WITHDRAWN: Cardio-cerebrovascular protective effects of valsartan in high-risk hypertensive patients with overweight/obesity: A post-hoc analysis of the KYOTO HEART Study

Changes in Drug Utilization After Publication of Clinical Trials and Drug-Related Scandals in Japan: An Interrupted Time Series Analysis, 2005-2017

BACKGROUND

Breaches of ethics undermine the practice of medicine. In Japan, two major scandals involving clinical research and drug marketing occurred after the publication of clinical trials. To study the effects of those scandals, we evaluated changes in the use of first-generation angiotensin II receptor blockers (ARBs) after publication of relevant clinical trials and also after the subsequent scandals.

METHODS

We conducted a quasi-experimental design of an interrupted time series analysis (ITSA) on nationwide monthly drug-market data covering 12 years (2005 to 2017) in Japan. The main outcome was the use of first-generation ARBs (valsartan, candesartan, and losartan). The two exposures were the publication of ARB-related clinical-trial results (October 2006) and subsequent ARB-related scandals involving research and marketing (February 2013). A generalized estimating equation model was fitted for ITSA with a log link, Poisson distribution, robust variance estimators, and seasonality adjustment.

RESULTS

The publication of clinical trials was associated with 12% increase in the use of first-generation ARBs in Japan, and the subsequent ARB-related scandals was associated with 19% decrease. The decrease in the use of first-generation ARBs after the scandals was greater than the increase in their use after the publication of clinical-trial results. The net effect of the two exposures was a 9% decrease in the use of first-generation ARBs.

CONCLUSIONS

The scandals were associated with decrease in the use of first-generation ARBs, and that decrease was greater than the increase associated with the publication of "successful" clinical trials, making the net effect not zero but negative.

Effects of blood pressure lowering on cardiovascular risk according to baseline body-mass index: a meta-analysis of randomised trials

BACKGROUND

The cardiovascular benefits of blood pressure lowering in obese people compared with people of normal weight might depend on choice of drug. We compared the effects of blood pressure-lowering regimens on cardiovascular risk in groups of patients categorised by baseline body-mass index (BMI).

METHODS

We used individual patient data from trials included in the Blood Pressure Lowering Treatment Trialists' Collaboration to compare the effects of different classes of blood pressure-lowering regimens for the primary outcome of total major cardiovascular events (stroke, coronary heart disease, heart failure, and cardiovascular death). We used meta-analyses and meta-regressions to assess interactions between treatment and BMI when fitted as either a categorical variable (<25 kg/m(2), 25 to <30 kg/m(2), and ≥30 kg/m(2)) or a continuous variable.

FINDINGS

Analyses were based on 135,715 individuals from 22 trials who had 14,353 major cardiovascular events. None of the six primary comparisons showed evidence that protection varied by drug class across the three BMI groups (all p for trend >0·20). When analysed as a continuous variable, angiotensin-converting-enzyme inhibitors gave slightly greater protection for each 5 kg/m(2) higher BMI than did calcium antagonists (hazard ratio 0·93, 95% CI 0·89-0·98; p=0·004) or diuretics (0·93, 0·89-0·98; p=0·002). The meta-regressions showed no relation between BMI category and the risk reduction for a given fall in systolic blood pressure. By contrast with a previous report, we noted no relation between BMI and the efficacy of calcium antagonists compared with diuretics.

INTERPRETATION

We found little evidence that selection of a particular class of blood pressure-lowering drug will lead to substantially different outcomes for individuals who are obese compared with those who are lean.

FUNDING

None.

[Quality and integrity in the production and publication of scientific results: data trimming, manipulation and (self) plagiarism]

The publication of scientific manuscripts is an essential part in the research process and in the attempt to produce novel knowledge: only what is published exists. It is the aim of research to produce reproducible and sustainable knowledge. Reproducible knowledge is based on precise observation, the use of modern methodologies and an appropriate statistical analysis. As a consequence, it must be the intention of any scientist to report the truth and nothing but the truth. This principle requires precision and honesty. Deviation from such a behavior may lead to scientific misconduct: It encompasses the use of inappropriate methods and/or statistics, double publication of data, sloppy data presentation and processing, up to data massaging, manipulation, data theft or fabrication. Famous examples can be found throughout the history of research but it appears that such behavior has recently become more common possibly due to excessive competition, the crucial role of grants for scientific productivity and funding as well as promotion. Accordingly, in the training of researchers it seems essential to emphasize the importance of precise data acquisition and analysis to ascertain reproducible data. Similarly, it must be assured that data sets are only published once, that authors have contributed technically and/or intellectually in an important manner and that the work of other scientists is cited appropriately. Editors and reviewers should carefully assess the quality of submitted manuscripts. In fact, it is the aim of the peer review process to assure as much as possible that the quality of submitted manuscripts meets current methodological as well as ethical standards.