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Rivard L, Nault I, Krahn AD, Daneault B, Roux JF, Natarajan M, Healey JS, Quadros K, Sandhu RK, Kouz R, Greiss I, Leong-Sit P, Gourraud JB, Ben Ali W, Asgar A, Aguilar M, Bonan R, Cadrin-Tourigny J, Cartier R, Dorval JF, Dubuc M, Dürrleman N, Dyrda K, Guerra P, Ibrahim M, Ibrahim R, Macle L, Mondesert B, Moss E, Raymond-Paquin A, Roy D, Tadros R, Thibault B, Talajic M, Nozza A, Guertin MC, Khairy P. Rationale and Design of the Randomized Bayesian Multicenter COME-TAVI Trial in Patients With a New Onset Left Bundle Branch Block. CJC Open 2023; 5:611-618. [PMID: 37720184 PMCID: PMC10502429 DOI: 10.1016/j.cjco.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/22/2023] [Indexed: 09/19/2023] Open
Abstract
Patients with new-onset left bundle branch block (LBBB) after transcatheter aortic valve implantation (TAVI) are at risk of developing delayed high-degree atrioventricular block. Management of new-onset LBBB post-TAVI remains controversial. In the Comparison of a Clinical Monitoring Strategy Versus Electrophysiology-Guided Algorithmic Approach in Patients With a New LBBB After TAVI (COME-TAVI) trial, consenting patients with new-onset LBBB that persists on day 2 after TAVI, meeting exclusion/inclusion criteria, are randomized to an electrophysiological study (EPS)-guided approach or 30-day electrocardiographic monitoring. In the EPS-guided approach, patients with a His to ventricle (HV) interval ≥ 65 ms undergo permanent pacemaker implantation. Patients randomized to noninvasive monitoring receive a wearable continuous electrocardiographic recording and transmitting device for 30 days. Follow-up will be performed at 3, 6, and 12 months. The primary endpoint is a composite outcome designed to capture net clinical benefit. The endpoint incorporates major consequences of both strategies in patients with new-onset LBBB after TAVI, as follows: (i) sudden cardiac death; (ii) syncope; (iii) atrioventricular conduction disorder requiring a pacemaker (for a class I or IIa indication); and (iv) complications related to the pacemaker or EPS. The trial incorporates a Bayesian design with a noninformative prior, outcome-adaptive randomization (initially 1:1), and 2 prespecified interim analyses once 25% and 50% of the anticipated number of primary endpoints are reached. The trial is event-driven, with an anticipated upper limit of 452 patients required to reach 77 primary outcome events over 12 months of follow-up. In summary, the aim of this Bayesian multicentre randomized trial is to compare 2 management strategies in patients with new-onset LBBB post-TAVI-an EPS-guided approach vs noninvasive 30-day monitoring. Trial registration number: NCT03303612.
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Affiliation(s)
- Lena Rivard
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Isabelle Nault
- Department of Cardiology, Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Andrew D. Krahn
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Benoit Daneault
- Department of Cardiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Jean-Francois Roux
- Department of Cardiology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Madhu Natarajan
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Kenneth Quadros
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Roopinder K. Sandhu
- Division of Cardiology, Department of Medicine, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Remi Kouz
- Department of Cardiology, Hopital Sacre-Coeur de Montreal, Montreal, Quebec, Canada
| | - Isabelle Greiss
- Department of Cardiology, Centre Hospitalier de Université de Montréal, Montreal, Quebec, Canada
| | - Peter Leong-Sit
- Department of Cardiology, Western University, London, Ontario, Canada
| | | | - Walid Ben Ali
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Anita Asgar
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Martin Aguilar
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Raoul Bonan
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Julia Cadrin-Tourigny
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Raymond Cartier
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Francois Dorval
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Marc Dubuc
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Nicolas Dürrleman
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Katia Dyrda
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Peter Guerra
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Marina Ibrahim
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Reda Ibrahim
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Laurent Macle
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Blandine Mondesert
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Emmanuel Moss
- Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Alexandre Raymond-Paquin
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Denis Roy
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Rafik Tadros
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Bernard Thibault
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Mario Talajic
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Anna Nozza
- Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Paul Khairy
- Department of Cardiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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Liu S, Gao J, Zheng Y, Huang L, Yan F. Bayesian Two-Stage Adaptive Design in Bioequivalence. Int J Biostat 2019; 16:ijb-2018-0105. [PMID: 31302643 DOI: 10.1515/ijb-2018-0105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 06/26/2019] [Indexed: 11/15/2022]
Abstract
Bioequivalence (BE) studies are an integral component of new drug development process, and play an important role in approval and marketing of generic drug products. However, existing design and evaluation methods are basically under the framework of frequentist theory, while few implements Bayesian ideas. Based on the bioequivalence predictive probability model and sample re-estimation strategy, we propose a new Bayesian two-stage adaptive design and explore its application in bioequivalence testing. The new design differs from existing two-stage design (such as Potvin's method B, C) in the following aspects. First, it not only incorporates historical information and expert information, but further combines experimental data flexibly to aid decision-making. Secondly, its sample re-estimation strategy is based on the ratio of the information in interim analysis to total information, which is simpler in calculation than the Potvin's method. Simulation results manifested that the two-stage design can be combined with various stop boundary functions, and the results are different. Moreover, the proposed method saves sample size compared to the Potvin's method under the conditions that type I error rate is below 0.05 and statistical power reaches 80 %.
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Affiliation(s)
- Shengjie Liu
- Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing210009, P.R. China
| | - Jun Gao
- Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing210009, P.R. China
| | - Yuling Zheng
- Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing210009, P.R. China
| | - Lei Huang
- Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing210009, P.R. China
| | - Fangrong Yan
- Research Center of Biostatistics and Computational Pharmacy, China Pharmaceutical University, Nanjing210009, P.R. China
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Holubkov R, Casper TC, Dean JM, Anand KJS, Zimmerman J, Meert KL, Newth CJL, Berger J, Harrison R, Willson DF, Nicholson C. The role of the Data and Safety Monitoring Board in a clinical trial: the CRISIS study. Pediatr Crit Care Med 2013; 14:374-83. [PMID: 23392377 PMCID: PMC3648617 DOI: 10.1097/pcc.0b013e318274568c] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Randomized clinical trials are commonly overseen by a Data and Safety Monitoring Board comprised of experts in medicine, ethics, and biostatistics. Data and Safety Monitoring Board responsibilities include protocol approval, interim review of study enrollment, protocol compliance, safety, and efficacy data. Data and Safety Monitoring Board decisions can affect study design and conduct, as well as reported findings. Researchers must incorporate Data and Safety Monitoring Board oversight into the design, monitoring, and reporting of randomized trials. DESIGN Case study, narrative review. METHODS The Data and Safety Monitoring Board's role during the comparative pediatric Critical Illness Stress-Induced Immune Suppression (CRISIS) Prevention Trial is described. FINDINGS The National Institutes of Health-appointed CRISIS Data and Safety Monitoring Board was charged with monitoring sample size adequacy and feasibility, safety with respect to adverse events and 28-day mortality, and efficacy with respect to the primary nosocomial infection/sepsis outcome. The Federal Drug Administration also requested Data and Safety Monitoring Board interim review before opening CRISIS to children below 1 yr of age. The first interim analysis found higher 28-day mortality in one treatment arm. The Data and Safety Monitoring Board maintained trial closure to younger children and requested a second interim data review 6 months later. At this second meeting, mortality was no longer of concern, whereas a weak efficacy trend of lower infection/sepsis rates in one study arm emerged. As over 40% of total patients had been enrolled, the Data and Safety Monitoring Board elected to examine conditional power and unmask treatment arm identities. On finding somewhat greater efficacy in the placebo arm, the Data and Safety Monitoring Board recommended stopping CRISIS due to futility. CONCLUSIONS The design and operating procedures of a multicenter randomized trial must consider a pivotal Data and Safety Monitoring Board role. Maximum study design flexibility must be allowed, and investigators must be prepared for protocol modifications due to interim findings. The Data and Safety Monitoring Board must have sufficient clinical and statistical expertise to assess potential importance of interim treatment differences in the setting of multiple looks at accumulating data with numerous outcomes and subgroups.
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Affiliation(s)
- Richard Holubkov
- Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA.
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