can modify the study population, the randomization, the intervention arms, the primary outcome or the clinical trial phase. Such key aspects can be reported using the Adaptive designs CONSORT Extension (ACE) statement, and additionally, conceptualised and represented using the Graphic Appraisal Tool for Epidemiological (GATE) and the PICO terminology (Population, Intervention, Comparison and Outcome). The main purpose of this article is to show how the GATE frame can complement the ACE guidelines by serving as a teaching tool to explain adaptive design clinical trials to a clinical or nonspecialist audience using examples of clinical trials for the prevention and treatment of COVID-19.