The COVID-19 pandemic has challenged the clinical research community in many ways. In response, how we think about designing clinical trials may change. “Adaptive” and “platform” study designs can help eliminate less promising investigational treatments and speed development of therapies. Such designs have gained favor recently but remain under-utilized, and many IRBs may be unfamiliar with reviewing them. The current circumstances give us a chance to reflect on the features and benefits of these innovative study designs, challenges for IRB review, and strategies for facilitating adoption.