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Van Norman GA. Data Safety and Monitoring Boards Should Be Required for Both Early- and Late-Phase Clinical Trials. JACC Basic Transl Sci 2021; 6:887-896. [PMID: 34869954 PMCID: PMC8617574 DOI: 10.1016/j.jacbts.2021.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Gail A. Van Norman
- Address for correspondence: Dr Gail A. Van Norman, Department of Anesthesia and Pain Medicine, University of Washington, 2601 West Boston Street, Seattle, Washington 98199, USA.
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2
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Schöffski P. Importance and role of independent data monitoring committees (IDMCs) in oncology clinical trials. BMJ Open 2021; 11:e047294. [PMID: 34697110 PMCID: PMC8547363 DOI: 10.1136/bmjopen-2020-047294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The role and use of independent data monitoring committees (IDMCs) has evolved over the past decades. The Food and Drug Administration and European Medicines Agency have issued guidelines on the role and functioning of such committees. In general, data monitoring committees are recommended for large, often randomised clinical trials involving life-threatening diseases, studies performed in vulnerable populations or where the experimental intervention can potentially harm the trial participant. Such committees play an important role in trials evaluating treatments with the potential to prolong life or reduce the risk of major adverse health outcomes.Typically, oncology clinical trials fall within these recommendations, as they are often large, randomised, multicentric protocols aiming at improving survival outcomes by exploring the use of study treatments that may be associated with a significant risk of serious, even life-threatening adverse events. IDMCs are required for National Cancer Institute phase III randomised trials, European Organisation for Research and Treatment of Cancer phase II/III trials with formal interim analyses, early-stopping rules or adaptive studies. The primary role of an IDMC of ensuring the safety of study participants and maintaining clinical trial integrity is particularly important in oncology trials, due to the nature of the disease, the potential for treatment toxicity and for instilling confidence that the clinical trial data are reliable. A clear understanding by IDMC members of the natural course of the disease, treatment landscape, importance and relevance of certain adverse events in trial participants, clinical trial methodology in general and stopping rules for oncology trials in particular, is crucial for the functioning of an IDMC.It is recommended that IDMC members should be experienced trialists, have a track record of strong clinical, statistical and/or methodological expertise and the required level of independence, as they play a highly important role in the protection of study participants, and in commercially and strategically important go/no decisions. Ideally, IDMC members should have relevant experience or have some training, mentorship or guidelines.
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Affiliation(s)
- P Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, KU Leuven, Leuven Cancer Institute, Leuven, Belgium
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3
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Holbein B, Rape MT, Hammack BN, Melvin A, Reider C, Knox TA. Institutionally chartered Data and Safety Monitoring Boards: structured approaches to assuring participant safety in clinical research. J Investig Med 2021; 69:1050-1055. [PMID: 34074706 DOI: 10.1136/jim-2021-001779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 11/04/2022]
Abstract
Data and Safety Monitoring Boards (DSMBs) derived from the need to monitor large federally funded multi-center clinical trials and evolved to include commercial and other large and complex trials. Eventually, academic health centers also created institutionally focused trial monitoring mechanisms. The basic general principles that define traditional DSMBs extend to the institutional level. The primary responsibilities are assuring safety of the participants, preserving the integrity of the trial, and ensuring the reliability of the results. Institutionally chartered DSMBs meet these responsibilities but usually have fewer members, have a structure specific to the needs of the trial, are more focused and/or have different scope reviewing smaller, single site, higher risk, and investigator-initiated studies and are flexible to accommodate institution-specific requirements and approaches. Their purpose is to meet the responsibilities of oversight for safety and data integrity, ensure proper study design, rigor and conduct, as well as provide statistical support appropriate to the setting of the research. Academic health centers should recognize the importance and existence of institution level safety and data monitoring and provide support as much as possible. Investigators should have sufficient resources available to assemble DSMBs. The Clinical and Translational Science Awards Collaborative DSMB Workgroup provides an online manual to assist investigators.
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Affiliation(s)
- Blair Holbein
- Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Marie T Rape
- North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Barbara N Hammack
- Colorado Clinical & Translational Sciences Institute, University of Colorado Denver - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ann Melvin
- Department of Pediatrics, Division of Pediatric Infectious Disease, University of Washington and Seattle Children's Research Institute, Seattle, Washington, USA .,Institute of Translational Health Sciences, University of Washington, Seattle, Washington, USA
| | - Carson Reider
- College of Public Health, The Ohio State University OSUMC, Columbus, Ohio, USA
| | - Tamsin A Knox
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.,Tufts Clinical and Translational Science Institute, Tufts University School of Medicine, Boston, Massachusetts, USA
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4
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Mütze T, Friede T. Data monitoring committees for clinical trials evaluating treatments of COVID-19. Contemp Clin Trials 2020; 98:106154. [PMID: 32961361 PMCID: PMC7833551 DOI: 10.1016/j.cct.2020.106154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/15/2020] [Indexed: 12/15/2022]
Abstract
The first cases of coronavirus disease 2019 (COVID-19) were reported in December 2019 and the outbreak of SARS-CoV-2 was declared a pandemic in March 2020 by the World Health Organization. This sparked a plethora of investigations into diagnostics and vaccination for SARS-CoV-2, as well as treatments for COVID-19. Since COVID-19 is a severe disease associated with a high mortality, clinical trials in this disease should be monitored by a data monitoring committee (DMC), also known as data safety monitoring board (DSMB). DMCs in this indication face a number of challenges including fast recruitment requiring an unusually high frequency of safety reviews, more frequent use of complex designs and virtually no prior experience with the disease. In this paper, we provide a perspective on the work of DMCs for clinical trials of treatments for COVID-19. More specifically, we discuss organizational aspects of setting up and running DMCs for COVID-19 trials, in particular for trials with more complex designs such as platform trials or adaptive designs. Furthermore, statistical aspects of monitoring clinical trials of treatments for COVID-19 are considered. Some recommendations are made regarding the presentation of the data, stopping rules for safety monitoring and the use of external data. The proposed stopping boundaries are assessed in a simulation study motivated by clinical trials in COVID-19.
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Affiliation(s)
- Tobias Mütze
- Statistical Methodology, Novartis Pharma AG, Basel, Switzerland
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany; DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.
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An Empirical Comparison of Statistical Methods for Missing Data in Randomized, Double-Blind, Placebo-Controlled, Phase 3 Clinical Trials for Chronic Pain and Lipid-Lowering Products. Ther Innov Regul Sci 2020; 54:1416-1427. [PMID: 32500449 DOI: 10.1007/s43441-020-00168-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Missing data are uncollected data but meaningful for the statistical analysis due to clinical relevancy of the data for properly specified estimands in clinical trials. Meanwhile the efforts to prevent or minimize missing data are commonly applied in clinical trials, in practice, missing data still occurs. Choosing a statistical method for imputation that deals with missing data targeting specified estimands provides the more reliable estimates of treatment effects. METHODS We considered longitudinal clinical settings that have different degrees of missing data and treatment effects, and simulated different missing mechanisms using data from randomized, double-blind, placebo-controlled phase 3 confirmatory clinical trials of approved drugs. We compared four commonly used statistical methods to deal with missing data in clinical trials. RESULTS We find that, when the data are missing not at random (MNAR) with higher missing rates, mixed model for repeated measurements (MMRM) method overestimates treatment difference. Pattern-mixture model estimates were seen to be more conservative in our studies than MMRM given MNAR assumptions, which are more realistic with missing data in clinical trials. CONCLUSIONS We emphasize the importance of prevention of missing data and specifying the estimand based on trial objectives beforehand. The specified proper estimand and the proper statistical method might be key features to value the clinical trial results despite missing data.
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Wang YB, Lv G, Xu FH, Ma LL, Yao YM. Comprehensive Survey of Clinical Trials Registration for Melanoma Immunotherapy in the ClinicalTrials.gov. Front Pharmacol 2020; 10:1539. [PMID: 31998135 PMCID: PMC6966167 DOI: 10.3389/fphar.2019.01539] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/27/2019] [Indexed: 12/24/2022] Open
Abstract
Objective: Comprehensively evaluate the immunotherapeutic clinical trials and provide reference for melanoma treatment and research. Methods: The website of ClinicalTrials.gov was searched to retrieve and download all registered clinical trials for melanoma immunotherapy on August 1 (updated on August 25), 2019. All registration trials met the inclusion criteria were collected regardless of the type of study, the status of recruitment, and the results of the study. The general characteristics, methodological characteristics, and the types of immunotherapeutic drugs included of these trials were analyzed. Results: Finally, 242 eligible trials were included and evaluated. Of them, 30.6% were completed, 16.9% were terminated, and two were withdrawn; 77.7% recruited less than 100 participants; 30.5% were randomized; 45.5% was single group assignment; 88.8% were not masked; the primary purpose was treatment; 44.2% had data on monitoring committees; 27.7% used US FDA-regulated immunization drugs; 78.5% without results posted; 43.0% were sponsored by the industry. Immunological checkpoint inhibitors were most often studied, with 53.6% of the trials involving PD-1, the most commonly studied was Nivolumab. Conclusions: Currently, most of the registered clinical trials for melanoma immunotherapy were interventional open-label trials. Most immunotherapy research hotspots were in the FDA-regulated drug product, and a few trials reported available test results. It is necessary to strengthen the supervision of results and explore and disseminate more effective and safe immunotherapy methods.
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Affiliation(s)
- Yan-Bo Wang
- Department of Microbiology and Immunology, Trauma Research Center, Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Gang Lv
- Department of General Surgery, The 8th Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Feng-Hua Xu
- Ward I of Internal Medicine, Beijing General Hospital of the Chinese People's Armed Police Force, Beijing, China
| | - Lin-Lu Ma
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yong-Ming Yao
- Department of Microbiology and Immunology, Trauma Research Center, Fourth Medical Center of the Chinese PLA General Hospital, Beijing, China
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Abstract
Major considerations in the provision of healthcare are availability, affordability, accessibility, and appropriateness, especially in the setting of heart failure where disease burden is growing, developments have been rapid and newer biomarkers, diagnostic and imaging techniques, monitoring systems, devices, procedures, and drugs have all been developed in a relatively short period of time. Many monitoring and diagnostic systems have been developed but the disproportionate cost of conducting trials of their effectiveness has limited their uptake. There are added complexities, in that the utilization of doctors for the supervision of the monitoring results may be optimal in one setting and not in another because of differences in the characteristics of organization of healthcare provision, making even interpretation of the trials we have had, still difficult to interpret. New technologies are continuously changing the approach to healthcare and will reshape the structure of the healthcare systems in the future. Mobile technologies can empower patients and carers by giving them more control over their health and social care needs and reducing their dependence on healthcare professionals for monitoring their health, but a significant problem is the integration of the multitude of monitored parameters with clinical data and the recognition of intervention thresholds. Digital technology can help, but we need to prove its cost/efficacy and how it will be paid for. Governments in many European countries and worldwide are trying to establish frameworks that promote the convergence of standards and regulations for telemedicine solutions and yet simultaneously health authorities are closely scrutinizing healthcare spending, with the objective of reducing and optimizing expenditure in the provision of health services. There are multiple factors to be considered for the reimbursement models associated with the implementation of physiological monitoring yet it remains a challenge in cash-strapped health systems.
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Affiliation(s)
- Giuseppe M C Rosano
- Department of Medical Sciences, Centre for Clinical, Basic Research IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
| | - Ilaria Spoletini
- Department of Medical Sciences, Centre for Clinical, Basic Research IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
- Corresponding author. Tel: +39 06 5225 2409, Fax: +39 06 5225 2465,
| | - Cristiana Vitale
- Department of Medical Sciences, Centre for Clinical, Basic Research IRCCS San Raffaele Pisana, via della Pisana, 235, 00163 Rome, Italy
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Ma LL, Qiu Y, Song MN, Chen Y, Qu JX, Li BH, Zhao MJ, Liu XC. Clinical Trial Registration and Reporting: Drug Therapy and Prevention of Cardiac-Related Infections. Front Pharmacol 2019; 10:757. [PMID: 31333470 PMCID: PMC6624234 DOI: 10.3389/fphar.2019.00757] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/11/2019] [Indexed: 12/18/2022] Open
Abstract
Objective: Clinical trials are the source of evidence. ClinicalTrials.gov is valuable for analyzing current conditions. Until now, the state of drug interventions for heart infections is unknown. The purpose of this study was to comprehensively assess the characteristics of trials on cardiac-related infections and the status of drug interventions. Methods: The website ClinicalTrials.gov was used to obtain all registered clinical trials on drug interventions for cardiac-related infections as of February 16, 2019. All registration studies were collected, regardless of their recruitment status, research results, and research type. Registration information, results, and weblink-publications of those trials were analyzed. Results: A total of 45 eligible trials were evaluated and 86.7% of them began from or after 2008 while 91.1% of them adopted interventional study design. Of all trials, 35.6% were completed and 15.6% terminated. Besides, 62.2% of interventional clinical trials recruited more than 100 subjects. Meanwhile, 86.7% of the eligible trials included adult subjects only. Of intervention trials, 65.8% were in the third or fourth phase; 78.1% adopted randomized parallel assignment, containing two groups; 53.6% were masking, and 61.0% described treatment. Moreover, 41.5% of the trials were conducted in North America while 29.3% in Europe. Sponsors for 40.0% of the studies were from the industry. Furthermore, 48.9% of the trials mentioned information on monitoring committees, 24.4% have been published online, and 13.3% have uploaded their results. Drugs for treatments mainly contained antibiotics, among which glycopeptides, β-lactams, and lipopeptides were the most commonly studied ones in experimental group, with the former ones more common. Additionally, 16.2% of the trials evaluated new antimicrobials. Conclusions: Most clinical trials on cardiac-related infections registered at ClinicalTrials.gov were interventional randomized controlled trials (RCTs) for treatment. Most drugs focused in trials were old antibiotics, and few trials reported valid results. It is necessary to strengthen supervision over improvements in results, and to combine antibacterial activity with drug delivery regimens to achieve optimal clinical outcomes.
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Affiliation(s)
- Lin-Lu Ma
- Department of Cardiology, First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China.,Center for Evidence-Based and Translational Medicine, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Yang Qiu
- Cardiovascular Department, Kaifeng Central Hospital, Kaifeng, China
| | - Mei-Na Song
- Department of Nursing, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Yun Chen
- Department of Cardiology, First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China.,Center for Evidence-Based and Translational Medicine, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Jian-Xin Qu
- Department of Cardiology, First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China.,Center for Evidence-Based and Translational Medicine, Henan University of Traditional Chinese Medicine, Zhengzhou, China
| | - Bing-Hui Li
- Center for Evidence-Based Medicine, Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, China
| | - Ming-Juan Zhao
- Center for Evidence-Based Medicine, Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, China.,Department of Cardiology, The First Affiliated Hospital of Henan University, Kaifeng, China
| | - Xin-Can Liu
- Department of Cardiology, First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou, China.,Center for Evidence-Based and Translational Medicine, Henan University of Traditional Chinese Medicine, Zhengzhou, China
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9
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Moffatt-Bruce SD, D'Amico TA, Weisel RD, Sade RM. The Aggressive Cholesterol Therapy to Inhibit Vein Graft Events trial: To continue or not? How to answer the question. J Thorac Cardiovasc Surg 2018; 157:164-165. [PMID: 30396741 DOI: 10.1016/j.jtcvs.2018.09.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Susan D Moffatt-Bruce
- Division of Thoracic Surgery, Department of Surgery, The Ohio State University, Columbus, Ohio.
| | - Thomas A D'Amico
- Section of General Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Richard D Weisel
- Division of Cardiovascular Surgery, Toronto General Hospital and Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Robert M Sade
- Division of Cardiothoracic Surgery, Department of Surgery, Institute of Human Values in Health Care, Medical University of South Carolina, Charleston, SC
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Ferrari R, Bueno H, Chioncel O, Cleland JG, Stough WG, Lettino M, Metra M, Parissis JT, Pinto F, Ponikowski P, Ruschitzka F, Tavazzi L. Acute heart failure: lessons learned, roads ahead. Eur J Heart Fail 2018. [DOI: 10.1002/ejhf.1169] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Roberto Ferrari
- Department of Cardiology and LTTA Centre; University Hospital of Ferrara; Ferrara Italy
- Maria Cecilia Hospital, GVM Care & Research; E.S. Health Science Foundation; Cotignola Italy
| | - Héctor Bueno
- Department of Cardiology; Hospital 12 de Octubre; Madrid Spain
| | - Ovidiu Chioncel
- University of Medicine Carol Davila Bucuresti; Institutul de Urgente Boli Cardiovasculare CC; Iliescu Romania
| | - John G. Cleland
- National Heart & Lung Institute; Harefield Hospital, Imperial College; London UK
| | - Wendy Gattis Stough
- Departments of Pharmacy Practice and Clinical Research; Campbell University College of Pharmacy and Health Sciences; Cary NC USA
| | | | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health; University of Brescia; Brescia Italy
| | | | - Fausto Pinto
- Departamento de Cardiologia, CCUL, CAML, Faculdade de Medicina; Universidade de Lisboa; Lisbon Portugal
| | - Piotr Ponikowski
- Medical University, Centre for Heart Disease; Clinical Military Hospital; Wroclaw Poland
| | - Frank Ruschitzka
- Department of Cardiology; University Heart Center; Zürich Switzerland
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research; E.S. Health Science Foundation; Cotignola Italy
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11
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Rosano GM, Seferovic P, Farmakis D, Filippatos G. Renin inhibition in heart failure and diabetes: the real story. Eur J Heart Fail 2017; 20:149-151. [DOI: 10.1002/ejhf.1072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 10/05/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Giuseppe M.C. Rosano
- Cardiovascular Clinical Academic Group; St George's Hospitals NHS Trust University of London; London UK
- IRCCS San Raffaele Roma; Rome Italy
| | - Petar Seferovic
- Department of Cardiology; University of Belgrade; Belgrade Serbia
| | - Dimitrios Farmakis
- Heart Failure Unit, Department of Cardiology; Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine; Athens Greece
| | - Gerasimos Filippatos
- Heart Failure Unit, Department of Cardiology; Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine; Athens Greece
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12
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Swedberg K. Lessons for the monitoring of safety in clinical trials. Eur J Heart Fail 2017; 20:148. [PMID: 29193642 DOI: 10.1002/ejhf.1085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/25/2017] [Indexed: 11/05/2022] Open
Affiliation(s)
- Karl Swedberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and National Heart and Lung Institute, Imperial College, London, UK
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13
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Metra M, Ravera A, Filippatos G. Understanding worsening heart failure as a therapeutic target: another step forward? Eur J Heart Fail 2017; 19:996-1000. [DOI: 10.1002/ejhf.866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 03/31/2017] [Indexed: 11/06/2022] Open
Affiliation(s)
- Marco Metra
- Cardiology Department of Medical and Surgical Specialties, Radiological Sciences and Public Health; University of Brescia; Brescia Italy
| | - Alice Ravera
- Cardiology Department of Medical and Surgical Specialties, Radiological Sciences and Public Health; University of Brescia; Brescia Italy
| | - Gerasimos Filippatos
- Department of Cardiology, School of Medicine; National and Kapodistrian University of Athens, Athens University Hospital Attikon; Athens Greece
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14
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Metra M. April 2017 at a glance: cardiomyopathies and clinical trials. Eur J Heart Fail 2017; 19:447-448. [DOI: 10.1002/ejhf.831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 02/27/2017] [Accepted: 03/07/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health; University of Brescia; Italy
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