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Hamilton F, Arnold D, Lilford R. Bad research is not all bad. Trials 2023; 24:680. [PMID: 37864198 PMCID: PMC10588138 DOI: 10.1186/s13063-023-07706-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 10/04/2023] [Indexed: 10/22/2023] Open
Abstract
In this commentary, we discuss a recent article in Trials that raised concerns about the number of poorly performed randomised trials in the medical literature and discuss the trials literature more widely. Although we all aim for higher methodological standards in trials, we argue that (i) the idea that 'most randomised trials are bad', which the recent article concludes is an overly simplistic representation of the situation, and (ii) the suggestion that an increased focus on methodological review during trial development (e.g. ethical boards performing some assessment of the methodologists on a trial), while well meaning, may have negative unintended consequences. We therefore propose that (a) trials should be assessed on their merits and weaknesses, including an assessment of risk of bias but placing that in a wider context; (b) we should recognise that although the methodological conduct of trials is of utmost importance, interventions that aim to improve this could have unintended consequences-such as bureaucracy-that have an overall negative effect; and (c) we should therefore generate an evidence base for policy interventions to improve conduct of trials rather than applying arbitrary rules.
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Affiliation(s)
- Fergus Hamilton
- Infection Science, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK.
- MRC Integrative Epidemiology Unit, Oakfield House, University of Bristol, Bristol, BS10 5NB, UK.
| | - David Arnold
- MRC Integrative Epidemiology Unit, Oakfield House, University of Bristol, Bristol, BS10 5NB, UK
- Academic Respiratory Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - Richard Lilford
- NIHR ARC West Midlands, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Concato J, Horwitz RI. Limited Usefulness of Meta-Analysis for Informing Patient Care. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:257-262. [PMID: 31416087 DOI: 10.1159/000502530] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Accepted: 08/06/2019] [Indexed: 11/19/2022]
Affiliation(s)
- John Concato
- Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA, .,Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, USA,
| | - Ralph I Horwitz
- Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
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Recovery of metabolic impairment in patients who cleared chronic hepatitis C infection after direct-acting antiviral therapy. Int J Antimicrob Agents 2018; 53:559-563. [PMID: 30550818 DOI: 10.1016/j.ijantimicag.2018.11.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/19/2018] [Accepted: 11/24/2018] [Indexed: 02/06/2023]
Abstract
Chronic hepatitis C (CHC) is a complex disease that can affect different metabolic processes, including glucose and lipid metabolic pathways, with a significant impact on the development of heart disease and stroke. Recent therapy with direct-acting antivirals (DAAs), beyond its high efficacy on CHC eradication, showed a beneficial impact on glucose and lipid metabolism. This review aimed to describe current evidence regarding the association between hepatitis C virus (HCV) infection and impairment of glucose and lipid metabolism and also discusses potential public-health implications in light of the new DAA therapies and their availability at a global level. The excellent safety profile and efficacy of DAAs offer an exceptional opportunity to control the HCV pandemic at a global level and represent an opportunity for developing an operational research framework aimed at investigating the complex dynamics between host, pathogen and therapy that lead to metabolic damage in subjects with infectious diseases.
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Lanini S, Pisapia R, Capobianchi MR, Ippolito G. Global epidemiology of viral hepatitis and national needs for complete control. Expert Rev Anti Infect Ther 2018; 16:625-639. [PMID: 30067107 DOI: 10.1080/14787210.2018.1505503] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION The World Health Organization recognizes that viral hepatitis is not only a massive public health issue but also a huge opportunity to improve quality of life and equity at a global level. Viral hepatitis causes about 1.5 million deaths each year and significantly affects the quality of life of hundreds of millions of people. To date, frail individuals in high-income countries and people living in low-income settings are paying the heaviest tool. Areas covered. Here we present a broad discussion on current knowledge and topical issues about the hepatitis pandemic. The report includes a structured overview of global epidemiology, including the definition of specific local epidemic profiles for each hepatitis agents (HAV, HBV, HCV, and HEV), and a perspective about the critical actions needed for achieving a complete control. Expert commentary. The control of viral hepatitis is currently, ethically urgent and even economically convenient. There is a wide consensus that viral hepatitis can be controlled through comprehensive intervention tailored on local needs addressing the issue of viral hepatitis as a unique public health issue. These strategies should include: (1) primary prevention (including vaccination and improved infection control), (2) improving diagnosis rate, and (3) management of existing cases of infections.
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Affiliation(s)
- Simone Lanini
- a Dipartimento Epidemiologia, Ricerca Preclinica e Diagnostica Avanzata , National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS , Rome , Italy
| | - Raffaella Pisapia
- a Dipartimento Epidemiologia, Ricerca Preclinica e Diagnostica Avanzata , National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS , Rome , Italy
| | - Maria Rosaria Capobianchi
- a Dipartimento Epidemiologia, Ricerca Preclinica e Diagnostica Avanzata , National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS , Rome , Italy
| | - Giuseppe Ippolito
- a Dipartimento Epidemiologia, Ricerca Preclinica e Diagnostica Avanzata , National Institute for Infectious Diseases Lazzaro Spallanzani-IRCCS , Rome , Italy
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Lanini S, Scognamiglio P, Mecozzi A, Lombardozzi L, Vullo V, Angelico M, Gasbarrini A, Taliani G, Attili AF, Perno CF, De Santis A, Puro V, Cerqua F, D’Offizi G, Pellicelli A, Armignacco O, Mennini FS, Siciliano M, Girardi E, Panella V, Ippolito G. Impact of new DAA therapy on real clinical practice: a multicenter region-wide cohort study. BMC Infect Dis 2018; 18:223. [PMID: 29769038 PMCID: PMC5956792 DOI: 10.1186/s12879-018-3125-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 04/30/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Management of chronic hepatitis C (CHC) has significantly accelerated in the last few years. Currently, second generation direct acting antivirals (DAAs) promise clearance of infection in most of patients. Here we present the results of the first analysis carried out on data of Lazio clinical network for DAAs. METHODS The study was designed as a multicenter cohort: a) to assess the evolution of treatment during the first 24 months of the activity of the Clinical Network; b) to report overall efficacy of treatments; c) to analyze potential factors associated with lack of virological response at 12 weeks after therapy (SVR12); d) to evaluate the variation of ALT at baseline and 12 weeks after therapy in those who achieved SVR12 in comparison to those who did not. Analyses of efficacy were carried out with multilevel mixed effect logistic regression model. ALT temporal variation was assessed by mixed effect model mixed models with random intercept at patient's level and random slope at the level of the time; i.e. either before or after therapy. RESULTS Between 30 December 2014 and 31 December 2016 5279 patients started a DAA treatment; of those, 5127 (in 14 clinical centers) had completed the 12-week follow-up. Overall proportion of SVR12 was 93.41% (N = 4780) with no heterogeneity between the 14 clinical centers. Interruption as the consequence of severe side effect was very low (only 23 patients). Unadjusted analysis indicates that proportion of SVR12 significantly changes according to patient's baseline characteristics, however after adjusting for potential confounders only adherence to current guidelines, stage of liver diseases, gender, transplant and HIV status were independently associated with the response to therapy. Analysis of ALT temporal variation showed that ALT level normalized in most, but not, all patients who achieved SVR12. CONCLUSION Our study confirmed the extraordinary efficacy of DAAs outside clinical trials. The advantage of DAAs was particularly significant for those patients who were previously considered as difficult-to-treat and did not have treatment options before DAAs era. Intervention based on network of select centers and prioritization of patients according to diseases severity was successful. Further studies are needed to establish whether clearance of HCV after DAAs therapy can arrest or even revert liver fibrosis in non-cirrhotic patients and/or improve life quality and expectancy in those who achieve SVR12 with cirrhosis.
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Affiliation(s)
- Simone Lanini
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
- Servizio Regionale per la Sorveglianza delle Malattie infettive (SeRESMI), Rome, Italy
| | - Paola Scognamiglio
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
- Servizio Regionale per la Sorveglianza delle Malattie infettive (SeRESMI), Rome, Italy
| | - Alessandra Mecozzi
- Regione Lazio Direzione Regionale Salute e Politiche Sociali, Rome, Italy
| | | | - Vincenzo Vullo
- Dipartimento di Sanità Pubblica e Malattie Infettive Sapienza Università di Roma, Rome, Italy
| | - Mario Angelico
- Unità di Epatologia e Trapianti, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Antonio Gasbarrini
- Gastroenterologia, Fondazione Policlinico Gemelli, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Gloria Taliani
- Dipartimento di Medicina Clinica Sapienza, Università di Roma, Rome, Italy
| | | | - Carlo Federico Perno
- Department of Experimental Medicine and Surgery, University of Roma Tor Vergata, Rome, Italy
| | - Adriano De Santis
- Dipartimento di Medicina Clinica Sapienza, Università di Roma, Rome, Italy
| | - Vincenzo Puro
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
- Servizio Regionale per la Sorveglianza delle Malattie infettive (SeRESMI), Rome, Italy
| | | | - Gianpiero D’Offizi
- UOC Malattie Infettive Epatologia Dipartimento Interaziendale Trapianti National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Adriano Pellicelli
- UOC Malattie del Fegato Dipartimento Interaziendale Trapianti AO San Camillo Forlanini Roma, Rome, Italy
| | | | - Francesco Saverio Mennini
- EEHTA CEIS, Università di Roma “Tor Vergata” e Institute of Leadership and Management in Health, Kingston University, London, UK
| | - Massimo Siciliano
- Gastroenterologia, Fondazione Policlinico Gemelli, Universita’ Cattolica del Sacro Cuore, Rome, Italy
| | - Enrico Girardi
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Vincenzo Panella
- Servizio Regionale per la Sorveglianza delle Malattie infettive (SeRESMI), Rome, Italy
| | - Giuseppe Ippolito
- National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
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