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von Niederhäusern B, Orleth A, Schädelin S, Rawi N, Velkopolszky M, Becherer C, Benkert P, Satalkar P, Briel M, Pauli-Magnus C. Generating evidence on a risk-based monitoring approach in the academic setting - lessons learned. BMC Med Res Methodol 2017; 17:26. [PMID: 28193170 PMCID: PMC5307807 DOI: 10.1186/s12874-017-0308-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In spite of efforts to employ risk-based strategies to increase monitoring efficiency in the academic setting, empirical evidence on their effectiveness remains sparse. This mixed-methods study aimed to evaluate the risk-based on-site monitoring approach currently followed at our academic institution. METHODS We selected all studies monitored by the Clinical Trial Unit (CTU) according to Risk ADApted MONitoring (ADAMON) at the University Hospital Basel, Switzerland, between 01.01.2012 and 31.12.2014. We extracted study characteristics and monitoring information from the CTU Enterprise Resource Management system and from monitoring reports of all selected studies. We summarized the data descriptively. Additionally, we conducted semi-structured interviews with the three current CTU monitors. RESULTS During the observation period, a total of 214 monitoring visits were conducted in 43 studies resulting in 2961 documented monitoring findings. Our risk-based approach predominantly identified administrative (46.2%) and patient right findings (49.1%). We identified observational study design, high ADAMON risk category, industry sponsorship, the presence of an electronic database, experienced site staff, and inclusion of vulnerable study population to be factors associated with lower numbers of findings. The monitors understand the positive aspects of a risk-based approach but fear missing systematic errors due to the low frequency of visits. CONCLUSIONS We show that the factors mostly increasing the risk for on-site monitoring findings are underrepresented in the current risk analysis scheme. Our risk-based on-site approach should further be complemented by centralized data checks, allowing monitors to transform their role towards partners for overall trial quality, and success.
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Affiliation(s)
- Belinda von Niederhäusern
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
| | - Annette Orleth
- Department of Medicine, Biomedicine and Clinical Research, Neurology, University Hospital Basel, Basel, Switzerland
| | - Sabine Schädelin
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | | | - Martin Velkopolszky
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Claudia Becherer
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Pascal Benkert
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Priya Satalkar
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland.,Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Matthias Briel
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, Basel, Switzerland.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Christiane Pauli-Magnus
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
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202
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Walter SD, Han H, Briel M, Guyatt GH. Quantifying the bias in the estimated treatment effect in randomized trials having interim analyses and a rule for early stopping for futility. Stat Med 2017; 36:1506-1518. [DOI: 10.1002/sim.7242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 01/11/2017] [Accepted: 01/17/2017] [Indexed: 11/09/2022]
Affiliation(s)
- S. D. Walter
- Clinical Epidemiology and Biostatistics; McMaster University; Hamilton Ontario Canada
| | - H. Han
- Mathematics and Statistics; McMaster University; Hamilton Ontario Canada
| | - M. Briel
- Clinical Epidemiology and Biostatistics; McMaster University; Hamilton Ontario Canada
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research; University Hospital Basel; Switzerland
| | - G. H. Guyatt
- Clinical Epidemiology and Biostatistics; McMaster University; Hamilton Ontario Canada
- Clinical Epidemiology and Biostatistics and Medicine; McMaster University; Hamilton Ontario Canada
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203
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Forsythe LP, Frank LB, Workman TA, Borsky A, Hilliard T, Harwell D, Fayish L. Health researcher views on comparative effectiveness research and research engagement. J Comp Eff Res 2017; 6:245-256. [PMID: 28173710 DOI: 10.2217/cer-2016-0063] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To understand researcher capability for and interest in patient-centered comparative effectiveness research (PC-CER), particularly related to engaging with patients/caregivers. MATERIALS & METHODS Web-based survey of 508 health researchers recruited via professional health research organizations. RESULTS Most respondents (94%) were familiar with CER and many (69%) reported having previously conducting some form of CER. Most respondents were familiar with (81%) and interested in (87%) partnering with patients and/or caregivers in research. Resources to assist in training, coordination of partners, guidance in apply for funding and improved infrastructure were commonly cited factors that would help researchers conduct PC-CER. CONCLUSION There is a significant opportunity for researchers to engage patients and caregivers as partners in CER. Researchers recognize the need for additional training and expertise to leverage those opportunities.
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Affiliation(s)
- Laura P Forsythe
- Patient-Centered Outcomes Research Institute, 1828 L Street NW, Suite 900, Washington, DC 20036, USA
| | - Lori B Frank
- Patient-Centered Outcomes Research Institute, 1828 L Street NW, Suite 900, Washington, DC 20036, USA
| | - Thomas A Workman
- American Institutes for Research, 1025 Thomas Jefferson St NW, Suite 3290, Washington, DC 20007, USA
| | - Amanda Borsky
- American Institutes for Research, 1025 Thomas Jefferson St NW, Suite 3290, Washington, DC 20007, USA
| | - Tandrea Hilliard
- American Institutes for Research, 1025 Thomas Jefferson St NW, Suite 3290, Washington, DC 20007, USA
| | - Daniel Harwell
- American Institutes for Research, 1025 Thomas Jefferson St NW, Suite 3290, Washington, DC 20007, USA
| | - Lauren Fayish
- Patient-Centered Outcomes Research Institute, 1828 L Street NW, Suite 900, Washington, DC 20036, USA
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204
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Trelle S. Exploratory trials in mental health: anything to learn from other disciplines? EVIDENCE-BASED MENTAL HEALTH 2017; 20:21-24. [PMID: 28073811 PMCID: PMC10688417 DOI: 10.1136/eb-2016-102581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 12/16/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Confirmatory randomised controlled trials require solid justifications, especially with regard to whether the experimental intervention is promising. Such evidence is generated in exploratory trials. However, empirical evidence shows that the quality of such trials is still suboptimal. More generally, the development process of healthcare interventions and especially of drugs, remains inefficient. Over the past 10-20 years, a vast amount of methodological work has been published about exploratory trials. This overview introduces some of the concepts and recent developments in the field. METHODS A narrative approach was taken for this overview. This article focuses on study designs developed outside the mental health field to introduce concepts that might not be familiar to clinical researchers in psychiatry and psychology. Non-randomised and randomised exploratory trial designs are covered. The article ends with a brief discussion on pilot studies and their difference to exploratory studies. RESULTS Classical designs for exploratory trials such as Simon's two-stage design still have a role. However, randomised exploratory trials are probably more suitable for mental health interventions. Newer, more flexible designs such as multistage, multiarm trials or platform trials have the potential to improve the efficiency of exploratory and subsequently confirmatory experiments. CONCLUSIONS Although often not directly applicable, borrowing (study) design ideas from other medical disciplines has the potential to improve exploratory trials in the mental health field. At the same time, more explicit use of study designs specifically designed for exploratory trials will help to improve the transparency of such trials.
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205
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Grill JD, Holbrook A, Pierce A, Hoang D, Gillen DL. Attitudes toward Potential Participant Registries. J Alzheimers Dis 2017; 56:939-946. [PMID: 28106553 PMCID: PMC5533604 DOI: 10.3233/jad-160873] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Difficult participant recruitment is a consistent barrier to successful medical research. Potential participant registries represent an increasingly common intervention to overcome this barrier. A variety of models for registries exist, but few data are available to instruct their design and implementation. To provide such data, we surveyed 110 cognitively normal research participants enrolled in a longitudinal study of aging and dementia. Seventy-four (67%) individuals participated in the study. Most (78%, CI: 0.67, 0.87) participants were likely to enroll in a registry. Willingness to participate was reduced for registries that required enrollment through the Internet using a password (26%, CI: 0.16, 0.36) or through email (38%, CI: 0.27, 0.49). Respondents acknowledged their expectations that researchers share information about their health and risk for disease and their concerns that their data could be shared with for-profit companies. We found no difference in respondent preferences for registries that shared contact information with researchers, compared to honest broker models that take extra precautions to protect registrant confidentiality (28% versus 30%; p = 0.46). Compared to those preferring a shared information model, respondents who preferred the honest broker model or who lacked model preference voiced increased concerns about sharing registrant data, especially with for-profit organizations. These results suggest that the design of potential participant registries may impact the population enrolled, and hence the population that will eventually be enrolled in clinical studies. Investigators operating registries may need to offer particular assurances about data security to maximize registry enrollment but also must carefully manage participant expectations.
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Affiliation(s)
- Joshua D. Grill
- Institute for Memory Impairments and Neurological Disorders and Alzheimer’s Disease Research Center, University of California, Irvine, CA, USA
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, USA
| | - Andrew Holbrook
- Institute for Memory Impairments and Neurological Disorders and Alzheimer’s Disease Research Center, University of California, Irvine, CA, USA
- Department of Statistics, University of California, Irvine, CA, USA
| | - Aimee Pierce
- Institute for Memory Impairments and Neurological Disorders and Alzheimer’s Disease Research Center, University of California, Irvine, CA, USA
- Department of Neurology, University of California, Irvine, CA, USA
| | - Dan Hoang
- Institute for Memory Impairments and Neurological Disorders and Alzheimer’s Disease Research Center, University of California, Irvine, CA, USA
| | - Daniel L. Gillen
- Institute for Memory Impairments and Neurological Disorders and Alzheimer’s Disease Research Center, University of California, Irvine, CA, USA
- Department of Statistics, University of California, Irvine, CA, USA
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Alturki R, Schandelmaier S, Olu KK, von Niederhäusern B, Agarwal A, Frei R, Bhatnagar N, Hooft L, von Elm E, Briel M. Premature trial discontinuation often not accurately reflected in registries: comparison of registry records with publications. J Clin Epidemiol 2017; 81:56-63. [DOI: 10.1016/j.jclinepi.2016.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 05/13/2016] [Accepted: 08/26/2016] [Indexed: 11/28/2022]
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Knottnerus JA, Tugwell P. Prevention of premature trial discontinuation: how to counter Lasagna's law. J Clin Epidemiol 2016; 80:1-2. [PMID: 27978964 DOI: 10.1016/j.jclinepi.2016.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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208
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van den Bogert CA, Souverein PC, Brekelmans CTM, Janssen SWJ, Koëter GH, Leufkens HGM, Bouter LM. Non-Publication Is Common among Phase 1, Single-Center, Not Prospectively Registered, or Early Terminated Clinical Drug Trials. PLoS One 2016; 11:e0167709. [PMID: 27973571 PMCID: PMC5156378 DOI: 10.1371/journal.pone.0167709] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 11/18/2016] [Indexed: 12/28/2022] Open
Abstract
The objective of this study was to investigate the occurrence and determinants of non-publication of clinical drug trials in the Netherlands.All clinical drug trials reviewed by the 28 Institutional Review Boards (IRBs) in the Netherlands in 2007 were followed-up from approval to publication. Candidate determinants were the sponsor, phase, applicant, centers, therapeutic effect expected, type of trial, approval status of the drug(s), drug type, participant category, oncology or other disease area, prospective registration, and early termination. The main outcome was publication as peer reviewed article. The percentage of trials that were published, crude and adjusted odds ratio (OR), and 95% confidence interval (CI) were used to quantify the associations between determinants and publication. In 2007, 622 clinical drug trials were reviewed by IRBs in the Netherlands. By the end of follow-up, 19 of these were rejected by the IRB, another 19 never started inclusion, and 10 were still running. Of the 574 trials remaining in the analysis, 334 (58%) were published as peer-reviewed article. The multivariable logistic regression model identified the following determinants with a robust, statistically significant association with publication: phase 2 (60% published; adjusted OR 2.6, 95% CI 1.1-5.9), phase 3 (73% published; adjusted OR 4.1, 95% CI 1.7-10.0), and trials not belonging to phase 1-4 (60% published; adjusted OR 3.2, 95% CI 1.5 to 6.5) compared to phase 1 trials (35% published); trials with a company or investigator as applicant (63% published) compared to trials with a Contract Research Organization (CRO) as applicant (50% published; adjusted OR 1.7; 95% CI 1.1-2.8); and multicenter trials also conducted in other EU countries (68% published; adjusted OR 2.2, 95% CI 1.1-4.4) or also outside the European Union (72% published; adjusted OR 2.0, 95% CI 1.0-4.0) compared to single-center trials (45% published). Trials that were not prospectively registered (48% published) had a lower likelihood of publication compared to prospectively registered trials (75% published; adjusted OR 0.5, 95% CI 0.3-0.8), as well as trials that were terminated early (33% published) compared to trials that were completed as planned (64% published; adjusted OR 0.2, 95% CI 0.1-0.3). The non-publication rate of clinical trials seems to have improved compared to previous inception cohorts, but is still far from optimal, in particular among phase 1, single-center, not prospectively registered, and early terminated trials.
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Affiliation(s)
- Cornelis A. van den Bogert
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, TB Utrecht, The Netherlands
- Central Committee on Research involving Human Subjects (CCMO), BH The Hague, the Netherlands
- National Institute for Public Health and the Environment (RIVM), Division of Public Health and Health Services, BA Bilthoven, The Netherlands
| | - Patrick C. Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, TB Utrecht, The Netherlands
| | - Cecile T. M. Brekelmans
- Central Committee on Research involving Human Subjects (CCMO), BH The Hague, the Netherlands
| | - Susan W. J. Janssen
- National Institute for Public Health and the Environment (RIVM), Division of Public Health and Health Services, BA Bilthoven, The Netherlands
| | - Gerard H. Koëter
- Central Committee on Research involving Human Subjects (CCMO), BH The Hague, the Netherlands
| | - Hubert G. M. Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, TB Utrecht, The Netherlands
| | - Lex M. Bouter
- VU University Medical Center, Department of Epidemiology and Biostatistics, MB Amsterdam, the Netherlands
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Wieschowski S, Silva DS, Strech D. Animal Study Registries: Results from a Stakeholder Analysis on Potential Strengths, Weaknesses, Facilitators, and Barriers. PLoS Biol 2016; 14:e2000391. [PMID: 27832101 PMCID: PMC5104355 DOI: 10.1371/journal.pbio.2000391] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 10/05/2016] [Indexed: 01/18/2023] Open
Abstract
Publication bias in animal research, its extent, its predictors, and its potential countermeasures are increasingly discussed. Recent reports and conferences highlight the potential strengths of animal study registries (ASRs) in this regard. Others have warned that prospective registration of animal studies could diminish creativity, add administrative burdens, and complicate intellectual property issues in translational research. A literature review and 21 international key-informant interviews were conducted and thematically analyzed to develop a comprehensive matrix of main- and subcategories for potential ASR-related strengths, weaknesses, facilitators, and barriers (SWFBs). We identified 130 potential SWFBs. All stakeholder groups agreed that ASRs could in various ways improve the quality and refinement of animal studies while allowing their number to be reduced, as well as supporting meta-research on animal studies. However, all stakeholder groups also highlighted the potential for theft of ideas, higher administrative burdens, and reduced creativity and serendipity in animal studies. Much more detailed reasoning was captured in the interviews than is currently found in the literature, providing a comprehensive account of the issues and arguments around ASRs. All stakeholder groups highlighted compelling potential strengths of ASRs. Although substantial weaknesses and implementation barriers were highlighted as well, different governance measures might help to minimize or even eliminate their impact. Such measures might include confidentiality time frames for accessing prospectively registered protocols, harmonized reporting requirements across ASRs, ethics reviews, lab notebooks, and journal submissions. The comprehensive information gathered in this study could help to guide a more evidence-based debate and to design pilot tests for ASRs. The manifold contributions over the last years on “publication bias” and “reproducibility crisis” in animal research initiated a debate on whether and how prospective animal study registries (ASRs) should be established in analogy to clinical trial registries. All recent debate, however, followed rather broad lines of argumentation and concluded that future decision-making on the issue of ASRs depends strongly on better knowledge about relevant characteristics of ASRs and about conflicting stakeholder interests. More qualitative but systematically developed evidence in this regard is needed. The primary objective of this study, therefore, was to present a systematically derived spectrum of all relevant strengths, weaknesses, facilitators and barriers (SWFBs) for ASRs. A systematic literature review and 21 key-informant interviews with experts from preclinical and clinical research, industry, and regulatory bodies were conducted to fulfill this objective. Our investigations resulted in a comprehensive and structured account of 130 issues and arguments around ASRs. Future debate and decision-making on ASRs might be heavily influenced by arguments and reasoning from individual experts and thus result in “eminence-based” policy making that relies on expert opinion. This study’s comprehensive spectrum of arguments and issues around ASR, developed through systematic and transparent methods, helps to balance the ongoing debate and thus facilitate a more evidence-based policy making.
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Affiliation(s)
- Susanne Wieschowski
- Institute for Ethics, History, and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Diego S. Silva
- Institute for Ethics, History, and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Daniel Strech
- Institute for Ethics, History, and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
- * E-mail:
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210
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Blümle A, Schandelmaier S, Oeller P, Kasenda B, Briel M, von Elm E. Premature Discontinuation of Prospective Clinical Studies Approved by a Research Ethics Committee - A Comparison of Randomised and Non-Randomised Studies. PLoS One 2016; 11:e0165605. [PMID: 27792749 PMCID: PMC5085068 DOI: 10.1371/journal.pone.0165605] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 10/15/2016] [Indexed: 11/22/2022] Open
Abstract
Background Premature discontinuation of clinical studies affects about 25% of randomised controlled trials (RCTs) which raises concerns about waste of scarce resources for research. The risk of discontinuation of non-randomised prospective studies (NPSs) is yet unclear. Objectives To compare the proportion of discontinued studies between NPSs and RCTs that received ethical approval. Methods We systematically surveyed prospective longitudinal clinical studies that were approved by a single REC in Freiburg, Germany between 2000 and 2002. We collected study characteristics, identified subsequent publications, and surveyed investigators to elucidate whether a study was discontinued and, if so, why. Results Of 917 approved studies, 547 were prospective longitudinal studies (306 RCTs and 241 NPSs). NPSs were on average smaller than RCTs, more frequently single centre and pilot studies, and less frequently funded by industry. NPSs were less frequently discontinued than RCTs: 32/221 (14%) versus 78/288 (27%, p<0.001, missing data excluded). Poor recruitment was the most frequent reason for discontinuation in both NPSs (36%) and RCTs (37%). Conclusions Compared to RCTs, NPSs were at lower risk for discontinuation. Measures to reliably predict, sustain, and stimulate recruitment could prevent discontinuation of many RCTs but also of some NPSs.
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Affiliation(s)
- Anette Blümle
- Cochrane Germany, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- * E-mail:
| | - Stefan Schandelmaier
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Patrick Oeller
- Cochrane Germany, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Benjamin Kasenda
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Matthias Briel
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Erik von Elm
- Cochrane Switzerland, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
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Rooshenas L, Elliott D, Wade J, Jepson M, Paramasivan S, Strong S, Wilson C, Beard D, Blazeby JM, Birtle A, Halliday A, Rogers CA, Stein R, Donovan JL. Conveying Equipoise during Recruitment for Clinical Trials: Qualitative Synthesis of Clinicians' Practices across Six Randomised Controlled Trials. PLoS Med 2016; 13:e1002147. [PMID: 27755555 PMCID: PMC5068710 DOI: 10.1371/journal.pmed.1002147] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/07/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Randomised controlled trials (RCTs) are essential for evidence-based medicine and increasingly rely on front-line clinicians to recruit eligible patients. Clinicians' difficulties with negotiating equipoise is assumed to undermine recruitment, although these issues have not yet been empirically investigated in the context of observable events. We aimed to investigate how clinicians conveyed equipoise during RCT recruitment appointments across six RCTs, with a view to (i) identifying practices that supported or hindered equipoise communication and (ii) exploring how clinicians' reported intentions compared with their actual practices. METHODS AND FINDINGS Six pragmatic UK-based RCTs were purposefully selected to include several clinical specialties (e.g., oncology, surgery) and types of treatment comparison. The RCTs were all based in secondary-care hospitals (n = 16) around the UK. Clinicians recruiting to the RCTs were interviewed (n = 23) to understand their individual sense of equipoise about the RCT treatments and their intentions for communicating equipoise to patients. Appointments in which these clinicians presented the RCT to trial-eligible patients were audio-recorded (n = 105). The appointments were analysed using thematic and content analysis approaches to identify practices that supported or challenged equipoise communication. A sample of appointments was independently coded by three researchers to optimise reliability in reported findings. Clinicians and patients provided full written consent to be interviewed and have appointments audio-recorded. Interviews revealed that clinicians' sense of equipoise varied: although all were uncertain about which trial treatment was optimal, they expressed different levels of uncertainty, ranging from complete ambivalence to clear beliefs that one treatment was superior. Irrespective of their personal views, all clinicians intended to set their personal biases aside to convey trial treatments neutrally to patients (in accordance with existing evidence). However, equipoise was omitted or compromised in 48/105 (46%) of the recorded appointments. Three commonly recurring practices compromised equipoise communication across the RCTs, irrespective of clinical context. First, equipoise was overridden by clinicians offering treatment recommendations when patients appeared unsure how to proceed or when they asked for the clinician's expert advice. Second, clinicians contradicted equipoise by presenting imbalanced descriptions of trial treatments that conflicted with scientific information stated in the RCT protocols. Third, equipoise was undermined by clinicians disclosing their personal opinions or predictions about trial outcomes, based on their intuition and experience. These broad practices were particularly demonstrated by clinicians who had indicated in interviews that they held less balanced views about trial treatments. A limitation of the study was that clinicians volunteering to take part in the research might have had a particular interest in improving their communication skills. However, the frequency of occurrence of equipoise issues across the RCTs suggests that the findings are likely to be reflective of clinical recruiters' practices more widely. CONCLUSIONS Communicating equipoise is a challenging process that is easily disrupted. Clinicians' personal views about trial treatments encroached on their ability to convey equipoise to patients. Clinicians should be encouraged to reflect on personal biases and be mindful of the common ways in which these can arise in their discussions with patients. Common pitfalls that recurred irrespective of RCT context indicate opportunities for specific training in communication skills that would be broadly applicable to a wide clinical audience.
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Affiliation(s)
- Leila Rooshenas
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Daisy Elliott
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Julia Wade
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Marcus Jepson
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Sangeetha Paramasivan
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Sean Strong
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Caroline Wilson
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Jane M. Blazeby
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Alison Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, United Kingdom
| | | | - Chris A. Rogers
- Clinical Trials and Evaluation Unit, Bristol Royal Infirmary, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Rob Stein
- University College London Hospitals, London, United Kingdom
| | - Jenny L. Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Trust, Bristol, United Kingdom
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Pica N, Bourgeois F. Discontinuation and Nonpublication of Randomized Clinical Trials Conducted in Children. Pediatrics 2016; 138:peds.2016-0223. [PMID: 27492817 PMCID: PMC5005019 DOI: 10.1542/peds.2016-0223] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Trial discontinuation and nonpublication represent potential waste in research resources and lead to compromises in medical evidence. Pediatric trials may be particularly vulnerable to these outcomes given the challenges encountered in conducting trials in children. We aimed to determine the prevalence of discontinuation and nonpublication of randomized clinical trials (RCTs) conducted in pediatric populations. METHODS Retrospective, cross-sectional study of pediatric RCTs registered in ClinicalTrials.gov from 2008 to 2010. Data were collected from the registry and associated publications identified (final search on September 1, 2015). RESULTS Of 559 trials, 104 (19%) were discontinued early, accounting for an estimated 8369 pediatric participants. Difficulty with patient accrual (37%) was the most commonly cited reason for discontinuation. Trials were less likely to be discontinued if they were funded by industry compared with academic institutions (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.27-0.77). Of the 455 completed trials, 136 (30%) were not published, representing 69 165 pediatric participants. Forty-two unpublished trials posted results on ClinicalTrials.gov. Trials funded by industry were more than twice as likely to result in nonpublication at 24 and 36 months (OR 2.21, 95% CI 1.35-3.64; OR 3.12, 95% CI 1.6-6.08, respectively) and had a longer mean time to publication compared with trials sponsored by academia (33 vs 24 months, P < .001). CONCLUSIONS In this sample of pediatric RCTs, discontinuation and nonpublication were common, with thousands of children exposed to interventions that did not lead to informative or published findings. Trial funding source was an important determinant of these outcomes, with both academic and industry sponsors contributing to inefficiencies.
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Affiliation(s)
- Natalie Pica
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;,Boston Combined Residency Program, Boston Children's Hospital and Boston Medical Center, Boston, Massachusetts; and
| | - Florence Bourgeois
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Emergency Medicine and Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts
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213
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Urrútia G, Ballesteros M, Djulbegovic B, Gich I, Roqué M, Bonfill X. Cancer randomized trials showed that dissemination bias is still a problem to be solved. J Clin Epidemiol 2016; 77:84-90. [DOI: 10.1016/j.jclinepi.2016.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 03/19/2016] [Accepted: 04/29/2016] [Indexed: 10/21/2022]
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214
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Briel M, Olu KK, von Elm E, Kasenda B, Alturki R, Agarwal A, Bhatnagar N, Schandelmaier S. A systematic review of discontinued trials suggested that most reasons for recruitment failure were preventable. J Clin Epidemiol 2016; 80:8-15. [PMID: 27498376 DOI: 10.1016/j.jclinepi.2016.07.016] [Citation(s) in RCA: 123] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 07/14/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To collect and classify reported reasons for recruitment failure in discontinued randomized controlled trials (RCTs) and to assess reporting quality. METHODS We systematically searched MEDLINE and EMBASE (2010-2014) and a previous cohort of RCTs for published RCTs reporting trial discontinuation due to poor recruitment. Teams of two investigators selected eligible RCTs working independently and extracted information using standardized forms. We used an iterative approach to classify reasons for poor recruitment. RESULTS We included 172 RCTs discontinued due to poor recruitment (including 26 conference abstracts and 63 industry-funded RCTs). Of those, 131 (76%) reported one or more reasons for discontinuation due to poor recruitment. We identified 28 different reasons for recruitment failure; most frequently mentioned were overestimation of prevalence of eligible participants and prejudiced views of recruiters and participants on trial interventions. Few RCTs reported relevant details about the recruitment process such as how eligible participants were identified, the number of patients assessed for eligibility, and who actually recruited participants. CONCLUSION Our classification could serve as a checklist to assist investigators in the planning of RCTs. Most reasons for recruitment failure seem preventable with a pilot study that applies the planned informed consent procedure.
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Affiliation(s)
- Matthias Briel
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 12, 4031 Basel, Switzerland; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada.
| | - Kelechi Kalu Olu
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 12, 4031 Basel, Switzerland
| | - Erik von Elm
- Cochrane Switzerland, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Route de la Corniche 10, Lausanne, 1010, Switzerland
| | - Benjamin Kasenda
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 12, 4031 Basel, Switzerland; Department of Oncology, University Hospital Basel, Petersgraben 4, Basel, 4031, Switzerland
| | - Reem Alturki
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 12, 4031 Basel, Switzerland
| | - Arnav Agarwal
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Neera Bhatnagar
- Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Stefan Schandelmaier
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Spitalstrasse 12, 4031 Basel, Switzerland; Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
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Leucht S, Davis JM. Second-generation antipsychotics and quality of life in schizophrenia. Lancet Psychiatry 2016; 3:694-695. [PMID: 27265549 DOI: 10.1016/s2215-0366(16)30093-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/05/2016] [Accepted: 05/09/2016] [Indexed: 11/24/2022]
Affiliation(s)
- Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität München, Klinikum rechts der Isar, 81675 München, Germany.
| | - John M Davis
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
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216
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Affiliation(s)
- Riaz A Agha
- Balliol College, University of Oxford and Department of Plastic Surgery, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
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217
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Strech D, Littmann J. The contribution and attitudes of research ethics committees to complete registration and non-selective reporting of clinical trials: A European survey. RESEARCH ETHICS REVIEW 2016. [DOI: 10.1177/1747016115626497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: For many years, studies have shown that the results of clinical trials are often published or reported selectively with a statistically significant bias in favour of positive trial results. Trial registration as a precondition for publication had only limited effects on current practice. Results of trials which were approved by research ethics committees (RECs) are often published only partially, with a substantial time lag or not at all. This study examined existing procedures of RECs in the European Union to monitor and prevent incomplete registration of trials and selective reporting of trial results. It further investigated opinions of REC members about the need to update current legislation on this matter. Methods: Web-based survey on members of RECs in 22 European countries. Results: Over 90 percent of respondents agreed that the incomplete publication of trial results had a strong or somewhat negative impact on public health and on healthcare professionals’ trust in the validity of clinical research, yet only 30 percent reported that their REC had some (often unsystematic) mechanism in place to check that findings of approved studies are published in some form. Less than 10 percent stated that their REC has further specific procedures in place to prevent or minimize selective reporting of study results. Respondents stated variously that their REC did not have the resources to follow up on this matter. Conclusions: The existing legislation to regulate trial registration and encourage complete publication of trial results leaves room for improvement. REC members welcome guidelines to adequately address both problems. The new Regulation EU No. 536/2014 as well as the FDA Amendment Act from 2007 require the reporting of summary results within 1 year after study end. As recent reviews demonstrated, without any systematic approach to monitor the adherence to these regulations, publication rates remain rather low.
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Affiliation(s)
- Daniel Strech
- Hannover Medical School, Institute for History, Ethics and Philosophy of Medicine, Hannover, Germany
| | - Jasper Littmann
- Hannover Medical School, Institute for History, Ethics and Philosophy of Medicine, Hannover, Germany
- ReAct - Action on Antibiotic Resistance, Uppsala University, Uppsala, Sweden
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218
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Kasenda B, von Elm E, You JJ, Blümle A, Tomonaga Y, Saccilotto R, Amstutz A, Bengough T, Meerpohl JJ, Stegert M, Olu KK, Tikkinen KAO, Neumann I, Carrasco-Labra A, Faulhaber M, Mulla SM, Mertz D, Akl EA, Bassler D, Busse JW, Ferreira-González I, Lamontagne F, Nordmann A, Gloy V, Raatz H, Moja L, Ebrahim S, Schandelmaier S, Sun X, Vandvik PO, Johnston BC, Walter MA, Burnand B, Schwenkglenks M, Hemkens LG, Bucher HC, Guyatt GH, Briel M. Agreements between Industry and Academia on Publication Rights: A Retrospective Study of Protocols and Publications of Randomized Clinical Trials. PLoS Med 2016; 13:e1002046. [PMID: 27352244 PMCID: PMC4924795 DOI: 10.1371/journal.pmed.1002046] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 05/06/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Little is known about publication agreements between industry and academic investigators in trial protocols and the consistency of these agreements with corresponding statements in publications. We aimed to investigate (i) the existence and types of publication agreements in trial protocols, (ii) the completeness and consistency of the reporting of these agreements in subsequent publications, and (iii) the frequency of co-authorship by industry employees. METHODS AND FINDINGS We used a retrospective cohort of randomized clinical trials (RCTs) based on archived protocols approved by six research ethics committees between 13 January 2000 and 25 November 2003. Only RCTs with industry involvement were eligible. We investigated the documentation of publication agreements in RCT protocols and statements in corresponding journal publications. Of 647 eligible RCT protocols, 456 (70.5%) mentioned an agreement regarding publication of results. Of these 456, 393 (86.2%) documented an industry partner's right to disapprove or at least review proposed manuscripts; 39 (8.6%) agreements were without constraints of publication. The remaining 24 (5.3%) protocols referred to separate agreement documents not accessible to us. Of those 432 protocols with an accessible publication agreement, 268 (62.0%) trials were published. Most agreements documented in the protocol were not reported in the subsequent publication (197/268 [73.5%]). Of 71 agreements reported in publications, 52 (73.2%) were concordant with those documented in the protocol. In 14 of 37 (37.8%) publications in which statements suggested unrestricted publication rights, at least one co-author was an industry employee. In 25 protocol-publication pairs, author statements in publications suggested no constraints, but 18 corresponding protocols documented restricting agreements. CONCLUSIONS Publication agreements constraining academic authors' independence are common. Journal articles seldom report on publication agreements, and, if they do, statements can be discrepant with the trial protocol.
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Affiliation(s)
- Benjamin Kasenda
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland
| | - Erik von Elm
- Cochrane Switzerland, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - John J. You
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anette Blümle
- Cochrane Germany, University of Freiburg, Freiburg, Germany
| | - Yuki Tomonaga
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Ramon Saccilotto
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland
| | - Alain Amstutz
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland
| | - Theresa Bengough
- Cochrane Switzerland, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
- Austrian Federal Institute for Health Care, Department of Health and Society, Vienna, Austria
| | | | - Mihaela Stegert
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland
| | - Kelechi K. Olu
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland
| | - Kari A. O. Tikkinen
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Departments of Urology and Public Health, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ignacio Neumann
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alonso Carrasco-Labra
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Evidence-Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Markus Faulhaber
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Sohail M. Mulla
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Dominik Mertz
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, Ontario, Canada
| | - Elie A. Akl
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
- Department of Medicine, State University of New York at Buffalo, Buffalo, New York, United States of America
| | - Dirk Bassler
- Department of Neonatology, University Hospital of Zurich, Zurich, Switzerland
| | - Jason W. Busse
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Ignacio Ferreira-González
- Epidemiology Unit, Department of Cardiology, Vall d’Hebron Hospital and Centro de Investigación Biomédica en Red de Epidemiología y Salud Publica (CIBERESP), Barcelona, Spain
| | - Francois Lamontagne
- Centre de Recherche Clinique Étienne-Le Bel and Department of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Alain Nordmann
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland
| | - Viktoria Gloy
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland
- Institute of Nuclear Medicine, University Hospital of Bern, Bern, Switzerland
| | - Heike Raatz
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland
| | - Lorenzo Moja
- IRCCS Orthopedic Institute Galeazzi, Milan, Italy
| | - Shanil Ebrahim
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Stanford Prevention Research Center, Stanford University, Stanford, California, United States of America
| | - Stefan Schandelmaier
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland
- Academy of Swiss Insurance Medicine, University Hospital of Basel, Basel, Switzerland
| | - Xin Sun
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Per O. Vandvik
- Department of Medicine, Innlandet Hospital Trust–Division Gjøvik, Oppland, Norway
| | - Bradley C. Johnston
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Martin A. Walter
- Institute of Nuclear Medicine, University Hospital of Bern, Bern, Switzerland
| | - Bernard Burnand
- Cochrane Switzerland, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Matthias Schwenkglenks
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Lars G. Hemkens
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland
| | - Heiner C. Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland
| | - Gordon H. Guyatt
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Matthias Briel
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital of Basel, Basel, Switzerland
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Abstract
John Ioannidis argues that problem base, context placement, information gain, pragmatism, patient centeredness, value for money, feasibility, and transparency define useful clinical research. He suggests most clinical research is not useful and reform is overdue.
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Affiliation(s)
- John P. A. Ioannidis
- Stanford Prevention Research Center, Department of Medicine and Department of Health Research and Policy, Stanford University School of Medicine, Palo Alto, California, United States of America
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Palo Alto, California, United States of America
- * E-mail:
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220
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Cullati S, Courvoisier DS, Gayet-Ageron A, Haller G, Irion O, Agoritsas T, Rudaz S, Perneger TV. Patient enrollment and logistical problems top the list of difficulties in clinical research: a cross-sectional survey. BMC Med Res Methodol 2016; 16:50. [PMID: 27145883 PMCID: PMC4855713 DOI: 10.1186/s12874-016-0151-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 04/26/2016] [Indexed: 11/17/2022] Open
Abstract
Background Many medical research projects encounter difficulties. The objective of this study was to assess the self-reported frequency of difficulties encountered by medical researchers while conducting research and to identify factors associated with their occurrence. Methods The authors conducted a cross-sectional survey in 2010 among principal investigators of 996 study protocols approved by the Research Ethics Committee in Geneva, Switzerland, between 2001 and 2005. The authors asked principal investigators to rate the level of difficulty (1: none, to 5: very great) encountered across the research process. Results 588 questionnaires were sent back (participation rate 59.0 %). 391 (66.5 %) studies were completed at the time of the survey. Investigators reported that the most frequent difficulties were related to patient enrollment (44.3 %), data collection (26.7 %), data analysis and interpretation (21.5 %), collaboration with caregivers (21.0 %), study design (20.4 %), publication in peer-reviewed journal (20.2 %), hiring of competent study personnel (20.2 %), and getting funding (19.2 %). On average, investigators reported 2.8 difficulties per project (SD 2.8, range 0 to 12). In multivariable analysis, the number of difficulties was higher for studies initiated by public sponsors (vs. private), single center studies (vs. multicenter), and studies about treatment, diagnosis or prognosis (i.e., clinical vs. other studies). Conclusions Medical researchers reported substantial logistical difficulties in conducting clinical research. Electronic supplementary material The online version of this article (doi:10.1186/s12874-016-0151-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stéphane Cullati
- Division of Clinical Epidemiology, Geneva University Hospitals, University of Geneva, Rue Gabrielle Perret-Gentil 6, CH-1211, Geneva 14, Switzerland.
| | - Delphine S Courvoisier
- Division of Clinical Epidemiology, Geneva University Hospitals, University of Geneva, Rue Gabrielle Perret-Gentil 6, CH-1211, Geneva 14, Switzerland
| | - Angèle Gayet-Ageron
- Division of Clinical Epidemiology, Geneva University Hospitals, University of Geneva, Rue Gabrielle Perret-Gentil 6, CH-1211, Geneva 14, Switzerland
| | - Guy Haller
- Division of Clinical Epidemiology, Geneva University Hospitals, University of Geneva, Rue Gabrielle Perret-Gentil 6, CH-1211, Geneva 14, Switzerland.,Division of Anesthesia, Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, Geneva, Switzerland
| | - Olivier Irion
- Department of Gynecology and Obstetrics, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Agoritsas
- Division of Clinical Epidemiology, Geneva University Hospitals, University of Geneva, Rue Gabrielle Perret-Gentil 6, CH-1211, Geneva 14, Switzerland.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
| | - Sandrine Rudaz
- Division of Clinical Epidemiology, Geneva University Hospitals, University of Geneva, Rue Gabrielle Perret-Gentil 6, CH-1211, Geneva 14, Switzerland
| | - Thomas V Perneger
- Division of Clinical Epidemiology, Geneva University Hospitals, University of Geneva, Rue Gabrielle Perret-Gentil 6, CH-1211, Geneva 14, Switzerland
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Espinoza M, Hsieh A, Hsiehchen D. Systematic characterization of gastrointestinal clinical trials. Dig Liver Dis 2016; 48:480-488. [PMID: 26847963 DOI: 10.1016/j.dld.2016.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/15/2015] [Accepted: 01/05/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Clinical guidelines are commonly based on inadequate evidence, suggesting deficiencies in the present portfolio of clinical research. AIMS To investigate characteristics of clinical trials examining gastrointestinal (GI) diseases registered in ClinicalTrials.gov. METHODS A cross-sectional analysis of 13,647 GI trials and 111,535 non-GI trials initiated between January 1997 and September 2013 was performed. Entries were sorted by operational status, purpose, interventions, trial design, and epochs to identify trends and interactions in trial properties. RESULTS The global production of GI trials has remained static in recent years and a majority of research efforts are focused on a few diseases. While GI trials are generally produced by highly populated US states and countries, they are also seldom larger than 500 patients. The likelihood of using data monitoring committees, randomization, and double blinding in GI trials has increased over time, though a substantial fraction of GI trials still do not employ rigorous trial designs. While levels of GI trials correlate with disease burden, the explained variance of GI trials by disease burden worldwide is poor. CONCLUSION GI trials are chiefly concentrated in few diseases and highly populated regions, exhibit heterogeneous trends and methodologies, and are sensitive to disease burdens, though more so within North America than worldwide.
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Affiliation(s)
| | - Antony Hsieh
- Northwestern Memorial Hospital, Northwestern University, Chicago, IL, USA
| | - David Hsiehchen
- Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA.
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Schandelmaier S, von Elm E, You JJ, Blümle A, Tomonaga Y, Lamontagne F, Saccilotto R, Amstutz A, Bengough T, Meerpohl JJ, Stegert M, Olu KK, Tikkinen KAO, Neumann I, Carrasco-Labra A, Faulhaber M, Mulla SM, Mertz D, Akl EA, Sun X, Bassler D, Busse JW, Ferreira-González I, Nordmann A, Gloy V, Raatz H, Moja L, Rosenthal R, Ebrahim S, Vandvik PO, Johnston BC, Walter MA, Burnand B, Schwenkglenks M, Hemkens LG, Cook DJ, Meade MO, Bucher HC, Kasenda B, Briel M. Premature Discontinuation of Randomized Trials in Critical and Emergency Care: A Retrospective Cohort Study. Crit Care Med 2016; 44:130-7. [PMID: 26468895 DOI: 10.1097/ccm.0000000000001369] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Randomized clinical trials that enroll patients in critical or emergency care (acute care) setting are challenging because of narrow time windows for recruitment and the inability of many patients to provide informed consent. To assess the extent that recruitment challenges lead to randomized clinical trial discontinuation, we compared the discontinuation of acute care and nonacute care randomized clinical trials. DESIGN Retrospective cohort of 894 randomized clinical trials approved by six institutional review boards in Switzerland, Germany, and Canada between 2000 and 2003. SETTING Randomized clinical trials involving patients in an acute or nonacute care setting. SUBJECTS AND INTERVENTIONS We recorded trial characteristics, self-reported trial discontinuation, and self-reported reasons for discontinuation from protocols, corresponding publications, institutional review board files, and a survey of investigators. MEASUREMENTS AND MAIN RESULTS Of 894 randomized clinical trials, 64 (7%) were acute care randomized clinical trials (29 critical care and 35 emergency care). Compared with the 830 nonacute care randomized clinical trials, acute care randomized clinical trials were more frequently discontinued (28 of 64, 44% vs 221 of 830, 27%; p = 0.004). Slow recruitment was the most frequent reason for discontinuation, both in acute care (13 of 64, 20%) and in nonacute care randomized clinical trials (7 of 64, 11%). Logistic regression analyses suggested the acute care setting as an independent risk factor for randomized clinical trial discontinuation specifically as a result of slow recruitment (odds ratio, 4.00; 95% CI, 1.72-9.31) after adjusting for other established risk factors, including nonindustry sponsorship and small sample size. CONCLUSIONS Acute care randomized clinical trials are more vulnerable to premature discontinuation than nonacute care randomized clinical trials and have an approximately four-fold higher risk of discontinuation due to slow recruitment. These results highlight the need for strategies to reliably prevent and resolve slow patient recruitment in randomized clinical trials conducted in the critical and emergency care setting.
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Affiliation(s)
- Stefan Schandelmaier
- 1Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland.2Department of Medicine, Academy of Swiss Insurance Medicine, University Hospital Basel, Basel, Switzerland.3Cochrane Switzerland, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland.4Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.5Department of Medicine, McMaster University, Hamilton, Ontario, Canada.6German Cochrane Centre, Medical Center-University of Freiburg, Freiburg, Germany.7Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.8Centre de Recherche Clinique du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, Canada.9Department of Health and Society, Austrian Federal Institute for Health Care, Vienna, Austria.10Departments of Urology and Public Health, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.11Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile.12Evidence-Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Santiago, Chile.13Michael G. DeGroote Institute for Infectious Diseases Research, McMaster University, Hamilton, Ontario, Canada.14Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.15Department of Medicine, State University of New York at Buffalo, Buffalo, NY.16Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.17Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.18Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada.19Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada.20Epidemiology Unit, Department of Cardiology, Vall d'Hebron Hospital and CIBER de Epidem
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Traversa G, Masiero L, Sagliocca L, Trotta F. Italian program for independent research on drugs: 10 year follow-up of funded studies in the area of rare diseases. Orphanet J Rare Dis 2016; 11:36. [PMID: 27068647 PMCID: PMC4828875 DOI: 10.1186/s13023-016-0420-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 04/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2005 the Italian Medicines Agency (AIFA) started a program on independent research on drugs, with the aim to promote clinical research in areas of limited commercial interest. For 3 years (2005-2007) an area of the program was reserved to studies in the field of rare diseases. There is a concern that public funding of research may be wasted. We investigated the outcome of the program. METHODS We conducted a cohort study on the projects that were funded by the AIFA in the area of rare diseases. The outcomes were the proportion of published studies, time to publication, impact factor of the publishing journals and relevance for clinical practice. We retrieved published articles through a literature search in peer reviewed biomedical journals indexed by Pubmed. We used the Kaplan-Meier method to estimate the cumulative probability of publication by time from project starting to publication. RESULTS During the period 2005-2007, 62 projects were funded in the area of rare diseases. Most of the studies (n 39; 63%) had a randomized design and in 22 (35%) the control group received an active treatment. For 39 studies (63%) we retrieved a publication in a peer reviewed journal. The median time to publication was 74 months and, at the maximum period of follow up (109 months), the cumulative probability of publication reached 77%. The median impact factor was 5.4 (range 1.4-52.4). Considering the clinical relevance, more than 30% of the published articles presented conclusive findings; an additional 10% of the studies reached potential breakthrough findings. CONCLUSIONS Even though it takes time to set up and conduct a funding program for independent research on drugs, the results are highly rewarding. Independent funding is crucial in supporting studies aimed at answering questions that are relevant for clinical practice despite the lack of sufficient commercial interest.
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Affiliation(s)
- Giuseppe Traversa
- Pharmacoepidemiology Unit, National Centre for Epidemiology, National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy.
| | - Lucia Masiero
- Italian National Transplant Center, National Institute of Health, Viale Regina Elena 299, 00161, Rome, Italy
| | - Luciano Sagliocca
- ARSan Agenzia Regionale Sanitaria Regione Campania, Centro Direzionale di Napoli, Isola F9, 80143, Naples, Italy
| | - Francesco Trotta
- Department of Epidemiology, Lazio Regional Health Service, Via Cristoforo Colombo 112, 00147, Rome, Italy
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Brænd AM, Straand J, Jakobsen RB, Klovning A. Publication and non-publication of drug trial results: a 10-year cohort of trials in Norwegian general practice. BMJ Open 2016; 6:e010535. [PMID: 27067893 PMCID: PMC4838717 DOI: 10.1136/bmjopen-2015-010535] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Previously, we identified a 10-year cohort of protocols from applications to the Norwegian Medicines Agency 1998-2007, consisting of 196 drug trials in general practice. The aim of this study was to examine whether trial results were published and whether trial funding and conflicts of interest were reported. DESIGN Cohort study of trials with systematic searches for published results. SETTING Clinical drug trials in Norwegian general practice. METHODS We performed systematic literature searches of MEDLINE, Embase and CENTRAL to identify publications originating from each trial using characteristics such as test drug, comparator and patient groups as search terms. When no publication was identified, we contacted trial sponsors for information regarding trial completion and reference to any publications. MAIN OUTCOME MEASURES We determined the frequency of publication of trial results and trial characteristics associated with publication of results. RESULTS Of the 196 trials, 5 were never started. Of the remaining 191 trials, 71% had results published in a journal, 11% had results publicly available elsewhere and 18% of trials had no results available. Publication was more common among trials with an active comparator drug (χ(2) test, p=0.040), with a larger number of patients (total sample size≥median, p=0.010) and with a longer trial period (duration≥median, p=0.025). Trial funding was reported in 85% of publications and increased over time, as did reporting of conflicts of interest among authors. Among the 134 main journal articles from the trials, 60% presented statistically significant results for the investigational drug, and the conclusion of the article was favourable towards the test drug in 78% of papers. CONCLUSIONS We did not identify any journal publication of results for 29% of the general practice drug trials. Trials with an active comparator, larger and longer trials were more likely to be published.
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Affiliation(s)
- Anja Maria Brænd
- Faculty of Medicine, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Jørund Straand
- Faculty of Medicine, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Rune Bruhn Jakobsen
- Faculty of Medicine, Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Orthopedic Surgery, Akershus University Hospital, Lørenskog, Norway
| | - Atle Klovning
- Faculty of Medicine, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Dell-Kuster S, Hoesli I, Lapaire O, Seeberger E, Steiner LA, Bucher HC, Girard T. Efficacy and safety of carbetocin applied as an intravenous bolus compared to as a short-infusion for caesarean section: study protocol for a randomised controlled trial. Trials 2016; 17:155. [PMID: 27004531 PMCID: PMC4802918 DOI: 10.1186/s13063-016-1285-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 03/09/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The two most commonly used uterotonic drugs in caesarean section are oxytocin and carbetocin, a synthetic oxytocin analogue. Carbetocin has a longer half-life when compared to oxytocin, resulting in a reduced use of additional uterotonics. Oxytocin is known to cause fewer cardiovascular side effects when administered as a short-infusion compared to as an intravenous bolus. Based on these findings, we aim at comparing carbetocin 100 mcg given as a slow intravenous bolus with carbetocin 100 mcg applied as a short-infusion in 100 ml 0.9 % sodium chloride in women undergoing a planned or unplanned caesarean delivery. We hypothesise uterine contraction not to be inferior to a bolus application (primary efficacy endpoint) and greater haemodynamic stability to be achieved after a short-infusion than after a bolus administration, as measured by heart rate and mean arterial blood pressure (primary safety endpoint). METHODS/DESIGN This is a prospective, double-blind, randomised controlled, investigator-initiated, non-inferiority trial taking place at the University Hospital Basel, Switzerland. Uterine tone is quantified by manual palpation by the obstetrician using a linear analogue scale from 0 to 100 at 2, 3, 5 and 10 minutes after cord clamping. We will evaluate whether the lower limit of the confidence interval for the difference of the maximal uterine tone within the first 5 minutes after cord clamping between both groups does not include the pre-specified non-inferiority limit of -10. Both haemodynamic secondary endpoints will be analysed using a linear regression model, adjusting for the baseline value and the dosage of vasoactive drug given between cord clamping and 1 minute thereafter, in order to investigate superiority of a short-infusion as compared to a bolus application. We will follow the extension of CONSORT guidelines for reporting the results of non-inferiority trials. DISCUSSION Haemodynamic stability and adequate uterine tone are important outcomes in caesarean sections. The results of this trial may be used to optimise these factors and thereby increase patient safety due to a reduction in cardiovascular side effects. TRIAL REGISTRATION Clinicaltrials.gov NCT02221531 on 19 August 2014 and www.kofam.ch SNCTP000001197 on 15 November 2014.
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Affiliation(s)
- Salome Dell-Kuster
- />Department of Anaesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, 4031 Basel, Switzerland
- />Basel Institute for Clinical Epidemiology and Biostatistics, Basel, Switzerland
| | - Irene Hoesli
- />Department of Obstetrics and Antenatal Care, University Hospital Basel, Basel, Switzerland
- />Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Olav Lapaire
- />Department of Obstetrics and Antenatal Care, University Hospital Basel, Basel, Switzerland
| | - Esther Seeberger
- />Department of Anaesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, 4031 Basel, Switzerland
| | - Luzius A. Steiner
- />Department of Anaesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, 4031 Basel, Switzerland
- />Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Heiner C. Bucher
- />Basel Institute for Clinical Epidemiology and Biostatistics, Basel, Switzerland
- />Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Thierry Girard
- />Department of Anaesthesiology, Surgical Intensive Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, 4031 Basel, Switzerland
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Massey PR, Wang R, Prasad V, Bates SE, Fojo T. Assessing the Eventual Publication of Clinical Trial Abstracts Submitted to a Large Annual Oncology Meeting. Oncologist 2016; 21:261-8. [PMID: 26888691 DOI: 10.1634/theoncologist.2015-0516] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 12/17/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Despite the ethical imperative to publish clinical trials when human subjects are involved, such data frequently remain unpublished. The objectives were to tabulate the rate and ascertain factors associated with eventual publication of clinical trial results reported as abstracts in the Proceedings of the American Society of Clinical Oncology (American Society of Clinical Oncology). MATERIALS AND METHODS Abstracts describing clinical trials for patients with breast, lung, colorectal, ovarian, and prostate cancer from 2009 to 2011 were identified by using a comprehensive online database (http://meetinglibrary.asco.org/abstracts). Abstracts included reported results of a treatment or intervention assessed in a discrete, prospective clinical trial. Publication status at 4-6 years was determined by using a standardized search of PubMed. Primary outcomes were the rate of publication for abstracts of randomized and nonrandomized clinical trials. Secondary outcomes included factors influencing the publication of results. RESULTS A total of 1,075 abstracts describing 378 randomized and 697 nonrandomized clinical trials were evaluated. Across all years, 75% of randomized and 54% of nonrandomized trials were published, with an overall publication rate of 61%. Sample size was a statistically significant predictor of publication for both randomized and nonrandomized trials (odds ratio [OR] per increase of 100 participants = 1.23 [1.11-1.36], p < .001; and 1.64 [1.15-2.34], p = .006, respectively). Among randomized studies, an industry coauthor or involvement of a cooperative group increased the likelihood of publication (OR 2.37, p = .013; and 2.21, p = .01, respectively). Among nonrandomized studies, phase II trials were more likely to be published than phase I (p < .001). Use of an experimental agent was not a predictor of publication in randomized (OR 0.76 [0.38-1.52]; p = .441) or nonrandomized trials (OR 0.89 [0.61-1.29]; p = .532). CONCLUSION This is the largest reported study examining why oncology trials are not published. The data show that 4-6 years after appearing as abstracts, 39% of oncology clinical trials remain unpublished. Larger sample size and advanced trial phase were associated with eventual publication; among randomized trials, an industry-affiliated author or a cooperative group increased likelihood of publication. Unfortunately, we found that, despite widespread recognition of the problem and the creation of central data repositories, timely publishing of oncology clinical trials results remains unsatisfactory.
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Affiliation(s)
- Paul R Massey
- Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Ruibin Wang
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Vinay Prasad
- Medical Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Susan E Bates
- Medical Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Tito Fojo
- Medical Oncology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Srikanthan A, Vera-Badillo F, Ethier J, Goldstein R, Templeton A, Ocana A, Seruga B, Amir E. Evolution in the eligibility criteria of randomized controlled trials for systemic cancer therapies. Cancer Treat Rev 2016; 43:67-73. [DOI: 10.1016/j.ctrv.2015.12.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 11/25/2022]
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Wise T, Arnone D, Marwood L, Zahn R, Lythe KE, Young AH. Recruiting for research studies using online public advertisements: examples from research in affective disorders. Neuropsychiatr Dis Treat 2016; 12:279-85. [PMID: 26917961 PMCID: PMC4751904 DOI: 10.2147/ndt.s90941] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Successful recruitment is vital for any research study. Difficulties in recruitment are not uncommon and can have important implications. This is particularly relevant to research conducted in affective disorders due to the nature of the conditions and the clinical services that serve these patients. Recently, online public advertisements have become more generally accessible and may provide an effective way to recruit patient populations. However, there is paucity of evidence on their viability as a method of recruiting patients into studies of disease mechanisms in these disorders. Public advertisement methods can be useful when researchers require specific populations, such as those not receiving pharmacological treatment. This work describes our experience in successfully recruiting participants into neuroimaging research studies in affective disorders using online public advertisements. Results suggest that these online public advertisements are an effective method for successfully recruiting participants with affective disorders into research studies, particularly for research focusing on disease mechanisms in specific populations.
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Affiliation(s)
- Toby Wise
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| | - Danilo Arnone
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| | - Lindsey Marwood
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| | - Roland Zahn
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK; Neuroscience and Aphasia Research Unit, School of Psychological Sciences, Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Karen E Lythe
- Neuroscience and Aphasia Research Unit, School of Psychological Sciences, Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Allan H Young
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
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229
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Stegert M, Kasenda B, von Elm E, You JJ, Blümle A, Tomonaga Y, Saccilotto R, Amstutz A, Bengough T, Briel M, Stegert M, Kasenda B, Elm EV, You JJ, Blümle A, Tomonaga Y, Saccilotto R, Amstutz A, Bengough T, Meerpohl JJ, Tikkinen KA, Neumann I, Carrasco-Labra A, Faulhaber M, Mulla S, Mertz D, Akl EA, Bassler D, Busse JW, Ferreira-González I, Lamontagne F, Nordmann A, Gloy V, Olu KK, Raatz H, Moja L, Rosenthal R, Ebrahim S, Schandelmaier S, Sun X, Vandvik PO, Johnston BC, Walter MA, Burnand B, Schwenkglenks M, Hemkens LG, Bucher HC, Guyatt GH, Briel M. An analysis of protocols and publications suggested that most discontinuations of clinical trials were not based on preplanned interim analyses or stopping rules. J Clin Epidemiol 2016; 69:152-60. [DOI: 10.1016/j.jclinepi.2015.05.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 05/15/2015] [Accepted: 05/19/2015] [Indexed: 11/29/2022]
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230
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Patterson RE, Marinac CR, Natarajan L, Hartman SJ, Cadmus-Bertram L, Flatt SW, Li H, Parker B, Oratowski-Coleman J, Villaseñor A, Godbole S, Kerr J. Recruitment strategies, design, and participant characteristics in a trial of weight-loss and metformin in breast cancer survivors. Contemp Clin Trials 2015; 47:64-71. [PMID: 26706665 DOI: 10.1016/j.cct.2015.12.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/09/2015] [Accepted: 12/14/2015] [Indexed: 01/03/2023]
Abstract
Weight loss and metformin are hypothesized to improve breast cancer outcomes; however the joint impacts of these treatments have not been investigated. Reach for Health is a randomized trial using a 2 × 2 factorial design to investigate the effects of weight loss and metformin on biomarkers associated with breast cancer prognosis among overweight/obese postmenopausal breast cancer survivors. This paper describes the trial recruitment strategies, design, and baseline sample characteristics. Participants were randomized in equal numbers to (1) placebo, (2) metformin, (3) weight loss intervention and placebo, or (4) weight-loss intervention and metformin. The lifestyle intervention was a personalized, telephone-based program targeting a 7% weight-loss in the intervention arm. The metformin dose was 1500 mg/day. The duration of the intervention was 6 months. Main outcomes were biomarkers representing 3 metabolic systems putatively related to breast cancer mortality: glucoregulation, inflammation, and sex hormones. Between August 2011 and May 2015, we randomized 333 breast cancer survivors. Mass mailings from the California Cancer Registry were the most successful recruitment strategy with over 25,000 letters sent at a cost of $191 per randomized participant. At baseline, higher levels of obesity were significantly associated with worse sleep disturbance and impairment scores, lower levels of physical activity and higher levels of sedentary behavior, hypertension, hypercholesterolemia, and lower quality of life (p<0.05 for all). These results illustrate the health burden of obesity. Results of this trial will provide mechanistic data on biological pathways and circulating biomarkers associated with lifestyle and pharmacologic interventions to improve breast cancer prognosis.
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Affiliation(s)
- Ruth E Patterson
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA; Moores UC San Diego Cancer Center, UC San Diego, La Jolla, CA, USA.
| | - Catherine R Marinac
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA; Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Loki Natarajan
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA; Moores UC San Diego Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Sheri J Hartman
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA; Moores UC San Diego Cancer Center, UC San Diego, La Jolla, CA, USA
| | | | - Shirley W Flatt
- Moores UC San Diego Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Hongying Li
- Moores UC San Diego Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Barbara Parker
- Moores UC San Diego Cancer Center, UC San Diego, La Jolla, CA, USA
| | | | - Adriana Villaseñor
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA; Moores UC San Diego Cancer Center, UC San Diego, La Jolla, CA, USA
| | - Suneeta Godbole
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA
| | - Jacqueline Kerr
- Department of Family Medicine and Public Health, UC San Diego, La Jolla, CA, USA
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Boudoulas KD, Leier CV, Geleris P, Boudoulas H. The shortcomings of clinical practice guidelines. Cardiology 2015; 130:187-200. [PMID: 25790843 DOI: 10.1159/000371572] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 12/11/2014] [Indexed: 11/19/2022]
Abstract
Accumulation of medical knowledge related to diagnosis and management over the last 5-6 decades has altered the course of diseases, improved clinical outcomes and increased survival. Thus, it has become difficult for the practicing physician to evaluate the long-term effects of a particular therapy on survival of an individual patient. Further, the approach by each physician to an individual patient with the same disease is not always uniform. In an attempt to assist physicians in applying newly acquired knowledge to patients, clinical practice guidelines were introduced by various scientific societies. Guidelines assist in facilitating the translation of new research discoveries into clinical practice; however, despite the improvements over the years, there are still several issues related to guidelines that often appear ‘lost in translation'. Guidelines are based on the results of randomized clinical trials, other nonrandomized studies, and expert opinion (i.e. the opinion of most members of the guideline committees). The merits and limitations of randomized clinical trials, guideline committees, and presentation of guidelines will be discussed. In addition, proposals to improve guidelines will be presented.
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232
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Kowalski C, Jena S, Kliemann D, Antes G. [Up for Discussion: Using study registries for Oncology: StudyBox and the German Clinical Trials Register (DRKS)]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2015; 109:431-6. [PMID: 26474647 DOI: 10.1016/j.zefq.2015.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Study registries serve various purposes. Primarily, they provide as complete an overview as possible on planned, ongoing and completed studies and are thus intended to contribute to transparency in research. As such, they are an instrument for identifying and reducing publication bias. Study registries can also help doctors and patients to identify suitable studies for them. The National Cancer Plan (NCP) calls for ensuring an efficient oncological treatment, which requires the knowledge derived from trials. Study registries can play an important role in their identification. This paper describes the purpose that study registries fulfil in oncology as well as their health policy rationale. It then discusses two registries relevant for oncology, i. e. StudyBox and the German Clinical Trials Register (DRKS), against the backdrop of the National Cancer Plan and introduces the cooperation of the two registries.
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Affiliation(s)
| | | | | | - Gerd Antes
- Universitätsklinikum Freiburg, Deutschland
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233
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Denhoff ER, Milliren CE, de Ferranti SD, Steltz SK, Osganian SK. Factors Associated with Clinical Research Recruitment in a Pediatric Academic Medical Center--A Web-Based Survey. PLoS One 2015; 10:e0140768. [PMID: 26473602 PMCID: PMC4608599 DOI: 10.1371/journal.pone.0140768] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 09/30/2015] [Indexed: 12/03/2022] Open
Abstract
Background One of the most difficult aspects of conducting clinical research is the ability to successfully recruit participants. Pediatric clinical research presents unique recruitment challenges that relate to the need for parental consent on behalf of a minor, child assent, and school attendance. Yet, this has been less well studied. We conducted a survey of investigators performing human subjects research in a single large academic pediatric hospital to better understand characteristics of studies with successful recruitment. Methods We conducted a web-based survey from September 2011 to December 2011 of all principal investigators with an Institutional Review Board approved human subjects protocol at Boston Children’s Hospital, a pediatric Academic Medical Center. The survey captured various characteristics of the protocols including study design, staffing, resources, and investigator experience and training as well as respondents’ perceived barriers and facilitators to recruitment. We used chi square tests and Mantel-Haenszel test for linear trend to examine the relationship between selected predictor variables and the binary outcome of successful vs. unsuccessful recruitment and multivariable logistic regression analyses to examine the simultaneous influence of potential predictors on each outcome. Results Among the 349 eligible investigators, 52% responded to the survey, and 181 with valid data were included in the analyses. Two-thirds of the 87 protocols closed to enrollment reached 80% or more of their target enrollment, whereas, only one-third of the 94 protocols actively recruiting were meeting 80% of their target. Recruitment method appeared to be the only significant and independent factor associated with achieving 80% or more of target enrollment in closed to enrollment protocols. Closed to enrollment protocols that used recruitment in person were 4.55 times (95% CI 1.30 to 15.93; p = 0.02) more likely to achieve 80% or more of their target enrollment when compared to those that used other recruitment methods. Other potentially modifiable factors such as number of study visits, study duration and investigator experience were suggestive of being meaningfully related to recruitment. Conclusion Recruiting in person may promote reaching an acceptable target enrollment in pediatric as well as adult clinical research. Future research is needed on larger and more diverse samples to gain a better understanding of how the characteristics and qualifications of the individuals who conduct recruitment influence participant enrollment as well as how best to approach patient and families for their participation.
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Affiliation(s)
- Erica Rose Denhoff
- The Clinical Research Center, Boston Children’s Hospital, Boston, MA, United States of America
- * E-mail:
| | - Carly E. Milliren
- The Clinical Research Center, Boston Children’s Hospital, Boston, MA, United States of America
| | - Sarah D. de Ferranti
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, United States of America
| | - Sarah K. Steltz
- New Balance Obesity Prevention Center, Boston Children’s Hospital, Boston, MA, United States of America
| | - Stavroula K. Osganian
- The Clinical Research Center, Boston Children’s Hospital, Boston, MA, United States of America
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, MA, United States of America
- Division of Endocrinology, Department of Medicine, Boston Children’s Hospital, Boston, MA, United States of America
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234
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Jamjoom AB, Jamjoom AM, Samman AM, Gahtani AY. Fate of registered clinical trials performed in Saudi Arabia. Saudi Med J 2015; 36:1245-8. [PMID: 26446340 PMCID: PMC4621735 DOI: 10.15537/smj.2015.10.12506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Abdulhakim B Jamjoom
- Section of Neurosurgery, Department of Surgery, King Khalid National Guard Hospital, Jeddah, Kingdom of Saudi Arabia. E-mail.
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Completion and Publication Rates of Randomized Controlled Trials in Surgery: An Empirical Study. Ann Surg 2015; 262:68-73. [PMID: 24979608 DOI: 10.1097/sla.0000000000000810] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the prevalence of discontinuation and nonpublication of surgical versus medical randomized controlled trials (RCTs) and to explore risk factors for discontinuation and nonpublication of surgical RCTs. BACKGROUND Trial discontinuation has significant scientific, ethical, and economic implications. To date, the prevalence of discontinuation of surgical RCTs is unknown. METHODS All RCT protocols approved between 2000 and 2003 by 6 ethics committees in Canada, Germany, and Switzerland were screened. Baseline characteristics were collected and, if published, full reports retrieved. Risk factors for early discontinuation for slow recruitment and nonpublication were explored using multivariable logistic regression analyses. RESULTS In total, 863 RCT protocols involving adult patients were identified, 127 in surgery (15%) and 736 in medicine (85%). Surgical trials were discontinued for any reason more often than medical trials [43% vs 27%, risk difference 16% (95% confidence interval [CI]: 5%-26%); P = 0.001] and more often discontinued for slow recruitment [18% vs 11%, risk difference 8% (95% CI: 0.1%-16%); P = 0.020]. The percentage of trials not published as full journal article was similar in surgical and medical trials (44% vs 40%, risk difference 4% (95% CI: -5% to 14%); P = 0.373). Discontinuation of surgical trials was a strong risk factor for nonpublication (odds ratio = 4.18, 95% CI: 1.45-12.06; P = 0.008). CONCLUSIONS Discontinuation and nonpublication rates were substantial in surgical RCTs and trial discontinuation was strongly associated with nonpublication. These findings need to be taken into account when interpreting surgical literature. Surgical trialists should consider feasibility studies before embarking on full-scale trials.
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You JJ, Liu Y, Kirby J, Vora P, Moayyedi P. Virtual colonoscopy, optical colonoscopy, or fecal occult blood testing for colorectal cancer screening: results of a pilot randomized controlled trial. Trials 2015; 16:296. [PMID: 26156248 PMCID: PMC4499903 DOI: 10.1186/s13063-015-0826-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 06/29/2015] [Indexed: 11/10/2022] Open
Abstract
Background No head-to-head randomized controlled trials have demonstrated the superiority of one colorectal screening modality over another in reducing colorectal cancer mortality. We conducted a pilot randomized controlled trial of fecal occult blood testing (FOBT), optical colonoscopy (OC), and virtual colonoscopy (VC), to inform the planning of a larger evaluative trial. Methods Eligible patients (aged 50 to 70) were recruited from five primary care practices in Hamilton, ON, Canada, between March 23, 2010 and August 11, 2010, and randomized 1:1:1 in a parallel design using an automated, centralized telephone service to either FOBT, OC, or VC. To reflect conventional practice, patients received no additional reminders to complete their allocated screening test beyond those received in usual practice. The primary outcome was completion of the assigned screening procedure. Results of the index test and any follow-up investigations were ascertained at 6 months. Participants, caregivers, and outcome assessors were not blinded to group assignment. The trial was stopped early due to lack of ongoing funding. Results A total of 198 participants were enrolled, of whom 67 were allocated to FOBT, 66 to OC, and 65 to VC. The allocated screening procedure was completed by 43 (64 %) subjects allocated to FOBT (95 % confidence interval [CI], 52–75 %), 53 (80 %) subjects allocated to OC (95 % CI, 69–88 %), and 50 (77 %) subjects allocated to VC (95 % CI, 65–85 %); because the trial stopped early, we had insufficient statistical power to detect clinically relevant differences in completion rates. During 6 months follow-up, colorectal adenomas were detected in 0 (0 %) subjects allocated to FOBT, 12 (18 %) subjects allocated to OC, and 2 (3 %) subjects allocated to VC. One subject in the OC arm had histological evidence of high-grade dysplasia. No subjects were diagnosed with colorectal cancer. Conclusions In this pilot randomized controlled trial of colorectal cancer screening in a primary care setting, 64–80 % of subjects completed their allocated screening test. These findings may be of value to investigators planning clinical trials to evaluate the effectiveness of colorectal cancer screening. Trial registration ClinicalTrials.gov NCT00865527. https://clinicaltrials.gov/ct2/show/NCT00865527
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Affiliation(s)
- John J You
- Department of Medicine, McMaster University, 1280 Main Street West, Room HSC-2C8, Hamilton, Ontario, L8S 4K1, Canada. .,Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Room HSC-2C8, Hamilton, Ontario, L8S 4K1, Canada.
| | - Yudong Liu
- Faculty of Dentistry, Western University, Dental Sciences Building, Room 1003, London, Ontario, N6A 5C1, Canada.
| | - John Kirby
- Department of Radiology, Connolly Hospital Blanchardstown, Dublin, Ireland.
| | - Parag Vora
- Department of Radiology, McMaster University, 1280 Main Street West, Room 2S284, Hamilton, Ontario, L8S 4K1, Canada.
| | - Paul Moayyedi
- Department of Medicine, McMaster University, 1280 Main Street West, Room HSC-2C8, Hamilton, Ontario, L8S 4K1, Canada.
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van den Bogert CA, Souverein PC, Brekelmans CTM, Janssen SWJ, van Hunnik M, Koëter GH, Leufkens HGM, Bouter LM. Occurrence and determinants of selective reporting of clinical drug trials: design of an inception cohort study. BMJ Open 2015; 5:e007827. [PMID: 26152325 PMCID: PMC4499740 DOI: 10.1136/bmjopen-2015-007827] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Responsible conduct of research implies that results of clinical trials should be completely and adequately reported. This article describes the design of a cohort study that aims to investigate the occurrence and the determinants of selective reporting in an inception cohort of all clinical drug trials that were reviewed by the Dutch Institutional Review Boards (IRBs) in 2007. It also describes the characteristics of the study cohort. METHODS AND ANALYSIS In 2007, Dutch IRBs reviewed 622 clinical drug trials. For each trial, we assessed the stages of progress. We discriminated five intermediate stages and five definite stages. Intermediate stages of progress are: approved by an IRB; started inclusion; completed as planned; terminated early; published as article. The definite stages of progress are: rejected by an IRB; never started inclusion; not published as article; completely reported; selectively reported. We will use univariate and multivariate Cox regression models to identify trial characteristics associated with non-publication. We will identify seven trial-specific discrepancy items, including the objectives, inclusion and exclusion criteria, end points, sample size, additional analyses, type of population analysis and sponsor acknowledgement. The percentage of trials with discrepancies between the protocol and the publication will be scored. We will investigate the association between trial characteristics and the occurrence of discrepancies. ETHICS AND DISSEMINATION No IRB-approval is required for this study. Access to confidential research protocols was provided by the Central Committee on Research Involving Human Subjects. We plan to finish data collection in June 2015, and expect to complete data cleaning, analysis and manuscript preparation within the next 3 months. Hence, a first draft of an article containing the results is expected before the end of October 2015.
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Affiliation(s)
- Cornelis A van den Bogert
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
- Central Committee on Research involving Human Subjects (CCMO), The Hague, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Cecile T M Brekelmans
- Central Committee on Research involving Human Subjects (CCMO), The Hague, The Netherlands
| | - Susan W J Janssen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Manon van Hunnik
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Gerard H Koëter
- Central Committee on Research involving Human Subjects (CCMO), The Hague, The Netherlands
| | - Hubertus G M Leufkens
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Faculty of Science, Utrecht University, Utrecht, The Netherlands
| | - Lex M Bouter
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
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238
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Schandelmaier S, Conen K, von Elm E, You JJ, Blümle A, Tomonaga Y, Amstutz A, Briel M, Kasenda B. Planning and reporting of quality-of-life outcomes in cancer trials. Ann Oncol 2015; 26:1966-1973. [PMID: 26133966 DOI: 10.1093/annonc/mdv283] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/24/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Information about the impact of cancer treatments on patients' quality of life (QoL) is of paramount importance to patients and treating oncologists. Cancer trials that do not specify QoL as an outcome or fail to report collected QoL data, omit crucial information for decision making. To estimate the magnitude of these problems, we investigated how frequently QoL outcomes were specified in protocols of cancer trials and subsequently reported. DESIGN Retrospective cohort study of RCT protocols approved by six research ethics committees in Switzerland, Germany, and Canada between 2000 and 2003. We compared protocols to corresponding publications, which were identified through literature searches and investigator surveys. RESULTS Of the 173 cancer trials, 90 (52%) specified QoL outcomes in their protocol, 2 (1%) as primary and 88 (51%) as secondary outcome. Of the 173 trials, 35 (20%) reported QoL outcomes in a corresponding publication (4 modified from the protocol), 18 (10%) were published but failed to report QoL outcomes in the primary or a secondary publication, and 37 (21%) were not published at all. Of the 83 (48%) trials that did not specify QoL outcomes in their protocol, none subsequently reported QoL outcomes. Failure to report pre-specified QoL outcomes was not associated with industry sponsorship (versus non-industry), sample size, and multicentre (versus single centre) status but possibly with trial discontinuation. CONCLUSIONS About half of cancer trials specified QoL outcomes in their protocols. However, only 20% reported any QoL data in associated publications. Highly relevant information for decision making is often unavailable to patients, oncologists, and health policymakers.
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Affiliation(s)
- S Schandelmaier
- Basel Institute for Clinical Epidemiology and Biostatistics; Academy of Swiss Insurance Medicine
| | - K Conen
- Department of Oncology, University Hospital of Basel, Basel
| | - E von Elm
- Cochrane Switzerland, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - J J You
- Department of Clinical Epidemiology and Biostatistics; Department of Medicine, McMaster University, Hamilton, Canada
| | - A Blümle
- German Cochrane Centre, Medical Center-University of Freiburg, Freiburg, Germany
| | - Y Tomonaga
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich
| | - A Amstutz
- Basel Institute for Clinical Epidemiology and Biostatistics
| | - M Briel
- Basel Institute for Clinical Epidemiology and Biostatistics; Department of Clinical Epidemiology and Biostatistics; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - B Kasenda
- Basel Institute for Clinical Epidemiology and Biostatistics; Department of Oncology, University Hospital of Basel, Basel; Department of Medical Oncology, Royal Marsden Hospital, London, UK.
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Williams RJ, Tse T, DiPiazza K, Zarin DA. Terminated Trials in the ClinicalTrials.gov Results Database: Evaluation of Availability of Primary Outcome Data and Reasons for Termination. PLoS One 2015; 10:e0127242. [PMID: 26011295 PMCID: PMC4444136 DOI: 10.1371/journal.pone.0127242] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 04/13/2015] [Indexed: 11/18/2022] Open
Abstract
Background Clinical trials that end prematurely (or “terminate”) raise financial, ethical, and scientific concerns. The extent to which the results of such trials are disseminated and the reasons for termination have not been well characterized. Methods and Findings A cross-sectional, descriptive study of terminated clinical trials posted on the ClinicalTrials.gov results database as of February 2013 was conducted. The main outcomes were to characterize the availability of primary outcome data on ClinicalTrials.gov and in the published literature and to identify the reasons for trial termination. Approximately 12% of trials with results posted on the ClinicalTrials.gov results database (905/7,646) were terminated. Most trials were terminated for reasons other than accumulated data from the trial (68%; 619/905), with an insufficient rate of accrual being the lead reason for termination among these trials (57%; 350/619). Of the remaining trials, 21% (193/905) were terminated based on data from the trial (findings of efficacy or toxicity) and 10% (93/905) did not specify a reason. Overall, data for a primary outcome measure were available on ClinicalTrials.gov and in the published literature for 72% (648/905) and 22% (198/905) of trials, respectively. Primary outcome data were reported on the ClinicalTrials.gov results database and in the published literature more frequently (91% and 46%, respectively) when the decision to terminate was based on data from the trial. Conclusions Trials terminate for a variety of reasons, not all of which reflect failures in the process or an inability to achieve the intended goals. Primary outcome data were reported most often when termination was based on data from the trial. Further research is needed to identify best practices for disseminating the experience and data resulting from terminated trials in order to help ensure maximal societal benefit from the investments of trial participants and others involved with the study.
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Affiliation(s)
- Rebecca J. Williams
- National Library of Medicine (NLM), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, Maryland, United States of America
- * E-mail:
| | - Tony Tse
- National Library of Medicine (NLM), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, Maryland, United States of America
| | - Katelyn DiPiazza
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Deborah A. Zarin
- National Library of Medicine (NLM), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Bethesda, Maryland, United States of America
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Cauley JA, Fluharty L, Ellenberg SS, Gill TM, Ensrud KE, Barrett-Connor E, Cifelli D, Cunningham GR, Matsumoto AM, Bhasin S, Pahor M, Farrar JT, Cella D, Rosen RC, Resnick SM, Swerdloff RS, Lewis CE, Molitch ME, Crandall JP, Stephens-Shields AJ, Strorer TW, Wang C, Anton S, Basaria S, Diem S, Tabatabaie V, Dougar D, Hou X, Snyder PJ. Recruitment and Screening for the Testosterone Trials. J Gerontol A Biol Sci Med Sci 2015; 70:1105-11. [PMID: 25878029 DOI: 10.1093/gerona/glv031] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 03/02/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We describe the recruitment of men for The Testosterone (T) Trials, which were designed to determine the efficacy of T treatment. METHODS Men were eligible if they were ≥65 years, had an average of two morning total T values <275 ng/dL with neither value >300 ng/mL, and had symptoms and objective evidence of mobility limitation, sexual dysfunction, and/or low vitality. Men had to be eligible for and enroll in at least one of these three main trials (physical function, sexual function, vitality). RESULTS Men were recruited primarily through mass mailings in 12 U.S. communities: 82% of men who contacted the sites did so in response to mailings. Men who responded were screened by telephone to ascertain eligibility. Of 51,085 telephone screens, 53.5% were eligible for further screening. Of 23,889 initial screening visits (SV1), 2,781 (11.6%) men were eligible for the second screening visit (SV2), which 2,261 (81.3%) completed. At SV2, 931 (41.2%) men met the criteria for one or more trials, the T level criterion and had no other exclusions. Of these, 790 (84.6%) were randomized; 99 (12.5%) in all three trials and 348 (44%) in two trials. Their mean age was 72 years and mean body mass index (BMI) was 31.0 kg/m(2). Mean (standard deviation) total T (ng/dL) was 212.0 (40.0). CONCLUSION Despite the telephone screening to enrollment ratio of 65 to 1, we met the recruitment goals for each trial. Recruitment of symptomatic older men with low testosterone levels is difficult but feasible.
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Affiliation(s)
- Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh.
| | | | - Susan S Ellenberg
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Thomas M Gill
- Division of Geriatric Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Kristine E Ensrud
- Department of Medicine, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis. Minneapolis VA Health Care System, Minnesota
| | - Elizabeth Barrett-Connor
- Division of Epidemiology, Department of Family and Preventative Medicine, University of California, San Diego School of Medicine, La Jolla
| | | | - Glenn R Cunningham
- Division of Diabetes, Endocrinology and Metabolism, Baylor College of Medicine and Baylor St. Luke's Medical Center, Houston, Texas
| | - Alvin M Matsumoto
- Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs Puget Sound Health Care System and Division of Gerontology and Geriatric Medicine, Department of Internal Medicine, University of Washington School of Medicine, Seattle
| | - Shalender Bhasin
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marco Pahor
- Department of Aging & Geriatric Research, University of Florida, Gainesville
| | - John T Farrar
- Division of Geriatric Medicine, Yale School of Medicine, New Haven, Connecticut
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Raymond C Rosen
- New England Research Institutes, Inc., Watertown, Massachusetts
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Ronald S Swerdloff
- Division of Endocrinology, Harbor-University of California at Los Angeles Medical Center and Los Angeles Biomedical Research Institute, Torrance
| | - Cora E Lewis
- Division of Preventive Medicine, University of Alabama at Birmingham
| | - Mark E Molitch
- Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Jill P Crandall
- Divisions of Endocrinology and Geriatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Alisa J Stephens-Shields
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Thomas W Strorer
- Section of Endocrinology, Diabetes, and Nutrition, Boston Medical Center, Massachusetts
| | - Christina Wang
- Division of Endocrinology, Harbor-University of California at Los Angeles Medical Center and Los Angeles Biomedical Research Institute, Torrance
| | - Stephen Anton
- Department of Aging & Geriatric Research, University of Florida, Gainesville
| | - Shehzad Basaria
- Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Susan Diem
- Department of Medicine, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis
| | - Vafa Tabatabaie
- Divisions of Endocrinology and Geriatrics, Albert Einstein College of Medicine, Bronx, New York
| | | | - Xiaoling Hou
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Peter J Snyder
- Division of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Heywood J, Evangelou M, Goymer D, Kennet J, Anselmiova K, Guy C, O'Brien C, Nutland S, Brown J, Walker NM, Todd JA, Waldron-Lynch F. Effective recruitment of participants to a phase I study using the internet and publicity releases through charities and patient organisations: analysis of the adaptive study of IL-2 dose on regulatory T cells in type 1 diabetes (DILT1D). Trials 2015; 16:86. [PMID: 25881192 PMCID: PMC4369347 DOI: 10.1186/s13063-015-0583-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 01/27/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND A barrier to the successful development of new disease treatments is the timely recruitment of participants to experimental medicine studies that are primarily designed to investigate biological mechanisms rather than evaluate clinical efficacy. The aim of this study was to analyse the performance of three recruitment sources and the effect of publicity events during the Adaptive study of IL-2 dose on regulatory T cells in type 1 diabetes (DILT1D). METHODS The final study outcome, demography, disease duration, residence and the effect of publicity events on the performance of three recruitment sources (clinics, type 1 diabetes (T1D) disease register and the internet) were analysed from a bespoke DILT1D recruitment database. For the internet source, the origin of website hits in relation to publicity events was also evaluated. RESULTS A total of 735 potentially eligible participants were approached to identify the final 45 DILT1D participants. A total of 477 (64%) were identified via the disease register, but only 59 (12%) responded to contact. A total of 317 individuals registered with the DILT1D study team. Self-referral via the study website generated 170 (54%) registered individuals and was the most popular and successful source, with 88 (28%) sourced from diabetes clinics and 59 (19%) from the disease register. Of those with known T1D duration (N = 272), the internet and clinics sources identified a larger number (57, 21%) of newly diagnosed T1D (<100 days post-diagnosis) compared to the register (1, 0.4%). The internet extended the geographical reach of the study, enabling both national and international participation. Targeted website posts and promotional events from organisations supporting T1D research and treatment during the trial were essential to the success of the internet recruitment strategy. CONCLUSIONS Analysis of the DILT1D study recruitment outcomes illustrates the utility of an active internet recruitment strategy, supported by patient groups and charities, funding agencies and sponsors, in successfully conducting an early phase study in T1D. This recruitment strategy should now be evaluated in late-stage trials to develop treatments for T1D and other diseases. TRIAL REGISTRATION NCT01827735 (registered: 4 April 2013); ISRCTN27852285 (registered: 23 March 2013); DRN767 (registered: 21 January 2013).
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Affiliation(s)
- James Heywood
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, Wellcome Trust/MRC Building, Cambridge Biomedical Campus, Cambridge, CB2 0XY, UK.
| | - Marina Evangelou
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, Wellcome Trust/MRC Building, Cambridge Biomedical Campus, Cambridge, CB2 0XY, UK.
| | - Donna Goymer
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, Wellcome Trust/MRC Building, Cambridge Biomedical Campus, Cambridge, CB2 0XY, UK.
| | - Jane Kennet
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, Wellcome Trust/MRC Building, Cambridge Biomedical Campus, Cambridge, CB2 0XY, UK.
| | - Katerina Anselmiova
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, Wellcome Trust/MRC Building, Cambridge Biomedical Campus, Cambridge, CB2 0XY, UK.
| | - Catherine Guy
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, Wellcome Trust/MRC Building, Cambridge Biomedical Campus, Cambridge, CB2 0XY, UK.
| | - Criona O'Brien
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, Wellcome Trust/MRC Building, Cambridge Biomedical Campus, Cambridge, CB2 0XY, UK.
| | - Sarah Nutland
- The Cambridge BioResource, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
| | - Judy Brown
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, Wellcome Trust/MRC Building, Cambridge Biomedical Campus, Cambridge, CB2 0XY, UK.
| | - Neil M Walker
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, Wellcome Trust/MRC Building, Cambridge Biomedical Campus, Cambridge, CB2 0XY, UK.
| | - John A Todd
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, Wellcome Trust/MRC Building, Cambridge Biomedical Campus, Cambridge, CB2 0XY, UK.
| | - Frank Waldron-Lynch
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, Wellcome Trust/MRC Building, Cambridge Biomedical Campus, Cambridge, CB2 0XY, UK.
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van Lent M, Rongen GA, Out HJ. Shortcomings of protocols of drug trials in relation to sponsorship as identified by Research Ethics Committees: analysis of comments raised during ethical review. BMC Med Ethics 2014; 15:83. [PMID: 25490963 PMCID: PMC4269968 DOI: 10.1186/1472-6939-15-83] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 11/26/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Submission of study protocols to research ethics committees (RECs) constitutes one of the earliest stages at which planned trials are documented in detail. Previous studies have investigated the amendments requested from researchers by RECs, but the type of issues raised during REC review have not been compared by sponsor type. The objective of this study was to identify recurring shortcomings in protocols of drug trials based on REC comments and to assess whether these were more common among industry-sponsored or non-industry trials. METHODS Retrospective analysis of 226 protocols of drug trials approved in 2010-2011 by three RECs affiliated to academic medical centres in The Netherlands. For each protocol, information on sponsorship, number of participating centres, participating countries, study phase, registration status of the study drug, and type and number of subjects was retrieved. REC comments were extracted from decision letters sent to investigators after review and were classified using a predefined checklist that was based on legislation and guidelines on clinical drug research and previous literature. RESULTS Most protocols received comments regarding participant information and consent forms (n = 182, 80.5%), methodology and statistical analyses (n = 160, 70.8%), and supporting documentation, including trial agreements and certificates of insurance (n = 154, 68.1%). Of the submitted protocols, 122 (54.0%) were non-industry and 104 (46.0%) were industry-sponsored trials. Non-industry trials more often received comments on subject selection (n = 44, 36.1%) than industry-sponsored trials (n = 18, 17.3%; RR, 1.58; 95% CI, 1.01 to 2.47), and on methodology and statistical analyses (n = 95, 77.9% versus n = 65, 62.5%, respectively; RR, 1.18; 95% CI, 1.01 to 1.37). Non-industry trials less often received comments on supporting documentation (n = 72, 59.0%) than industry-sponsored trials (n = 82, 78.8%; RR, 0.83; 95% CI, 0.72 to 0.95). CONCLUSIONS RECs identified important ethical and methodological shortcomings in protocols of both industry-sponsored and non-industry drug trials. Investigators, especially of non-industry trials, should better prepare their research protocols in order to facilitate the ethical review process.
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Affiliation(s)
- Marlies van Lent
- />Clinical Research Centre Nijmegen, Department of Pharmacology – Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gerard A Rongen
- />Department of Pharmacology – Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
- />Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henk J Out
- />Clinical Research Centre Nijmegen, Department of Pharmacology – Toxicology, Radboud University Medical Center, Nijmegen, The Netherlands
- />Teva Pharmaceuticals, Amsterdam, The Netherlands
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243
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Chapman SJ, Shelton B, Mahmood H, Fitzgerald JE, Harrison EM, Bhangu A. Discontinuation and non-publication of surgical randomised controlled trials: observational study. BMJ 2014; 349:g6870. [PMID: 25491195 PMCID: PMC4260649 DOI: 10.1136/bmj.g6870] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the rate of early discontinuation and non-publication of randomised controlled trials involving patients undergoing surgery. DESIGN Cross sectional observational study of registered and published trials. SETTING Randomised controlled trials of interventions in patients undergoing a surgical procedure. DATA SOURCES The ClinicalTrials.gov database was searched for interventional trials registered between January 2008 and December 2009 using the keyword "surgery". Recruitment status was extracted from the ClinicalTrials.gov database. A systematic search for studies published in peer reviewed journals was performed; if they were not found, results posted on the ClinicalTrials.gov results database were sought. Email queries were sent to trial investigators of discontinued and unpublished completed trials if no reason for the respective status was disclosed. MAIN OUTCOME MEASURES Trial discontinuation before completion and non-publication after completion. Logistic regression was used to determine the effect of funding source on publication status, with adjustment for intervention type and trial size. RESULTS Of 818 registered trials found using the keyword "surgery", 395 met the inclusion criteria. Of these, 21% (81/395) were discontinued early, most commonly owing to poor recruitment (44%, 36/81). The remaining 314 (79%) trials proceeded to completion, with a publication rate of 66% (208/314) at a median time of 4.9 (interquartile range 4.0-6.0) years from study completion to publication search. A further 6% (20/314) of studies presented results on ClinicalTrials.gov without a corresponding peer reviewed publication. Industry funding did not affect the rate of discontinuation (adjusted odds ratio 0.91, 95% confidence interval 0.54 to 1.55) but was associated with a lower odds of publication for completed trials (0.43, 0.26 to 0.72). Investigators' email addresses for trials with an uncertain fate were identified for 71.4% (10/14) of discontinued trials and 83% (101/122) of unpublished studies. Only 43% (6/14) and 20% (25/122) replies were received. Email responses for completed trials indicated 11 trials in press, five published studies (four in non-indexed peer reviewed journals), and nine trials remaining unpublished. CONCLUSIONS One in five surgical randomised controlled trials are discontinued early, one in three completed trials remain unpublished, and investigators of unpublished studies are frequently not contactable. This represents a waste of research resources and raises ethical concerns regarding hidden clinical data and futile participation by patients with its attendant risks. To promote future efficiency and transparency, changes are proposed to research governance frameworks to overcome these concerns.
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Affiliation(s)
| | - Bryony Shelton
- University of Birmingham, College of Medical and Dental Sciences, Birmingham B15 2TH, UK
| | - Humza Mahmood
- St George's University Hospital Medical School, London SW17 0RE, UK
| | - J Edward Fitzgerald
- Royal Free Hospital NHS Trust, Barnet Hospital Campus, High Barnet EN5 3DJ, UK
| | - Ewen M Harrison
- Clinical Surgery, University of Edinburgh, Edinburgh EH16 4SA, UK
| | - Aneel Bhangu
- University of Birmingham, College of Medical and Dental Sciences, Birmingham B15 2TH, UK
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Horne KL, Packington R, Monaghan J, Reilly T, McIntyre CW, Selby NM. The effects of acute kidney injury on long-term renal function and proteinuria in a general hospitalised population. Nephron Clin Pract 2014; 128:192-200. [PMID: 25472765 DOI: 10.1159/000368243] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/09/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is common in hospitalised patients and is associated with adverse long-term consequences. There is an urgent need to understand these sequelae in general hospitalised patients utilising a prospective cohort-based approach. We aimed to test the feasibility of study methodology prior to commencing a large-scale study and investigate the effects of AKI on chronic kidney disease (CKD) progression and proteinuria. METHODS Pilot study testing novel methodology for remote patient recruitment within a prospective case-control design. 300 cases (hospitalised patients with AKI) and controls (hospitalised patients without AKI) were matched 1:1 for age and baseline estimated glomerular filtration rate (eGFR). 70% of cases had AKI stage 1, 16% AKI stage 2 and 14% AKI stage 3. Renal function and proteinuria were measured 3 and 12 months after hospital admission. RESULTS The study met pre-defined recruitment, withdrawal and matching criteria. Renal function was worse in the AKI group at 3 (eGFR 61 ± 20 vs. 74 ± 23 ml/min/1.73 m(2), p < 0.001) and 12 months (eGFR 64 ± 23 vs. 75 ± 25 ml/min/1.73 m(2), p < 0.001). More cases than controls had CKD progression at 3 months (14 vs. 0.7%, p < 0.001). This difference persisted to 12 months, but there was no significant change between 3 and 12 months. Proteinuria and albuminuria were more prevalent in the AKI group and associated with CKD progression. CONCLUSIONS We describe a method of remote patient recruitment which could be employed more widely for prospective observational studies. Even mild AKI is associated with long-term renal dysfunction. Further investigation using this methodology is now underway.
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Affiliation(s)
- Kerry L Horne
- Department of Renal Medicine, Royal Derby Hospital Derby, Derby, UK
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Akl EA, Kahale LA, Agarwal A, Al-Matari N, Ebrahim S, Alexander PE, Briel M, Brignardello-Petersen R, Busse JW, Diab B, Iorio A, Kwong J, Li L, Lopes LC, Mustafa R, Neumann I, Tikkinen KAO, Vandvik PO, Zhang Y, Alonso-Coello P, Guyatt G. Impact of missing participant data for dichotomous outcomes on pooled effect estimates in systematic reviews: a protocol for a methodological study. Syst Rev 2014; 3:137. [PMID: 25423894 PMCID: PMC4285551 DOI: 10.1186/2046-4053-3-137] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/13/2014] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There is no consensus on how authors conducting meta-analysis should deal with trial participants with missing outcome data. The objectives of this study are to assess in Cochrane and non-Cochrane systematic reviews: (1) which categories of trial participants the systematic review authors consider as having missing participant data (MPD), (2) how trialists reported on participants with missing outcome data in trials, (3) whether systematic reviewer authors actually dealt with MPD in their meta-analyses of dichotomous outcomes consistently with their reported methods, and (4) the impact of different methods of dealing with MPD on pooled effect estimates in meta-analyses of dichotomous outcomes. METHODS/DESIGN We will conduct a methodological study of Cochrane and non-Cochrane systematic reviews. Eligible systematic reviews will include a group-level meta-analysis of a patient-important dichotomous efficacy outcome, with a statistically significant effect estimate. Teams of two reviewers will determine eligibility and subsequently extract information from each eligible systematic review in duplicate and independently, using standardized, pre-piloted forms. The teams will then use a similar process to extract information from the trials included in the meta-analyses of interest. We will assess first which categories of trial participants the systematic reviewers consider as having MPD. Second, we will assess how trialists reported on participants with missing outcome data in trials. Third, we will compare what systematic reviewers report having done, and what they actually did, in dealing with MPD in their meta-analysis. Fourth, we will conduct imputation studies to assess the effects of different methods of dealing with MPD on the pooled effect estimates of meta-analyses. We will specifically calculate for each method (1) the percentage of systematic reviews that lose statistical significance and (2) the mean change of effect estimates across systematic reviews. DISCUSSION The impact of different methods of dealing with MPD on pooled effect estimates will help judge the associated risk of bias in systematic reviews. Our findings will inform recommendations regarding what assumptions for MPD should be used to test the robustness of meta-analytical results.
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Affiliation(s)
- Elie A Akl
- Department of Internal Medicine, Clinical Epidemiology Unit, American University of Beirut Medical Center, PO Box: 11-0236, Riad-El-Solh, Beirut 1107, 2020, Beirut, Lebanon.
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Moja L, Lucenteforte E, Kwag KH, Bertele V, Campomori A, Chakravarthy U, D’Amico R, Dickersin K, Kodjikian L, Lindsley K, Loke Y, Maguire M, Martin DF, Mugelli A, Mühlbauer B, Püntmann I, Reeves B, Rogers C, Schmucker C, Subramanian ML, Virgili G. Systemic safety of bevacizumab versus ranibizumab for neovascular age-related macular degeneration. Cochrane Database Syst Rev 2014; 9:CD011230. [PMID: 25220133 PMCID: PMC4262120 DOI: 10.1002/14651858.cd011230.pub2] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Neovascular age-related macular degeneration (AMD) is the leading cause of legal blindness in elderly populations of industrialised countries. Bevacizumab (Avastin®) and ranibizumab (Lucentis®) are targeted biological drugs (a monoclonal antibody) that inhibit vascular endothelial growth factor, an angiogenic cytokine that promotes vascular leakage and growth, thereby preventing its pathological angiogenesis. Ranibizumab is approved for intravitreal use to treat neovascular AMD, while bevacizumab is approved for intravenous use as a cancer therapy. However, due to the biological similarity of the two drugs, bevacizumab is widely used off-label to treat neovascular AMD. OBJECTIVES To assess the systemic safety of intravitreal bevacizumab (brand name Avastin®; Genentech/Roche) compared with intravitreal ranibizumab (brand name Lucentis®; Novartis/Genentech) in people with neovascular AMD. Primary outcomes were death and All serious systemic adverse events (All SSAEs), the latter as a composite outcome in accordance with the International Conference on Harmonisation Good Clinical Practice. Secondary outcomes examined specific SSAEs: fatal and non-fatal myocardial infarctions, strokes, arteriothrombotic events, serious infections, and events grouped in some Medical Dictionary for Regulatory Activities System Organ Classes (MedDRA SOC). We assessed the safety at the longest available follow-up to a maximum of two years. SEARCH METHODS We searched CENTRAL, MEDLINE, EMBASE and other online databases up to 27 March 2014. We also searched abstracts and clinical study presentations at meetings, trial registries, and contacted authors of included studies when we had questions. SELECTION CRITERIA Randomised controlled trials (RCTs) directly comparing intravitreal bevacizumab (1.25 mg) and ranibizumab (0.5 mg) in people with neovascular AMD, regardless of publication status, drug dose, treatment regimen, or follow-up length, and whether the SSAEs of interest were reported in the trial report. DATA COLLECTION AND ANALYSIS Two authors independently selected studies and assessed the risk of bias for each study. Three authors independently extracted data.We conducted random-effects meta-analyses for the primary and secondary outcomes. We planned a pre-specified analysis to explore deaths and All SSAEs at the one-year follow-up. MAIN RESULTS We included data from nine studies (3665 participants), including six published (2745 participants) and three unpublished (920 participants) RCTs, none supported by industry. Three studies excluded participants at high cardiovascular risk, increasing clinical heterogeneity among studies. The studies were well designed, and we did not downgrade the quality of the evidence for any of the outcomes due to risk of bias. Although the estimated effects of bevacizumab and ranibizumab on our outcomes were similar, we downgraded the quality of the evidence due to imprecision.At the maximum follow-up (one or two years), the estimated risk ratio (RR) of death with bevacizumab compared with ranibizumab was 1.10 (95% confidence interval (CI) 0.78 to 1.57, P value = 0.59; eight studies, 3338 participants; moderate quality evidence). Based on the event rates in the studies, this gives a risk of death with ranibizumab of 3.4% and with bevacizumab of 3.7% (95% CI 2.7% to 5.3%).For All SSAEs, the estimated RR was 1.08 (95% CI 0.90 to 1.31, P value = 0.41; nine studies, 3665 participants; low quality evidence). Based on the event rates in the studies, this gives a risk of SSAEs of 22.2% with ranibizumab and with bevacizumab of 24% (95% CI 20% to 29.1%).For the secondary outcomes, we could not detect any difference between bevacizumab and ranibizumab, with the exception of gastrointestinal disorders MedDRA SOC where there was a higher risk with bevacizumab (RR 1.82; 95% CI 1.04 to 3.19, P value = 0.04; six studies, 3190 participants).Pre-specified analyses of deaths and All SSAEs at one-year follow-up did not substantially alter the findings of our review.Fixed-effect analysis for deaths did not substantially alter the findings of our review, but fixed-effect analysis of All SSAEs showed an increased risk for bevacizumab (RR 1.12; 95% CI 1.00 to 1.26, P value = 0.04; nine studies, 3665 participants): the meta-analysis was dominated by a single study (weight = 46.9%).The available evidence was sensitive to the exclusion of CATT or unpublished results. For All SSAEs, the exclusion of CATT moved the overall estimate towards no difference (RR 1.01; 95% CI 0.82 to 1.25, P value = 0.92), while the exclusion of LUCAS yielded a larger RR, with more SSAEs in the bevacizumab group, largely driven by CATT (RR 1.19; 95% CI 1.06 to 1.34, P value = 0.004). The exclusion of all unpublished studies produced a RR of 1.12 for death (95% CI 0.78 to 1.62, P value = 0.53) and a RR of 1.21 for SSAEs (95% CI 1.06 to 1.37, P value = 0.004), indicating a higher risk of SSAEs in those assigned to bevacizumab than ranibizumab. AUTHORS' CONCLUSIONS This systematic review of non-industry sponsored RCTs could not determine a difference between intravitreal bevacizumab and ranibizumab for deaths, All SSAEs, or specific subsets of SSAEs in the first two years of treatment, with the exception of gastrointestinal disorders. The current evidence is imprecise and might vary across levels of patient risks, but overall suggests that if a difference exists, it is likely to be small. Health policies for the utilisation of ranibizumab instead of bevacizumab as a routine intervention for neovascular AMD for reasons of systemic safety are not sustained by evidence. The main results and quality of evidence should be verified once all trials are fully published.
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Affiliation(s)
- Lorenzo Moja
- Department of Biomedical Sciences for Health, University of Milan - IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Ersilia Lucenteforte
- Department of Neurosciences, Psychology, Drug Research and Children’s Health, University of Florence, Florence, Italy
| | - Koren H Kwag
- Clinical Epidemiology Unit, IRCCS Galeazzi Orthopaedic Institute, Milan, Italy
| | - Vittorio Bertele
- Laboratory of Regulatory Policies, IRCCS Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Annalisa Campomori
- Hospital Pharmacy, Trento General Hospital, Health Trust of the Autonomous Province of Trento, Trento, Italy
| | - Usha Chakravarthy
- Centre for Vision and Vascular Science, Queen’s University Belfast, Belfast, UK
| | - Roberto D’Amico
- Italian Cochrane Centre, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Kay Dickersin
- Center for Clinical Trials and US Cochrane Center, Johns Hopkins University, Baltimore, MD, USA
| | - Laurent Kodjikian
- Department of Ophthalmology, Hôpital de la Croix-Rousse, Lyon, France
| | - Kristina Lindsley
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yoon Loke
- School of Medicine, University of East Anglia, Norwich, UK
| | - Maureen Maguire
- Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Alessandro Mugelli
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Bernd Mühlbauer
- Dept of Pharmacology, Klinikum Bremen Mitte gGmbH, Bremen, Germany
| | - Isabel Püntmann
- Dept of Pharmacology, Klinikum Bremen Mitte gGmbH, Bremen, Germany
| | - Barnaby Reeves
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Chris Rogers
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Christine Schmucker
- German Cochrane Centre, Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Freiburg, Germany
| | - Manju L Subramanian
- Department of Ophthalmology, Boston University, School of Medicine, Boston, Massachusetts, USA
| | - Gianni Virgili
- Department of Translational Surgery and Medicine, Eye Clinic, University of Florence, Florence, Italy
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Galsky MD. Rethinking cancer clinical trials for the future. Future Oncol 2014; 10:1545-7. [PMID: 25145425 DOI: 10.2217/fon.14.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kasenda B, Schandelmaier S, Sun X, von Elm E, You J, Blümle A, Tomonaga Y, Saccilotto R, Amstutz A, Bengough T, Meerpohl JJ, Stegert M, Olu KK, Tikkinen KAO, Neumann I, Carrasco-Labra A, Faulhaber M, Mulla SM, Mertz D, Akl EA, Bassler D, Busse JW, Ferreira-González I, Lamontagne F, Nordmann A, Gloy V, Raatz H, Moja L, Rosenthal R, Ebrahim S, Vandvik PO, Johnston BC, Walter MA, Burnand B, Schwenkglenks M, Hemkens LG, Bucher HC, Guyatt GH, Briel M. Subgroup analyses in randomised controlled trials: cohort study on trial protocols and journal publications. BMJ 2014; 349:g4539. [PMID: 25030633 PMCID: PMC4100616 DOI: 10.1136/bmj.g4539] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the planning of subgroup analyses in protocols of randomised controlled trials and the agreement with corresponding full journal publications. DESIGN Cohort of protocols of randomised controlled trial and subsequent full journal publications. SETTING Six research ethics committees in Switzerland, Germany, and Canada. DATA SOURCES 894 protocols of randomised controlled trial involving patients approved by participating research ethics committees between 2000 and 2003 and 515 subsequent full journal publications. RESULTS Of 894 protocols of randomised controlled trials, 252 (28.2%) included one or more planned subgroup analyses. Of those, 17 (6.7%) provided a clear hypothesis for at least one subgroup analysis, 10 (4.0%) anticipated the direction of a subgroup effect, and 87 (34.5%) planned a statistical test for interaction. Industry sponsored trials more often planned subgroup analyses compared with investigator sponsored trials (195/551 (35.4%) v 57/343 (16.6%), P<0.001). Of 515 identified journal publications, 246 (47.8%) reported at least one subgroup analysis. In 81 (32.9%) of the 246 publications reporting subgroup analyses, authors stated that subgroup analyses were prespecified, but this was not supported by 28 (34.6%) corresponding protocols. In 86 publications, authors claimed a subgroup effect, but only 36 (41.9%) corresponding protocols reported a planned subgroup analysis. CONCLUSIONS Subgroup analyses are insufficiently described in the protocols of randomised controlled trials submitted to research ethics committees, and investigators rarely specify the anticipated direction of subgroup effects. More than one third of statements in publications of randomised controlled trials about subgroup prespecification had no documentation in the corresponding protocols. Definitive judgments regarding credibility of claimed subgroup effects are not possible without access to protocols and analysis plans of randomised controlled trials.
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