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Manswell K, Le V, Henry K, Casey M, Anumolu N, Putman MS. The State of Patient-Reported Outcome Measures in Rheumatology. J Rheumatol 2024; 51:920-927. [PMID: 38825357 DOI: 10.3899/jrheum.2023-1073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVE We sought to evaluate the quality and timeliness of patient-reported outcome (PRO) measure reporting, which have not been previously studied. METHODS Clinical trials that informed new US Food and Drug Administration (FDA) approvals for the first rheumatological indication between 1995 and 2021 were identified. Data were recorded to determine whether collected PROs were published, met minimum clinically important difference (MCID) or statistical significance (P < 0.05) thresholds, and were consistent with Consolidated Standards of Reporting Trials (CONSORT)-PRO standards. Hazard ratios and Kaplan-Meier estimate were used to assess the time from FDA approval to PRO publication. RESULTS Thirty-one FDA approvals corresponded with 110 pivotal trials and 262 reported PROs. Of the 90 included studies, 1 (1.1%) met all 5 recommended items, 10 (11.1%) met 4 items, 17 (18.9%) met 3 items, 21 (23.3%) met 2 items, 26 (28.9%) met 1 item, and 15 (16.7%) met none of the reporting standards. Most PROs met MCID thresholds (149/262; 56.9%) and were statistically significant (223/262; 85.1%). Of our subset analysis, one-third of PROs were not published upfront (70/212; 33%) and 1 of 9 (22/212; 10.4%) remained unpublished ≥ 4 years after initial trial reporting. Publication rates were highest for the Health Assessment Questionnaire-Disability Index (97.4%) and lowest for the 36-item Short Form Health Survey (81.8%). Less than half of these published PROs met MCID and statistical significance thresholds (94/212; 44.3%). CONCLUSION One in 9 PROs remained unpublished for ≥ 4 years after initial trial reporting, and compliance with CONSORT-PRO reporting guidelines was poor. Efforts should be made to ensure PROs are adequately reported and expeditiously published.
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Affiliation(s)
- Kenrick Manswell
- K. Manswell, BS, V. Le, BS, K. Henry, BS, M. Casey, BS, N. Anumolu, BS, M.S. Putman MD, MSci, Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Victoria Le
- K. Manswell, BS, V. Le, BS, K. Henry, BS, M. Casey, BS, N. Anumolu, BS, M.S. Putman MD, MSci, Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kathryn Henry
- K. Manswell, BS, V. Le, BS, K. Henry, BS, M. Casey, BS, N. Anumolu, BS, M.S. Putman MD, MSci, Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Maximilian Casey
- K. Manswell, BS, V. Le, BS, K. Henry, BS, M. Casey, BS, N. Anumolu, BS, M.S. Putman MD, MSci, Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Natalie Anumolu
- K. Manswell, BS, V. Le, BS, K. Henry, BS, M. Casey, BS, N. Anumolu, BS, M.S. Putman MD, MSci, Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael S Putman
- K. Manswell, BS, V. Le, BS, K. Henry, BS, M. Casey, BS, N. Anumolu, BS, M.S. Putman MD, MSci, Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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Gargula S, Babin E, Tuset MP, Daval M, Mattei A, Ayache D. French-language questionnaires in ENT: Inventory and review. Eur Ann Otorhinolaryngol Head Neck Dis 2024:S1879-7296(24)00099-1. [PMID: 39122589 DOI: 10.1016/j.anorl.2024.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
OBJECTIVE Patient-Reported Outcome Measures (PROMs) are now an integral part of clinical and academic practice in ENT, and it is essential to have tools with a validated French version. However, there are no guidelines on ENT questionnaires available in French or those that could have transcultural adaptation. METHODS The present study, under the auspices of the ENT National Professional Council and the French Society of ENT, inventoried PROMs, for each super-specialty and pathology, meeting one of the following inclusion criteria: validated French version, not translated but used internationally (i.e., translated into other languages and widely cited since 2017), or subjectively deemed useful by experts in the super-specialty in question. RESULTS In total, 103 questionnaires were identified. To encourage and accompany their intercultural adaptation and statistical validation, this article presents the rationale and methodology of such an undertaking. CONCLUSION PROMs either already validated in French or which it would be useful to translate were inventoried. The methodology of translation and validation to guarantee reliability and relevance is presented.
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Affiliation(s)
- S Gargula
- Service d'otorhinolaryngologie, hôpital La Conception - CHU de Marseille, 147, boulevard Baille, 13005 Marseille, France.
| | - E Babin
- Service d'otorhinolaryngologie, CHU de Caen-Normandie, 3, avenue du General-Harris, 14076 Caen, France
| | - M-P Tuset
- Service d'otorhinolaryngologie, hôpital Fondation Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France
| | - M Daval
- Service d'otorhinolaryngologie, hôpital Fondation Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France
| | - A Mattei
- Service d'otorhinolaryngologie, hôpital La Conception - CHU de Marseille, 147, boulevard Baille, 13005 Marseille, France
| | - D Ayache
- Service d'otorhinolaryngologie, hôpital Fondation Adolphe-de-Rothschild, 29, rue Manin, 75019 Paris, France
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Cleeland CS, Keating KN, Cuffel B, Elbi C, Siegel JM, Gerlinger C, Symonds T, Sloan JA, Dueck AC, Bottomley A, Wang XS, Williams LA, Mendoza TR. Developing a fit-for-purpose composite symptom score as a symptom burden endpoint for clinical trials in patients with malignant pleural mesothelioma. Sci Rep 2024; 14:14839. [PMID: 38937473 PMCID: PMC11211485 DOI: 10.1038/s41598-024-62307-5] [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: 04/16/2023] [Accepted: 05/15/2024] [Indexed: 06/29/2024] Open
Abstract
We developed a composite symptom score (CSS) representing disease-related symptom burden over time in patients with malignant pleural mesothelioma (MPM). Longitudinal data were collected from an open-label Phase IIB study in which 239 patients completed the validated MD Anderson Symptom Inventory for MPM (MDASI-MPM). A blinded, independent review committee of external patient-reported outcomes experts advised on MDASI-MPM symptoms to include in the CSS. Through iterative analyses of potential symptom-item combinations, 5 MPM symptoms (pain, fatigue, shortness of breath, muscle weakness, coughing) were selected. The CSS correlated strongly with the full MDASI-MPM symptom set (0.92-0.94) and the Lung Cancer Symptom Scale-Mesothelioma (0.79-0.87) at each co-administration of the scales. The CSS also had good sensitivity to worsening disease and global quality-of-life ratings. The MDASI-MPM CSS can be used as an outcome in MPM clinical trials, including in responder analyses and at the individual patient level. It is brief enough to administer frequently, including electronically, to better capture symptom trajectories during and after a trial and in clinical practice. As a single score, the CSS addresses multiplicity issues that can arise when several symptoms increase due to worsening disease. Our process can be adapted to produce a CSS for other advanced-cancer trials.
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Affiliation(s)
- Charles S Cleeland
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Symptom Assessment Systems, 1416 Marconi St, Houston, TX, USA
| | | | - Brian Cuffel
- Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA
| | - Cem Elbi
- Bayer HealthCare Pharmaceuticals, Whippany, NJ, USA
| | | | - Christoph Gerlinger
- Bayer AG, Berlin, Germany
- Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg/Saar, Germany
| | - Tara Symonds
- Clinical Outcomes Solutions, Folkestone, Kent, UK
| | - Jeff A Sloan
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Amylou C Dueck
- Section of Biostatistics, Division of Health Sciences Research, Mayo Clinic, Phoenix, AZ, USA
| | - Andrew Bottomley
- Quality of Life Department, European Organisation for Research and Treatment of Cancer, Brussels, Belgium
- Bottomley Consulting Group, Brussels, Belgium
| | - Xin Shelley Wang
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Loretta A Williams
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tito R Mendoza
- Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- National Cancer Institute Office of Patient-Centered Outcomes, National Institutes of Health, Bethesda, MD, 20814, USA.
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Meregaglia M, Malandrini F, Angelini S, Ciani O. The Assessment of Patient-Reported Outcomes for the Authorisation of Medicines in Europe: A Review of European Public Assessment Reports from 2017 to 2022. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:925-935. [PMID: 37659000 PMCID: PMC10627987 DOI: 10.1007/s40258-023-00827-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES Health regulators have progressively increased their attention and focus on patient-reported outcomes (PROs), driven by the diffusion of a patient-centred approach to the drug development process. This study investigates the consideration of PROs and their measures (PROMs) in the authorisation of medicines in Europe. METHODS All medicines for human use authorised or refused by the European Medicines Agency (EMA) in the period 2017-2022 were identified, and corresponding European Public Assessment Reports (EPARs) were downloaded for review. Medicine and PROs/PROM characteristics were systematically recorded. A multivariate logistic regression was performed to identify variables associated with the use of patient-reported evidence in EPARs. RESULTS Overall, 497 EPARs of authorised medicines and 19 EPARs of refused medicines were analysed; of these, 240 (48.3%) and 10 (52.6%), respectively, reported any use of PROs/PROMs (p = 0.710). For authorised medicines, the likelihood of using PROs/PROMs was negatively affected by generic (OR = 0.01, p < 0.001) and biosimilar status (OR = 0.46, p = 0.013) and positively affected by orphan status (OR = 1.41, p = 0.177). The use of PROMs (50.6% in 2017 vs 47.9% in 2022) did not show a clear pattern over the 6-year period considered (p = 0.758) and was particularly uncommon in some therapeutic areas (e.g., 15.2% in infectious diseases). A total of 816 dyads of PROs/PROMs were identified. On average each EPAR considered 1.6 (range: 0-14) instruments. Patient-reported outcomes were typically secondary (53.3%) and exploratory endpoints (18.8%); in one-third of cases (32.5%), they assessed generic quality of life. Among the PROMs, 227 (27.8%) targeted general population; EQ-5D (11.0%), SF-36/SF-12 (5.9%) and EORTC QLQ-C30 (5.6%) were the instruments most frequently used. CONCLUSIONS This study suggests PROs/PROMs are considered in less than half of total medicine assessments and even more rarely in some disease areas. The adoption of PROs is key in EMA strategy to 2025 and would be facilitated by consensus development on their measures and optimisation of data collection.
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Affiliation(s)
- Michela Meregaglia
- Centro di Ricerche sulla Gestione dell'Assistenza Sanitaria e Sociale (CERGAS), SDA Bocconi School of Management, Via Sarfatti 10, 20141, Milan, Italy
| | - Francesco Malandrini
- Centro di Ricerche sulla Gestione dell'Assistenza Sanitaria e Sociale (CERGAS), SDA Bocconi School of Management, Via Sarfatti 10, 20141, Milan, Italy
| | | | - Oriana Ciani
- Centro di Ricerche sulla Gestione dell'Assistenza Sanitaria e Sociale (CERGAS), SDA Bocconi School of Management, Via Sarfatti 10, 20141, Milan, Italy.
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Nishimura K, Kusunose M, Sanda R, Mori M, Shibayama A, Nakayasu K. Comparison of Predictive Properties between Tools of Patient-Reported Outcomes: Risk Prediction for Three Future Events in Subjects with COPD. Diagnostics (Basel) 2023; 13:2269. [PMID: 37443664 DOI: 10.3390/diagnostics13132269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) measures must be evaluated for their discriminatory, evaluative, and predictive properties. However, the predictive capability remains unclear. We aimed to examine the predictive properties of several PRO measures of all-cause mortality, acute exacerbation of chronic obstructive pulmonary disease (COPD), and associated hospitalization. METHODS A total of 122 outpatients with stable COPD were prospectively recruited and completed six self-administered paper questionnaires: the COPD Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ), Baseline Dyspnea Index (BDI), Dyspnoea-12, Evaluating Respiratory Symptoms in COPD and Hyland Scale at baseline. Cox proportional hazards analyses were conducted to examine the relationships with future outcomes. RESULTS A total of 66 patients experienced exacerbation, 41 were hospitalized, and 18 died. BDI, SGRQ Total and Activity, and CAT and Hyland Scale scores were significantly related to mortality (hazard ratio = 0.777, 1.027, 1.027, 1.077, and 0.951, respectively). The Hyland Scale score had the best predictive ability for PRO measures, but the C index did not reach the level of the most commonly used FEV1. Almost all clinical, physiological, and PRO measurements obtained at baseline were significant predictors of the first exacerbation and the first hospitalization due to it, with a few exceptions. CONCLUSIONS Measurement of health status and the global scale of quality of life as well as some tools to assess breathlessness, were significant predictors of all-cause mortality, but their predictive capacity did not reach that of FEV1. In contrast, almost all baseline measurements were unexpectedly related to exacerbation and associated hospitalization.
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Affiliation(s)
- Koichi Nishimura
- Visiting Researcher, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu 474-8511, Japan
- Clinic Nishimura, 4-3 Kohigashi, Kuri-cho, Ayabe 623-0222, Japan
| | - Masaaki Kusunose
- Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu 474-8511, Japan
| | - Ryo Sanda
- Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu 474-8511, Japan
| | - Mio Mori
- Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu 474-8511, Japan
| | - Ayumi Shibayama
- Department of Nursing, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu 474-8511, Japan
| | - Kazuhito Nakayasu
- Data Research Section, Kondo P.P. Inc., 17-25, Shimizudani-cho, Tennoujiku, Osaka 543-0011, Japan
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Morga A, Dibenedetto S, Adiutori R, Su J. Patient-reported outcomes validated in phase 3 clinical trials: a targeted literature review. Curr Med Res Opin 2023; 39:955-962. [PMID: 37337959 DOI: 10.1080/03007995.2023.2224164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Regulatory guidance advises validation of patient-reported outcome (PRO) instruments prior to use in pivotal clinical studies, which may then be used to generate critical patient-centered evidence and support labelling claims. This targeted literature review aimed to determine if PRO instruments psychometrically validated in a phase 3 trial setting could support label claims from the same phase 3 study (i.e. PRO data were generated as an endpoint). METHODS A targeted search of published studies (1 January 2006-3 June 2021) using the MEDLINE database identified PRO instruments validated during phase 3 trials. The search included instrument terms (e.g. patient-reported outcome measures, questionnaire, survey) and validation terms (e.g. reproducibility, minimal important difference), without filtering for therapeutic indications. Results were limited to phase 3 clinical trials or validation studies. The PROLABELS database was used to identify PROs validated in phase 3 trials and accepted in labelling claims. RESULTS Of 355 references identified, 68 studies with PRO psychometric validation in phase 3 studies were selected, covering 78 instruments. Of these, 20 were novel PRO instruments and 58 were existing instruments being validated for a new therapeutic indication/population. The psychometric properties most frequently validated were internal consistency reliability, known-group validity, responsiveness, minimal important difference, and concurrent validity. Five novel instruments obtained ten labelling claims for seven drugs/products. CONCLUSIONS These results suggest that quantitative validation of novel PRO instruments, and existing PROs for new indications, can occur within the context of phase 3 trials, and these PROs can also support label claims.
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Affiliation(s)
| | | | | | - Jun Su
- Astellas Pharma Inc, Westborough, MA, USA
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Bauer A, Thyssen JP, Buhl T, Nielsen TSS, Larsen LS, Østerskov AB, Agner T. Treatment with delgocitinib cream improves itch, pain and other signs and symptoms of chronic hand eczema: Results from the Hand Eczema Symptom Diary in a phase IIb randomized clinical trial. Contact Dermatitis 2023. [PMID: 37037780 DOI: 10.1111/cod.14303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Measuring patient-reported outcomes is crucial to fully capture the burden of chronic hand eczema (CHE). OBJECTIVES To assess the effect of delgocitinib cream on itch, pain and nine additional key signs and symptoms reported by patients with CHE using the Hand Eczema Symptom Diary (HESD). METHODS In a double-blind, phase IIb dose-ranging trial (NCT03683719), 258 adults with mild to severe CHE were randomized to delgocitinib cream 1, 3, 8 or 20 mg/g or cream vehicle twice daily for 16 weeks. Patients assessed 11 signs and symptoms of CHE daily through the HESD using an 11-point numeric rating scale; this was an exploratory endpoint. RESULTS Delgocitinib cream 20 mg/g was associated with an early and sustained reduction in itch and pain, along with clinically relevant reductions of ≥4 points from baseline to Week 16 in 48.4% and 63.6% of patients, respectively (17.9% and 5.9% with cream vehicle). There were improvements versus cream vehicle in all assessed CHE signs and symptoms (20 mg/g, p < 0.05). CONCLUSIONS Delgocitinib cream reduced itch, pain and other signs and symptoms in patients with CHE. This data correlated with clinician-reported outcomes, indicating that the HESD may be a useful assessment tool for CHE management.
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Affiliation(s)
- Andrea Bauer
- Department of Dermatology, University Allergy Center, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Jacob P Thyssen
- Department of Dermatology and Venereology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Timo Buhl
- Department of Dermatology, Venereology and Allergology, Georg August University, Göttingen, Germany
| | | | | | | | - Tove Agner
- Department of Dermatology and Venereology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Ly S, Miller J, Tong L, Blake L, Mostaghimi A, Barbieri JS. Use of Patient-Reported Outcomes in Acne Vulgaris and Rosacea Clinical Trials From 2011 to 2021: A Systematic Review. JAMA Dermatol 2022; 158:1419-1428. [PMID: 36287541 DOI: 10.1001/jamadermatol.2022.3911] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Importance Acne and rosacea have substantial implications for quality of life, and it is therefore important to ensure the patient's voice is being captured in pivotal randomized clinical trials (RCTs). Although patient-reported outcome measures (PROMs) are a valuable tool to capture the patient perspective, little is known about use of PROMs in RCTs on acne and rosacea. Objective To characterize the use of PROMs in RCTs on acne and rosacea. Evidence Review A systematic literature search was conducted using the search terms acne vulgaris and rosacea in the following databases: MEDLINE through PubMed, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. A modified search hedge for RCTs from the McGill Library was applied. All phase 2, 3, and 4 RCTs published between December 31, 2011, through December 31, 2021, that evaluated the efficacy and safety of therapies for acne and rosacea vs any comparator were eligible for inclusion. Findings A total of 2461 publications describing RCTs were identified, of which 206 RCTs met the inclusion criteria (163 trials [79%] on acne and 43 [21%] on rosacea). At least 1 PROM was used in 53% of trials (110) included; PROM use was more common in rosacea RCTs (67% [n = 29]) compared with acne RCTs (50% [n = 81]). At least 1 dermatology-specific (13% [n = 27]) or disease-specific (14% [n = 28]) PROM was included in the RCTs analyzed. Only 7% of trials (14) included a PROM as a primary outcome measure. There was no statistically significant increase in PROM inclusion over the study period (11 of 21 trials in 2011 vs 5 of 12 trials in 2021). Conclusions and Relevance In this systematic review, PROMs were included in approximately one-half of acne and rosacea RCTs performed over the study period. In addition, PROMs were rarely used as a primary outcome measure, and inclusion of PROMs has not increased substantially over the past 10 years. Increasing use of PROMs in RCTs can ensure that the patient's perspective is captured during the development of new treatments for acne and rosacea.
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Affiliation(s)
- Sophia Ly
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - John Miller
- College of Medicine, Sidney Kimmel Medical College, Philadelphia, Pennsylvania
| | - Lauren Tong
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Lindsay Blake
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock
| | - Arash Mostaghimi
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - John S Barbieri
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
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Antela A, Bernardino JI, de Quirós JCLB, Bachiller P, Fuster-RuizdeApodaca MJ, Puig J, Rodríguez S, Castrejón I, Álvarez B, Hermenegildo M. Patient-Reported Outcomes (PROs) in HIV Infection: Points to Consider and Challenges. Infect Dis Ther 2022; 11:2017-2033. [PMID: 36066841 DOI: 10.1007/s40121-022-00678-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/21/2022] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The aim of this study was to reach consensus on the use of PROs (patient-reported outcome measures) in people living with HIV (PLHIV). METHODS A scientific committee of professionals with experience in PROMs methodology issued recommendations and defined the points to support by evidence. A systematic review of the literature identified the coverage, utility, and psychometric properties of PROMs used in PLHIV. A Delphi survey was launched to measure the degree of agreement with the recommendations of a group of practicing clinicians and a group of patient representatives. RESULTS Four principles and ten recommendations were issued; however, the results of the Delphi showed significant differences in the opinion between health professionals and PLHIV, and polarization within collectives, hampering consensus. CONCLUSIONS Despite a wealth of evidence on the benefit of PROMs, there are clear barriers to their use by healthcare professionals in HIV care. Intervention on these barriers is paramount to allow truly patient-centered care.
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Affiliation(s)
- Antonio Antela
- Infectious Diseases Unit, Complejo Hospitalario Universitario de Santiago (CHUS), Santiago de Compostela, Spain.
| | | | | | - Pablo Bachiller
- Internal Medicine Department, Complejo Asistencial de Segovia, Segovia, Spain
| | | | - Jordi Puig
- Hospital Universitario Germans Trias I Pujol, Fundació Lluita Contra La Sida I Les Malalties Infeccioses, Badalona, Spain
| | | | - Isabel Castrejón
- Rheumatology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Beatriz Álvarez
- HIV and Infectious Diseases Unit, Hospital Fundación Jiménez Díaz, Madrid, Spain
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Teixeira MM, Borges FC, Ferreira PS, Rocha J, Sepodes B, Torre C. A review of patient-reported outcomes used for regulatory approval of oncology medicinal products in the European Union between 2017 and 2020. Front Med (Lausanne) 2022; 9:968272. [PMID: 36035431 PMCID: PMC9411861 DOI: 10.3389/fmed.2022.968272] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/25/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction Cancer and corresponding available treatments are associated with substantial symptoms and functional limitations. In this context, collection of patient-reported outcomes (PRO) in clinical trials gained special interest and is recommended by regulatory authorities. Within clinical trials framework, PRO may provide evidence to support medicines approval, labeling and marketing claims. This study aims to analyze the existing evidence based on PRO as part of new oncology indications receiving positive opinions issued by the European Medicines Agency (EMA) between 2017 and 2020 and to identify PRO related label claims granted. Methodology Oncology medicinal products and indications approved by the European Commission following a positive opinion from the EMA between 2017 and 2020 were identified. European Public Assessment Report (EPAR) and Summary of Product Characteristics (SmPC) were reviewed for each medicinal product to identify use of PRO and PRO label claims. Results A total of 128 oncology indications, corresponding to 76 medicines, were approved; of those, 100 (78.1%) included PRO in the confirmatory clinical trials. Thirty-seven indications were supported by double-blind randomized trials and the remainder 63 by open-label trials. Out of the 104 confirmatory trials analyzed, PRO were defined as a secondary endpoint in 60 studies (57.7%), exploratory in 31 (29.8%) and as both in 13 (12.5%). In total, 54 different PRO measures (PROM) were used, of those 41 (75.9%) were disease-specific measures. Nevertheless, PROM selected relied on the EORTC (41.3%), FACIT (17.1%) and EQ-5D (29.2%) measures. A total of 76 indications (59.4%) had PRO reviewers comments included in the EPAR, however only 22 indications (17.8%) included label claims in the SmPC. The reasons identified in the EMA assessment supporting the exclusion of PRO claims were described for 34 indications (44.7%). Conclusions Despite growing recognition of the value of PRO data for the development of improved cancer therapies, PRO implementation remains challenging. The main reasons identified in our study are related with study design, missing data, study conduct and PROM selection.
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Affiliation(s)
| | - Fábio Cardoso Borges
- European Organization for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Paula Sousa Ferreira
- Faculdade de Farmácia da Universidade de Lisboa, Lisbon, Portugal
- Laboratory of Systems Integration Pharmacology, Clinical and Regulatory Science, Research Institute for Medicines (iMED.ULisboa), Lisbon, Portugal
| | - João Rocha
- Faculdade de Farmácia da Universidade de Lisboa, Lisbon, Portugal
- Laboratory of Systems Integration Pharmacology, Clinical and Regulatory Science, Research Institute for Medicines (iMED.ULisboa), Lisbon, Portugal
| | - Bruno Sepodes
- Faculdade de Farmácia da Universidade de Lisboa, Lisbon, Portugal
- Laboratory of Systems Integration Pharmacology, Clinical and Regulatory Science, Research Institute for Medicines (iMED.ULisboa), Lisbon, Portugal
| | - Carla Torre
- Faculdade de Farmácia da Universidade de Lisboa, Lisbon, Portugal
- Laboratory of Systems Integration Pharmacology, Clinical and Regulatory Science, Research Institute for Medicines (iMED.ULisboa), Lisbon, Portugal
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11
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Zhou H, Yao M, Gu X, Liu M, Zeng R, Li Q, Chen T, He W, Chen X, Yuan G. Application of Patient-Reported Outcome Measurements in Clinical Trials in China. JAMA Netw Open 2022; 5:e2211644. [PMID: 35544134 PMCID: PMC9096600 DOI: 10.1001/jamanetworkopen.2022.11644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Regulatory authorities, industry peers, and international health policies have emphasized the value of assessing patient-reported outcomes (PROs) in clinical studies. Despite the increase in the number of clinical studies in the last decade in China, little is known about the extent of the use of PROs. OBJECTIVE To evaluate the application and characteristics of PRO instruments as primary and secondary outcomes in randomized clinical trials in China. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study of interventional clinical trials conducted in China from January 1, 2010, to December 31, 2020, was performed. Data obtained from the Chinese Clinical Trial Registry and ClinicalTrials.gov databases were evaluated. MAIN OUTCOMES AND MEASURES Trials were categorized according to those that (1) precisely listed PRO tools as outcomes, (2) mentioned patient subjective feelings in outcomes but did not clarify which tools were used for assessment, and (3) did not mention any PRO measurements. Data on study phase, setting, participant age, and sex were extracted from trials that considered patient feelings, along with the target diseases and names of the PRO tools. RESULTS Among a total of 34 033 trials, 6915 (20.3%) listed the explicit PRO instruments used and 3178 (9.3%) included PRO in their outcomes but did not include the names of the assessment tools. From more than 32 million people included in the registered trials, data on 1.5 million (4.7%) patients were scientifically collected by PRO instruments, and subjective feelings were assessed for 693 867 (2.1%) participants. Pain (16.8%), cancer (15.6%), and musculoskeletal symptoms (13.3%) were the most common conditions for which PROs were precisely collected by tools. The most common tools for PRO measurements were the visual analog scale, Short-Form 36, and Hamilton Depression Scale. CONCLUSIONS AND RELEVANCE In this cross-sectional study, the use of PROs increased during the study period in clinical trials conducted in China. However, patient opinion appears to still be rarely measured. The application of PRO is geographically unevenly distributed. Development of PRO instruments, especially those suitable for the Chinese population, may be useful. Further expansion of PROs with respect to the scope of diseases is needed to avoid missing important data.
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Affiliation(s)
- Hui Zhou
- Phase I Clinical Trial Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Pharmacy, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mi Yao
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Xiaodan Gu
- Phase I Clinical Trial Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mingrui Liu
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou, China
| | - Ruifeng Zeng
- Phase I Clinical Trial Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qin Li
- Department of Geriatrics, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tingjia Chen
- Healthcare Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wen He
- Department of Geriatrics, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao Chen
- Department of Pharmacy, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Gang Yuan
- Phase I Clinical Trial Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Geriatrics, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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12
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Gnanasakthy A, Norcross L, DeMuro Romano C, Carson RT. A Review of Patient-Reported Outcome Labeling of FDA-Approved New Drugs (2016-2020): Counts, Categories, and Comprehensibility. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:647-655. [PMID: 35365309 DOI: 10.1016/j.jval.2021.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/30/2021] [Accepted: 10/14/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES A review of new drug approvals (NDAs) by the US Food and Drug Administration (FDA) for 2006 to 2015 showed that approximately 20% of new drugs had labeling based on patient-reported outcomes (PROs). The purpose of this study was to review labeling text based on PRO endpoints for NDAs from 2016 to 2020, with a special focus on the comprehensibility of such statements when included. METHODS We reviewed drug approval reports on the Drugs@FDA web page of the FDA website to determine the number of NDAs from 2016 to 2020. For all identified NDAs, drug approval package and product labels were reviewed. NDAs from 2016 to 2020 were grouped by disease category as per International Classification of Diseases 10th Revision. Data were summarized for diseases that traditionally rely on PROs for evaluating treatment benefit (PRO dependent) and for diseases that traditionally do not rely on PROs (non-PRO dependent). Results were compared with NDAs from 2006 to 2010. RESULTS NDAs amounting to 228 were identified from 2016 to 2020, 26.3% of which had labeling statements based on PRO endpoints. From 2006 to 2015 and from 2016 to 2020, PRO labeling statements were included in 46.5% (46 of 99) and 50.0% (47 of 94), respectively, of NDAs for PRO-dependent new molecular entities and in 6.0% (12 of 199) and 9.7% (13 of 199), respectively, of NDAs for non-PRO-dependent new molecular entities. Comprehensibility of labeling statements based on PRO endpoints was judged to be complex in 56.7% of product labels. CONCLUSIONS The increase in labeling text based on PRO endpoints in product labels is encouraging. However, there is room for improvement on the comprehensibility of labeling statements based on PRO endpoints.
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Affiliation(s)
| | | | - Carla DeMuro Romano
- RTI Health Solutions, Research Triangle Park, NC, USA; AbbVie, HEOR, Patient-Centered Outcomes Research, Madison, NJ, USA
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13
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Winnette R, Banerjee A, Sikirica V, Peeva E, Wyrwich K. Characterizing the relationships between patient reported outcomes and clinician assessments of alopecia areata in a phase 2a randomized trial of ritlecitinib and brepocitinib. J Eur Acad Dermatol Venereol 2022; 36:602-609. [PMID: 35000236 PMCID: PMC9303953 DOI: 10.1111/jdv.17909] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/29/2021] [Accepted: 12/03/2021] [Indexed: 12/01/2022]
Abstract
Background The phase 2a ALLEGRO trial (NCT02974868) investigated the safety and efficacy of ritlecitinib (PF‐06651600) and brepocitinib (PF‐06700841) in adults with alopecia areata. No randomized controlled trial for alopecia areata has evaluated correlations between clinician‐assessed hair loss and patient‐reported outcomes. Objectives Report scores from the Alopecia Areata Symptom Impact Scale (AASIS; a patient‐reported outcome tool) and explore the relationships of those scores with clinician‐assessed Severity of Alopecia Tool (SALT) scores at baseline and week 24 of the ALLEGRO trial. Methods Adults with alopecia areata were randomized to ritlecitinib (n = 48), brepocitinib (n = 47) or placebo (n = 47). After 24 weeks, the mixed‐effects model with repeated measures was used to calculate the active treatment groups' AASIS score least‐squares mean differences. Relationships between AASIS and SALT scores at baseline and week 24 were evaluated by Pearson's correlation coefficients using pooled data. Results Baseline AASIS and SALT scores were similar among treatment groups. Both active treatment groups reported significant improvements in AASIS scores at week 24 (least‐squares mean differences vs. placebo for ritlecitinib, −0.8 to −2.3; brepocitinib, −0.9 to −3.7; P < 0.05 for all). At week 24, the mean SALT scores (standard deviation) improved compared with baseline [ritlecitinib, 54.4 (40.3) vs. 89.4 (15.8); brepocitinib, 31.9 (35.7) vs. 86.4 (18.1)]. The correlation coefficients between AASIS global and subscale scores and SALT scores at week 24 ranged from 0.34 to 0.58; P < 0.05 for all. Conclusions Patients randomized to ritlecitinib or brepocitinib reported significantly improved AASIS and SALT scores at week 24 of the ALLEGRO trial compared to placebo. At week 24, medium‐to‐large correlations can be seen between AASIS global and subscale scores and SALT scores. Our experience with AASIS instrument highlighted several aspects that suggest new patient‐reported outcome tools are needed to accurately assess patients' relevant alopecia areata related signs, symptoms and daily functioning. Linked Commentary: H.A. Ramírez‐Marín & A. Tosti J Eur Acad Dermatol Venereol 2022; 36: 494–495. https://doi.org/10.1111/jdv.17984.
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Affiliation(s)
- R Winnette
- Patient-Centered Outcomes Assessment, Pfizer, New York, NY, USA
| | - A Banerjee
- Early Clinical Development, Pfizer, Cambridge, MA, USA
| | - V Sikirica
- Patient & Health Impact, Pfizer, Collegeville, PA, USA
| | - E Peeva
- Inflammation & Immunology, Pfizer, Cambridge, MA, USA
| | - K Wyrwich
- Patient-Centered Outcomes Assessment, Pfizer, New York, NY, USA
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14
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Haag S, Junge L, Lotz F, McGauran N, Paulides M, Potthast R, Kaiser T. Results on patient-reported outcomes are underreported in summaries of product characteristics for new drugs. J Patient Rep Outcomes 2021; 5:127. [PMID: 34874524 PMCID: PMC8651888 DOI: 10.1186/s41687-021-00402-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 11/19/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Summaries of product characteristics (SmPCs) are regulatory documents published upon drug approval. They should report all relevant study data and advise how to use drugs safely and effectively. Patient-reported outcomes (PROs) are increasingly used in clinical trials to incorporate the patient perspective-SmPCs should thus adequately report PROs. In Germany, new drugs undergo mandatory early benefit assessment. Pharmaceutical companies submit dossiers containing all evidence; the subsequent dossier assessments focus on patient-relevant outcomes and comprehensively report PROs. OBJECTIVE The primary aim was to investigate to what extent PROs recorded as outcomes in clinical trials of new drugs are reported in SmPCs. METHODS We analysed dossier assessments with randomized controlled trials (RCTs) of new drugs entering the market between 01/2014 and 07/2018 and the corresponding SmPCs, and compared PRO reporting in both document types. For this purpose, we evaluated dossier assessment characteristics (e.g. drug name, indication, disease category) and study characteristics (e.g. evaluable PROs available?). PROs were divided into symptoms and health-related quality of life (HRQoL). SmPCs were screened to identify RCTs. We conducted 3 main evaluation steps: (1) Did the RCT included in the dossier assessment contain evaluable PROs? (2) If yes, was the RCT included in the SmPC? (3) If yes, were the PROs reported in the SmPC? Results are presented descriptively. RESULTS 88 dossier assessments including 143 RCTs on 72 drugs were considered: 109 (76.2%) RCTs included evaluable PROs, of which 89 were included in SmPCs. 38 RCTs (42.7%) investigated oncologics, 18 (20.2%) anti-infectives, and 33 (37.1%) other drugs. The RCTs considered symptoms more often than HRQoL (82 vs. 66 RCTs). In SmPCs, PROs were reported for 41 RCTs (46.1%), with a slightly higher reporting rate for RCTs considering HRQoL (43.9%) than for RCTs considering symptoms (41.5%). In oncologic indications, PROs were reported for 36.7% of RCTs considering HRQoL and 33.3% of RCTs considering symptoms. In infectious diseases, the rates were 21.4% (symptoms) and 0% (HRQoL), and for other diseases about 60% (symptoms) to 70% (HRQoL). CONCLUSION Even though a large amount of PRO data on new drugs is available from clinical trials included in SmPCs, the corresponding results are underreported.
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Affiliation(s)
- Susanne Haag
- Institute for Quality and Efficiency in Health Care, Cologne, Germany.
| | - Lisa Junge
- Institute for Quality and Efficiency in Health Care, Cologne, Germany
| | - Fabian Lotz
- Institute for Quality and Efficiency in Health Care, Cologne, Germany
| | - Natalie McGauran
- Institute for Quality and Efficiency in Health Care, Cologne, Germany
| | - Marios Paulides
- Drug Commission of the German Medical Association, Berlin, Germany
| | - Regine Potthast
- Institute for Quality and Efficiency in Health Care, Cologne, Germany
| | - Thomas Kaiser
- Institute for Quality and Efficiency in Health Care, Cologne, Germany
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15
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Affiliation(s)
- Joslyn S Kirby
- Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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16
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Shahraz S, Pham TP, Gibson M, De La Cruz M, Baara M, Karnik S, Dell C, Pease S, Nigam S, Cappelleri JC, Lipset C, Zornow P, Lee J, Byrom B. Does scrolling affect measurement equivalence of electronic patient-reported outcome measures (ePROM)? Results of a quantitative equivalence study. J Patient Rep Outcomes 2021; 5:23. [PMID: 33638726 PMCID: PMC7914324 DOI: 10.1186/s41687-021-00296-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/16/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Scrolling is a perceived barrier in the use of bring your own device (BYOD) to capture electronic patient reported outcomes (ePROs). This study explored the impact of scrolling on the measurement equivalence of electronic patient-reported outcome measures (ePROMs) in the presence and absence of scrolling. METHODS Adult participants with a chronic condition involving daily pain completed ePROMs on four devices with different scrolling properties: a large provisioned device not requiring scrolling; two provisioned devices requiring scrolling - one with a "smart-scrolling" feature that disabled the "next" button until all information was viewed, and a second without this feature; and BYOD with smart-scrolling. The ePROMs included were the SF-12, EQ-5D-5L, and three pain measures: a visual analogue scale, a numeric response scale and a Likert scale. Participants completed English or Spanish versions according to their first language. Associations between ePROM scores were assessed using intraclass correlation coefficients (ICCs), with lower bound of 95% confidence interval (CI) > 0.7 indicating comparability. RESULTS One hundred fifteen English- or Spanish-speaking participants (21-75y) completed all four administrations. High associations between scrolling and non-scrolling were observed (ICCs: 0.71-0.96). The equivalence threshold was met for all but one SF-12 domain score (bodily pain; lower 95% CI: 0.65) and two EQ-5D-5L item scores (pain/discomfort, usual activities; lower 95% CI: 0.64/0.67). Age, language, and device size produced insignificant differences in scores. CONCLUSIONS The measurement properties of PROMs are preserved even in the presence of scrolling on a handheld device. Further studies that assess scrolling impact over long-term, repeated use are recommended.
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17
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Akinosoglou K, Antonopoulou S, Katsarolis I, Gogos CA. Patient-reported outcomes in HIV clinical trials evaluating antiretroviral treatment: a systematic review. AIDS Care 2020; 33:1118-1126. [PMID: 33267620 DOI: 10.1080/09540121.2020.1852160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We aimed to assess patterns of patient-reported outcomes (PRO) instruments' utilization in HIV clinical trials in relation to antiretroviral therapy (ART). PubMed/MEDLINE, Scopus, and EMBASE were searched using the terms "Patient-Reported Outcomes" and "HIV/AIDS" or "Antiretroviral Treatment" or "ART" or "Antiretroviral Therapy" from 1 January 1990 until 1 December 2019. In total, 173 studies were identified and 26 were directly related to ART. Study population included treatment-naïve patients (n = 4), treatment-experienced (n = 20), or both (n = 2). Instruments were implemented to assess general experience with ART (n = 3), single-tablet regimens (STR) (n = 2), monotherapy (n = 4), regimen switch (n = 9), or regimen comparison (n = 8). The most commonly used instruments were Medical Outcomes Study-HIV Health Survey (MOS-HIV, n = 8), HIV Symptom Index (HIV-SI, n = 7) and unstructured self-reports (n = 5) followed by others. MOS-HIV was used mainly in comparative (n = 4) and monotherapy (n = 3) trials, HIV-SI in switch (n = 4) and STR (n = 2) trials, and self-reports in comparative trials (n = 3). Even though, the implementation of PRO tools is increasing with time, reporting of PRO in HIV clinical trials remains limited.
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Affiliation(s)
- Karolina Akinosoglou
- Department of Internal Medicine, University General Hospital of Patras, Patras, Greece.,Department of Infectious Diseases, University General Hospital of Patras, Patras, Greece
| | | | | | - Charalambos A Gogos
- Department of Internal Medicine, University General Hospital of Patras, Patras, Greece.,Department of Infectious Diseases, University General Hospital of Patras, Patras, Greece
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18
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Schultz-Knudsen K, Sabaliauskaite U, Hellsten J, Lassen AB, Morant AV. New Drug and Biologics Approvals in 2019: A Systematic Analysis of Patient Experience Data in FDA Drug Approval Packages and Product Labels. Ther Innov Regul Sci 2020; 55:503-513. [PMID: 33230660 PMCID: PMC8021513 DOI: 10.1007/s43441-020-00244-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/10/2020] [Indexed: 11/24/2022]
Abstract
Background The FDA Patient-Focused Drug Development Initiative was launched to ensure the incorporation of the patient voice into drug development and evaluation. Since 2017, the FDA must publish a statement outlining patient experience data (PED) considered in the approval of new drugs. This study investigated the presence and role of PED in drug approval and translation into product label claims. Methods PED reported in approval packages of the 48 drugs approved by FDA’s Center for Drug Evaluation and Research in 2019 was identified and categorized. PED in the form of clinical outcome assessments (COAs) was characterized by endpoint positioning and outcome. The product labels were analyzed for PED-related claims. Results PED was reported as relevant for 39 of 48 (81.3%) drugs approved in 2019. COAs were the predominant PED type; other PED was identified for only 9 (18.8%) drugs, and none included qualitative or patient preference studies. COAs were the only type of PED for which associated claims were identified in the product labels. 27 out of 48 (56.3%) labels contained one or more efficacy claims based on COAs; of these, patient-reported outcomes were the most prevalent with claims identified in 19 labels (39.6%). Conclusion There are ample opportunities for incorporating PED beyond COAs to inform drug development and facilitate availability of medicines tailored to patient needs. A higher level of transparency on the role of PED in regulatory decision-making and a clear path to PED-based label claims could incentivize sponsors and enable patient empowerment in treatment decisions. Electronic supplementary material The online version of this article (10.1007/s43441-020-00244-x) contains supplementary material, which is available to authorized users.
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Cottone F, Collins GS, Anota A, Sommer K, Giesinger JM, Kieffer JM, Aaronson NK, Van Steen K, Charton E, Castagnetti F, Fazi P, Vignetti M, Cella D, Efficace F. Time to health-related quality of life improvement analysis was developed to enhance evaluation of modern anticancer therapies. J Clin Epidemiol 2020; 127:9-18. [PMID: 32562837 DOI: 10.1016/j.jclinepi.2020.06.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 06/01/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Major advances have recently been made in the treatments of cancer, which now also have the potential to improve patients' health-related quality of life (HRQOL). We propose the time to HRQOL improvement (TTI) and the time to sustained HRQOL improvement (TTSI) as potentially important cancer outcomes to be used in longitudinal HRQOL analyses. STUDY DESIGN AND SETTING As proof of principle, we defined TTI and TTSI, using the Fine-Gray model to include competing risks in estimates, in a case study in real life of a cohort of newly diagnosed patients with cancer receiving a targeted therapy. HRQOL was evaluated before and during therapy with six assessments over a 24-month period, using the well-validated European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30. RESULTS For each assessed HRQOL domain, we assessed TTI and TTSI and estimated the cumulative incidence of patients' clinically meaningful improvements, also accounting for the occurrence of competing events. CONCLUSION TTI and TTSI are potentially important outcomes in the era of modern anticancer therapies. The analysis of TTI and TTSI by competing risks approach will further add to the statistical methods that can be used to inform on the impact of cancer therapies on patients' HRQOL.
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Affiliation(s)
- Francesco Cottone
- Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center and Health Outcomes Research Unit, Rome, Italy.
| | - Gary S Collins
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - Amelie Anota
- Methodology and Quality of Life in Oncology Unit (INSERM UMR 1098), University Hospital of Besançon, Besançon, France; French National Platform Quality of Life and Cancer, Besançon, France
| | - Kathrin Sommer
- Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Johannes M Giesinger
- Psychiatry II, Medical University of Innsbruck, University Hospital Innsbruck, Innsbruck, Austria
| | - Jacobien M Kieffer
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam
| | - Neil K Aaronson
- The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam
| | - Kristel Van Steen
- GIGA-R Medical Genomics Unit, BIO 3 University of Liège, Liège, Belgium
| | - Emilie Charton
- Methodology and Quality of Life in Oncology Unit (INSERM UMR 1098), University Hospital of Besançon, Besançon, France; French National Platform Quality of Life and Cancer, Besançon, France
| | - Fausto Castagnetti
- Institute of Hematology "L. and A. Seràgnoli", Department of Experimental, Diagnostic and Specialty Medicine, "S. Orsola-Malpighi" University Hospital, University of Bologna, Italy
| | - Paola Fazi
- Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Marco Vignetti
- Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center and Health Outcomes Research Unit, Rome, Italy
| | - David Cella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA) Data Center and Health Outcomes Research Unit, Rome, Italy; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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20
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Shea M, Audibert C, Stewart M, Gentile B, Merino D, Hong A, Lassiter L, Caze A, Leff J, Allen J, Sigal E. How Oncologists Perceive the Availability and Quality of Information Generated From Patient-Reported Outcomes (PROs). J Patient Exp 2020; 7:217-224. [PMID: 32851143 PMCID: PMC7427362 DOI: 10.1177/2374373519837256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Despite increased incorporation of patient-reported outcome (PRO) measures into clinical trials, information generated from PROs remains largely absent from drug labeling and electronic health records, giving rise to concerns that such information is not adequately informing clinical practice. Objective: To evaluate oncologists’ perceptions concerning the availability and quality of information generated from PRO measures. Additionally, to identify whether an association exists between perceptions of availability and attitudes concerning quality. Method: An online, 11-item questionnaire was developed to capture clinician perspectives on the availability and use of PRO data to inform practice. The survey also asked respondents to rate information on the basis of 4 quality metrics: “usefulness,” “interpretability,” “accessibility,” and “scientific rigor.” Results: Responses were received from 298 of 1301 invitations sent (22.9% response rate). Perceptions regarding the availability of PRO information differed widely among respondents and did not appear to be linked to practice setting. Ratings of PRO quality were generally consistent, with average ratings for the 4 quality metrics between “satisfactory” and “good.” A relationship was observed between ratings of PRO data quality and perceptions of the availability. Conclusion: Oncologists’ attitudes toward the quality of information generated from PRO measures are favorable but not enthusiastic. These attitudes may improve as the availability of PRO data increases, given the association we observed between oncologists’ ratings of the quality of PRO information and their perceptions of its availability.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Jeff Allen
- Friends of Cancer Research, Washington, DC, USA
| | - Ellen Sigal
- Friends of Cancer Research, Washington, DC, USA
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Papadopoulos EJ, Bush EN, Eremenco S, Coons SJ. Why Reinvent the Wheel? Use or Modification of Existing Clinical Outcome Assessment Tools in Medical Product Development. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:151-153. [PMID: 32113618 DOI: 10.1016/j.jval.2019.09.2745] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/24/2019] [Accepted: 09/02/2019] [Indexed: 06/10/2023]
Abstract
Assessment of clinical benefit in treatment trials can be made through report by a clinician, a patient, or a nonclinician observer (eg, caregiver) or through a performance-based assessment. The US Food and Drug Administration (FDA) published a final guidance for industry for one type of clinical outcome assessment (COA)-patient-reported outcome (PRO) measures-in 2009 that described how FDA reviews PRO measures for their adequacy to support medical product-labeling claims. Many of the principles described in the PRO Guidance could be applicable to the other types of COAs, including instruments completed by clinicians (ie, clinician-reported outcome assessments) and nonclinician observers (ie, observer-reported outcome assessments). FDA guidance describing the regulatory expectations for all COA types including performance outcome assessments, which are based on the patient's performance of a defined task or activity, is in progress to meet requirements described within the 21st Century Cures Act and PDUFA VI. This communication highlights potential ways in which existing instruments might be modified or used "as is" to conform to good measurement principles. An industry and a regulatory perspective are described.
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Affiliation(s)
- Elektra J Papadopoulos
- Clinical Outcome Assessments Staff, Office of New Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, White Oak, MD, USA
| | - Elizabeth Nicole Bush
- Patient-Focused Outcomes Center of Expertise, Eli Lilly and Company, Indianapolis, IN, USA.
| | - Sonya Eremenco
- Patient-Reported Outcome Consortium, Critical Path Institute, Tucson, AZ, USA
| | - Stephen Joel Coons
- Patient-Reported Outcome Consortium, Critical Path Institute, Tucson, AZ, USA
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22
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Nishimura K, Kusunose M, Sanda R, Tsuji Y, Hasegawa Y, Oga T. Comparison between electronic and paper versions of patient-reported outcome measures in subjects with chronic obstructive pulmonary disease: an observational study with a cross-over administration. BMJ Open 2019; 9:e032767. [PMID: 31857313 PMCID: PMC6937099 DOI: 10.1136/bmjopen-2019-032767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES A wide range of electronic devices can be used for data collection of patient-reported outcome (PRO) measures in subjects with chronic obstructive pulmonary disease (COPD). Although comparisons between electronic and paper-based PRO measures have been undertaken in asthmatics, it is currently uncertain whether electronic questionnaires work equally as well as paper versions in elderly subjects with COPD. The aim of this study was to compare the responses to paper and electronic versions of the Evaluating Respiratory Symptoms in COPD (E-RS) and the COPD Assessment Test (CAT). DESIGN A randomised cross-over design was used to compare the responses to paper and electronic versions of the two tools. The interval between the two administrations was 1 week. SETTING Electronic versions were self-administered under supervision using a tablet computer at our outpatient clinic (secondary care hospital in Japan) while paper questionnaires completed at home were requested to be returned by mail. It was intended that half of the patients completed the electronic versions of both questionnaires first, followed by the paper versions while the other half completed the paper versions first. PARTICIPANTS Eighty-one subjects with stable COPD were included. RESULTS The E-RS total scores (possible range 0-40) were 6.8±7.4 and 5.0±6.6 in the paper-based and electronic versions, respectively, and the CAT scores (possible range 0-40) were 10.0±7.4 and 8.6±7.8. In both questionnaires, higher scores indicate worse status. The relationship between electronic and paper versions showed significant reliability for both the E-RS total score and CAT score (intraclass correlation coefficient=0.82 and 0.89, respectively; both p<0.001). However, both the E-RS total and CAT scores were significantly higher in the paper versions (p<0.05). CONCLUSIONS In both cases, the two versions of the same questionnaire cannot be used interchangeably even though they have both been validated.
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Affiliation(s)
- Koichi Nishimura
- Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Masaaki Kusunose
- Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Ryo Sanda
- Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | | | | | - Toru Oga
- Department of Respiratory Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan
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Jelin E, Wisløff T, Jørstad ØK, Heiberg T, Moe MC. Patient-reported outcome measures in the management of neovascular age-related macular degeneration: a 1-year prospective study. BMJ Open Ophthalmol 2019; 4:e000353. [PMID: 31673632 PMCID: PMC6797267 DOI: 10.1136/bmjophth-2019-000353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/03/2019] [Accepted: 09/14/2019] [Indexed: 11/04/2022] Open
Abstract
Objective To prospectively explore the following patient-reported outcome measures (PROMs) in the management of neovascular age-related macular degeneration (nAMD): (1) self-reported visual function, (2) symptom-state, (3) general-health and (4) satisfaction of treatment. Methods and analysis Corresponding to the four PROMs, participants responded to the following questionnaires: (1) National Eye Institute Visual-Functioning-Questionnaire (NEI-VFQ-25), (2) Patient-Acceptable-Symptom-Status (PASS 5), (3) EuroQol-Group-Questionnaire (EQ-5D-3L) and (4) Dimensions of Importance in Treatment of nAMD (DITAMD). Data were collected at baseline and after 3, 6 and 12 months of intravitreal antivascular endothelial growth factor treatment. Results were evaluated with t-tests and mixed linear regression analyses. Results The study included 197 patients. At baseline NEI-VFQ-25 (79.53±14.52) and EQ-5D (0.74±0.28) had relatively high scores, whereas PASS 5 was below 'acceptable' (3.30±0.80). At 12 months NEI-VFQ-25 and PASS 5 showed significant improvement, whereas EQ-5D and DITAMD remained unchanged. At baseline patients receiving treatment of the better-seeing eye (BSE) (n=52) reported significantly worse NEI-VFQ-25 and PASS 5 than patients for whom treatment only involved the worse-seeing eye (WSE), (n=145). In contrast to BSE patients, there was no improvement of NEI-VFQ-25 for WSE patients at 12 months, despite a significant improvement in best-corrected visual acuity (BCVA). Two independent variables, treatment including the BSE and BCVA for the treated eye, were found to predict both NEI-VFQ-25 and PASS 5. Conclusion After 12 months of nAMD treatment, there was a significant improvement in PASS 5 and NEI-VFQ-25, the latter depending on whether therapy included BSE. EQ-5D and DITAMD remained unaltered.
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Affiliation(s)
- Elma Jelin
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torbjørn Wisløff
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway.,Department of Health and Society, University of Oslo, Oslo, Norway
| | - Øystein Kalsnes Jørstad
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Turid Heiberg
- Regional Research Support, Oslo University Hospital, Oslo, Norway.,Østfold University College, Halden, Norway
| | - Morten Carstens Moe
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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24
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Warsame R, D'Souza A. Patient Reported Outcomes Have Arrived: A Practical Overview for Clinicians in Using Patient Reported Outcomes in Oncology. Mayo Clin Proc 2019; 94:2291-2301. [PMID: 31563425 PMCID: PMC6832764 DOI: 10.1016/j.mayocp.2019.04.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/18/2019] [Accepted: 04/15/2019] [Indexed: 01/13/2023]
Abstract
Ensuring that the patient's voice is routinely incorporated in all aspects of health care in oncology is essential to provide quality care. Patient reported outcomes (PROs) are standardized measures that are used to obtain the patient's perspective and are increasingly used in all aspects of health care to ensure optimal delivery of patient-centered care. The US Food and Drug Administration encourages that PROs be used in studies for label indications. There are no uniform standardized methods to use PROs nor is there consensus on which PROs are best for regulatory approval, comparative effectiveness research, toxicity assessment, health-related quality of life, or symptom monitoring. For this review, we conducted a literature search using PubMed and Google Scholar, and herein summarize the evidence related to the use of PROs in clinic care and research. Using valid, reliable, and easily interpretable PROs developed in comparable populations will provide the most useful results. Various ways that PROs can be used successfully in oncology have been exemplified in this overview to provide clinicians and researchers practical guidance.
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Affiliation(s)
- Rahma Warsame
- Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN.
| | - Anita D'Souza
- Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee.
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Jelin E, Wisløff T, Moe MC, Heiberg T. Psychometric properties of the National Eye Institute Visual Function Questionnaire (NEI-VFQ 25) in a Norwegian population of patients with neovascular age-related macular degeneration compared to a control population. Health Qual Life Outcomes 2019; 17:140. [PMID: 31412873 PMCID: PMC6692950 DOI: 10.1186/s12955-019-1203-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 07/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Although visual acuity and optical coherence tomography (OCT) are most widely used as outcomes in treatment of neovascular age-related Macular Degeneration (nAMD), patient reported outcome measures are increasingly recognized. National Eye Institute Visual Function Questionnaire (NEI-VFQ 25) was developed to capture the perceived visual function. Yet, evidence of psychometric performance in the target population is required. The aim of this study was to examine the psychometric properties of NEI-VFQ 25 in a Norwegian cohort of newly diagnosed nAMD patients followed with a Treat and Extend (T/E) protocol. Methods Patients receiving intravitreal anti–vascular endothelial growth factor (anti-VEGF) injection treatment according to a T/E protocol completed a Norwegian translation of NEI-VFQ 25, EuroQoL Health Questionnaire (EQ-5D), and Patient acceptable symptom state (PASS 5) at baseline, 3, 6 and 12 months. In addition, a control population completed the same questionnaires. Visual acuity was assessed with LogMar for best/treated eye. Validity testing comprised face validity by a 0–10 numeric rating scale about relevance of NEI-VFQ 25 as well as regression analyses and correlations between NEI-VFQ 25 and other relevant variables. Reliability was examined with Intraclass Correlation Coefficient (ICC) and Cronbach’s alpha for internal consistency were performed. Responsiveness, discriminatory power and predictive value were also explored. Results Number of respondents at baseline, after 3, 6 and 12 months was 197, 186, 176 and 168, respectively. The control population comprised 26 individuals. Face validity of NEI-VFQ 25 had a mean (SD) of 7.8 (1.7) (n = 84). NEI-VFQ was significantly correlated to visual acuity and PASS 5 as well as EQ-5D at baseline. Reliability (ICC) of the overall and sub scores for the patients/controls ranged from 0.49–0.97/0.59–0.97. Cronbach’s alpha was 0.61–0.85. Discriminatory power was confirmed by significant differences of the overall score between controls and patients (P < 0.001). NEI-VFQ 25 indicates responsiveness showing overall score improved significantly (P ≤ 0.001) from baseline to 3 months. NEI-VFQ 25, general health and visual acuity at baseline were the strongest predictors for how patients reported vision after 6 months follow-up. Conclusion NEI-VFQ 25 showed acceptable psychometric performance, which supports that the Norwegian version can be used to monitor patients treated for nAMD.
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Affiliation(s)
- Elma Jelin
- Department of Ophthalmology, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway. .,Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318, Oslo, Norway.
| | - Torbjørn Wisløff
- Norwegian Institute of Public Health, Postboks 222 Skøyen, 0213, Oslo, Norway.,Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Morten C Moe
- Department of Ophthalmology, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Postboks 1171 Blindern, 0318, Oslo, Norway
| | - Turid Heiberg
- Department of Regional Research Support, Oslo University Hospital, Sogn Arena, POBox 4950, Nydalen, N-0424, Oslo, Norway.,Faculty of Health and Welfare, Østfold University College, POBox 700, N-1757, Halden, Norway
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26
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Hong YD, Villalonga-Olives E, Perfetto EM. Patient-Reported Outcomes in Orphan Drug Labels Approved by the US Food and Drug Administration. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:925-930. [PMID: 31426934 DOI: 10.1016/j.jval.2019.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 02/20/2019] [Accepted: 03/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES In recent years, there has been increasing recognition of the need to assess treatment benefit from the patient's perspective. The extent of patient-reported outcome (PRO) data included in labeling for rare disease treatment is largely unknown. The objective of this study was to review trends over time for PRO-based labeling granted by the US Food and Drug Administration (FDA) for orphan drugs. STUDY DESIGN Review of FDA package inserts. METHODS Products included in this analysis were all new molecular entities (NMEs) and biologic license applications (BLAs) with orphan designations approved by the FDA from 2002 through 2017. For identified products, package inserts were reviewed to determine the number and type of PRO claim(s) granted, endpoint status, and PRO measure named. Two trends were analyzed: (1) over all years 2002 to 2017 and (2) 2002 to 2017 stratified into 3 periods (before draft FDA PRO guidance [2006], between draft and final guidance release, and after final guidance [2009] release. RESULTS A total of 156 NMEs and BLAs with orphan designations were approved between 2002 and 2017. Of these, 13 products (8.3%) had PRO-based labeling, and 7 of 13 were symptom-related. The percent of orphan drugs approved with PRO-based labeling between 2002 and 2005, 2006 and 2008, and 2009 and 2017 was 0, 10.5, and 9.9, respectively. CONCLUSIONS In FDA-approved labeling for orphan therapies, PRO measures used as primary and secondary endpoints increased after draft FDA PRO guidance release but remained relatively low thereafter. It is important to understand barriers to PRO measure use to ensure that treatments capture perspectives of patients with rare diseases.
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Affiliation(s)
- Yoon Duk Hong
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.
| | - Ester Villalonga-Olives
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Eleanor M Perfetto
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA; National Health Council, Washington, DC, USA
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Nishimura K, Oga T, Nakayasu K, Ogasawara M, Hasegawa Y, Mitsuma S. How different are COPD-specific patient reported outcomes, health status, dyspnoea and respiratory symptoms? An observational study in a working population. BMJ Open 2019; 9:e025132. [PMID: 31345963 PMCID: PMC6661613 DOI: 10.1136/bmjopen-2018-025132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We hypothesised that chronic obstructive pulmonary disease (COPD)-specific health status measured by the COPD assessment test (CAT), respiratory symptoms by the evaluating respiratory symptoms in COPD (E-RS) and dyspnoea by Dyspnoea-12 (D-12) are independently based on specific conceptual frameworks and are not interchangeable. We aimed to discover whether health status, dyspnoea or respiratory symptoms could be related to smoking status and airflow limitation in a working population. DESIGN This is an observational, cross-sectional study. PARTICIPANTS 1566 healthy industrial workers were analysed. RESULTS Relationships between D-12, CAT and E-RS total were statistically significant but weak (Spearman's correlation coefficient=0.274 to 0.446). In 646 healthy non-smoking subjects, as the reference scores for healthy non-smoking subjects, that is, upper threshold, the bootstrap 95th percentile values were 1.00 for D-12, 9.88 for CAT and 4.44 for E-RS. Of the 1566 workers, 85 (5.4%) were diagnosed with COPD using the fixed ratio of the forced expiratory volume in one second/forced vital capacity <0.7, and 34 (2.2%) using the lower limit of normal. The CAT and E-RS total were significantly worse in non-COPD smokers and subjects with COPD than non-COPD never smokers, although the D-12 was not as sensitive. There were no significant differences between non-COPD smokers and subjects with COPD on any of the measures. CONCLUSIONS Assessment of health status and respiratory symptoms would be preferable to dyspnoea in view of smoking status and airflow limitation in a working population. However, these patient-reported measures were inadequate in differentiating between smokers and subjects with COPD identified by spirometry.
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Affiliation(s)
- Koichi Nishimura
- Department of Respiratory Medicine, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Toru Oga
- Department of Respiratory Medicine, Kawasaki Medical School, Kurashiki, Japan
| | | | - Miyoko Ogasawara
- Niigata Association of Occupational Health Incorporated, Niigata, Japan
| | - Yoshinori Hasegawa
- Division of Respiratory Medicine, Department of Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Mitsuma
- Niigata Association of Occupational Health Incorporated, Niigata, Japan
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28
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Ogata A, Kaneko M, Narukawa M. Lower-dose prescriptions in the post-marketing situation and the influencing factors thereon. PLoS One 2019; 14:e0218534. [PMID: 31199847 PMCID: PMC6570026 DOI: 10.1371/journal.pone.0218534] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/04/2019] [Indexed: 11/18/2022] Open
Abstract
The dosage of pharmaceuticals is determined through the process of clinical development and approval review based on clinical trial results; however, the information obtained from clinical trials before approval is limited. Some pharmaceutical products are used at doses lower than those approved for post-marketing use. The aim of this study was to reveal the actual state of lower-dose prescriptions for post-marketing clinical use of pharmaceuticals. We investigated the factors related to the deviation based on therapeutic area, detailed statement of the approved dosage, clinical data package, and post-marketing requirement. Among the new molecular entities approved in Japan between January 2005 and December 2014, we identified products that are orally administered and have the same daily dose for different indications, if any. For these products, we collected information on the actual daily dose from the medical information databases of Medical Data Vision Co., LTD. and JammNet Co., LTD. Products whose dose was lower than the approved dose (maintenance dose excluding the initial dose) in ≥ 30% prescriptions in 2015 were defined here as “lower-dose prescription drugs.” We identified 27 lower-dose prescription drugs out of 113 products investigated. The results of the multivariate analysis revealed that factors related to the Anatomical Therapeutic Chemical classification and the detailed statement of the approved dosage significantly influenced the occurrence of lower-dose prescription, whereas the factors related to clinical data package and post-marketing requirements did not. These results suggest the limitation in determining an optimal dosage for the actual clinical use of a drug based on the information obtained from clinical trials conducted before approval, emphasizing the importance of reexamining the optimal dosage that is applicable to a greater number of patients after marketing, if necessary. We believe that the utilization of real-world data could be of help in this regard.
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Affiliation(s)
- Akiko Ogata
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, Tokyo, Japan
- * E-mail:
| | - Masayuki Kaneko
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, Tokyo, Japan
| | - Mamoru Narukawa
- Department of Clinical Medicine (Pharmaceutical Medicine), Graduate School of Pharmaceutical Sciences, Kitasato University, Tokyo, Japan
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29
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Smith AB, Hanbury A, Retzler J. Item banking and computer-adaptive testing in clinical trials: Standing in sight of the PROMISed land. Contemp Clin Trials Commun 2019; 13:005-5. [PMID: 30582066 PMCID: PMC6299156 DOI: 10.1016/j.conctc.2018.11.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/07/2018] [Accepted: 11/09/2018] [Indexed: 11/24/2022] Open
Abstract
The use of patient-reported outcome instruments (PRO) in clinical trials in order to capture the impacts of treatment on patients is widespread. However, regulatory agencies have over the past decade highlighted the need for PROs that are fit for purpose and target relevant aspects of the patient's condition. Many legacy PROs were developed with little patient input, are lengthy, and may lack relevance having not been modified or adapted as medical treatments have advanced. Computer-adaptive test (CAT) systems provide the possibility of targeted approaches to capturing patient-centric data, while minimising patient burden. Coupled with greater patient input in the development of PROs, CAT offers the opportunity of overcoming the shortcomings of the previous generation of PROs. This paper describes the some of the issues facing legacy PROs, current regulatory guidance, and initiatives, such as the Patient-Reported Outcome Measurement Information System (PROMIS), as well as the early signs of use of CAT to capture PRO data in clinical trials.
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Affiliation(s)
- Adam B. Smith
- York Health Economics Consortium, Enterprise House, University of York, Hesling, York, YO105NQ, UK
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30
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Gnanasakthy A, Barrett A, Evans E, D'Alessio D, Romano CD. A Review of Patient-Reported Outcomes Labeling for Oncology Drugs Approved by the FDA and the EMA (2012-2016). VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:203-209. [PMID: 30711065 DOI: 10.1016/j.jval.2018.09.2842] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/27/2018] [Accepted: 09/25/2018] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To compare US Food and Drug Administration (FDA) and European Medicines Agency (EMA) labeling for evidence based on patient-reported outcomes (PROs) of new oncology treatments approved by both agencies. METHODS Oncology drugs and indications approved between 2012 and 2016 by both the FDA and the EMA were identified. PRO-related language and analysis reported in US product labels and drug approval packages and EMA summaries of product characteristics were compared for each indication. RESULTS In total, 49 oncology drugs were approved for a total of 64 indications. Of the 64 indications, 45 (70.3%) included PRO data in either regulatory submission. No FDA PRO labeling was identified. PRO language was included in the summary of product characteristics for 21 (46.7%) of 45 indications. European Organisation for Research and Treatment of Cancer and Functional Assessment of Cancer Therapy measures were used frequently in submissions. FDA's comments suggest that aspects of study design (eg, open labels) or the validity of PRO measures was the primary reason for the lack of labeling based on PRO endpoints. Both agencies identified missing PRO data as problematic for interpretation. CONCLUSIONS During this time period, the FDA and the EMA used different evidentiary standards to assess PRO data from oncology studies, with the EMA more likely to accept data from open-label studies and broad concepts such as health-related quality of life. An understanding of the key differences between the agencies may guide sponsor PRO strategy when pursuing labeling. Patient-focused proximal concepts are more likely than distal concepts to receive positive reviews.
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Affiliation(s)
| | - Amy Barrett
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - Emily Evans
- RTI Health Solutions, Research Triangle Park, NC, USA
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Cox SM, Lane A, Volchenboum SL. Use of Wearable, Mobile, and Sensor Technology in Cancer Clinical Trials. JCO Clin Cancer Inform 2018; 2:1-11. [PMID: 30652590 DOI: 10.1200/cci.17.00147] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
As the availability and sophistication of mobile health (mHealth) technology (wearables, mobile technology, and sensors) continues to increase, there is great promise that these tools will be transformative for clinical trials and drug development. This review provides an overview of the current landscape of potential measurement options, including the various types of data collected, methods/tools for collecting them, and a crosswalk of available options. The opportunities and potential drawbacks of mHealth in cancer clinical trials are discussed. Specific concerns related to data accuracy, provenance, and regulatory issues are highlighted, with suggestions for how to address these in future research. Next steps for establishing mHealth methods and tools as legitimate and accepted measures in oncology clinical trials include continuation of regulatory definition by the FDA; establishment of security standards and protocols; refinement and implementation of methods to establish and document data accuracy; and finally, creation of feedback loops wherein regulators receive updates from researchers with better and more timely data, which should decrease trial times and lessen drug development costs. Implementing mHealth technologies into cancer clinical trials has the potential to transform and propel oncology drug development and precision medicine to keep pace with the rapidly increasing developments in genomics and immunology.
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Affiliation(s)
- Suzanne M Cox
- Suzanne M. Cox and Samuel L. Volchenboum, University of Chicago, Chicago, IL; and Ashley Lane and Samuel L. Volchenboum, Litmus Health, Austin, TX
| | - Ashley Lane
- Suzanne M. Cox and Samuel L. Volchenboum, University of Chicago, Chicago, IL; and Ashley Lane and Samuel L. Volchenboum, Litmus Health, Austin, TX
| | - Samuel L Volchenboum
- Suzanne M. Cox and Samuel L. Volchenboum, University of Chicago, Chicago, IL; and Ashley Lane and Samuel L. Volchenboum, Litmus Health, Austin, TX
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32
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How should we assess patient-reported outcomes in the onco-hematology clinic? Curr Opin Support Palliat Care 2018; 12:522-529. [DOI: 10.1097/spc.0000000000000386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Austin E, Jagdeo J. Patient-reported outcomes in dermatology research and practice. GIORN ITAL DERMAT V 2018; 154:106-107. [PMID: 30428656 DOI: 10.23736/s0392-0488.18.06177-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Evan Austin
- Department of Dermatology, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - Jared Jagdeo
- Department of Dermatology, State University of New York, Downstate Medical Center, Brooklyn, NY, USA -
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Mercieca-Bebber R, King MT, Calvert MJ, Stockler MR, Friedlander M. The importance of patient-reported outcomes in clinical trials and strategies for future optimization. Patient Relat Outcome Meas 2018; 9:353-367. [PMID: 30464666 PMCID: PMC6219423 DOI: 10.2147/prom.s156279] [Citation(s) in RCA: 305] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Patient-reported outcomes (PROs) can be included in clinical trials as primary or secondary endpoints and are increasingly recognized by regulators, clinicians, and patients as valuable tools to collect patient-centered data. PROs provide unique information on the impact of a medical condition and its treatment from the patient's perspective; therefore, PROs can be included in clinical trials to ensure the impact of a trial intervention is comprehensively assessed. This review first discusses examples of how PRO endpoints have added value to clinical trial interpretation. Second, it describes the problems with current practices in designing, implementing, and reporting PRO studies, and how these problems may be addressed by complying with guidance for protocol development, selecting appropriate PRO measures to match clinically motivated PRO hypotheses, minimizing the rates of avoidable missing PRO data, analyzing and interpreting PRO data, and transparently reporting PRO findings.
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Affiliation(s)
| | - Madeleine T King
- Central Clinical School, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Melanie J Calvert
- Centre for Patient-Reported Outcomes Research and NIHR Birmingham Biomedical Research Centre, University of Birmingham, Edgbaston, Birmingham, UK
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Martin R Stockler
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia, ;
| | - Michael Friedlander
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia, ;
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia,
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35
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Nickman NA. The Chorus of User Voices: Meeting the Challenge of Patient-Reported Outcomes From Medications. QUALITATIVE HEALTH RESEARCH 2017; 27:1907-1909. [PMID: 29088988 DOI: 10.1177/1049732317733721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Prescription medication management by both healthcare providers and patients describe struggles not to inflict harm and encourage safe use in the context of culture and social relationships. Risk vs benefit assessments conducted in these contexts are essential for understanding how medication-taking decisions are made. Qualitatively-based Patient Reported Outcomes (PROs) are critical to understanding how medication pathways are navigated by both healthcare providers and patients seeking relief from maladies. Qualitative PROs have the potential to improve understanding of social and cultural factors that impact patient decision making whether to take a drug at all and would also serve to support developing models of patient-centered care.
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