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Butler CC. Democratising the design and delivery of large-scale randomised, controlled clinical trials in primary care: A personal view. Eur J Gen Pract 2024; 30:2293702. [PMID: 38180050 PMCID: PMC10773679 DOI: 10.1080/13814788.2023.2293702] [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] [Received: 08/25/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Rapid identification of effective treatments for use in the community during a pandemic is vital for the well-being of individuals and the sustainability of healthcare systems and society. Furthermore, identifying treatments that do not work reduces research wastage, spares people unnecessary side effects, rationalises the cost of purchasing and stockpiling medication, and reduces inappropriate medication use. Nevertheless, only a small minority of therapeutic trials for SARS-CoV-2 infections have been in primary care: most opened too late, struggled to recruit, and few produced actionable results. Participation in research is often limited by where one lives or receives health care, and trial participants may not represent those for whom the treatments are intended. INNOVATIVE TRIALS The ALIC4E, PRINCIPLE and the ongoing PANORAMIC trial have randomised over 40,500 people with COVID-19. This personal view describes how these trials have innovated in: trial design (by using novel adaptive platform designs); trial delivery (by complementing traditional site-based recruitment ('the patient comes to the research') with mechanisms to enable sick, infectious people to participate without having to leave home ('taking research to the people'), and by addressing the 'inverse research participation law,' which highlights disproportionate barriers faced by those who have the most to contribute, and benefit from, research, and; in transforming the evidence base by evaluating nine medicines to support guidelines and care decisions world-wide for COVID-19 and contribute to antimicrobial stewardship. CONCLUSION The PRINCIPLE and PANORAMIC trials represent models of innovation and inclusivity, and exemplify the potential of primary care to lead the way in addressing pressing global health challenges.
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Affiliation(s)
- Christopher C. Butler
- Nuffield Department of Primary Care Health Sciences, Primary Care Clinical Trials Unit, University of Oxford, Oxford, United Kingdom
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Bethe U, Pana ZD, Drosten C, Goossens H, König F, Marchant A, Molenberghs G, Posch M, Van Damme P, Cornely OA. Innovative approaches for vaccine trials as a key component of pandemic preparedness - a white paper. Infection 2024:10.1007/s15010-024-02347-1. [PMID: 39017997 DOI: 10.1007/s15010-024-02347-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/04/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND WHO postulates the application of adaptive design features in the global clinical trial ecosystem. However, the adaptive platform trial (APT) methodology has not been widely adopted in clinical research on vaccines. METHODS The VACCELERATE Consortium organized a two-day workshop to discuss the applicability of APT methodology in vaccine trials under non-pandemic as well as pandemic conditions. Core aspects of the discussions are summarized in this article. RESULTS An "ever-warm" APT appears ideally suited to improve efficiency and speed of vaccine research. Continuous learning based on accumulating APT trial data allows for pre-planned adaptations during its course. Given the relative design complexity, alignment of all stakeholders at all stages of an APT is central. Vaccine trial modelling is crucial, both before and in a pandemic emergency. Various inferential paradigms are possible (frequentist, likelihood, or Bayesian). The focus in the interpandemic interval may be on research gaps left by industry trials. For activation in emergency, template Disease X protocols of syndromal design for pathogens yet unknown need to be stockpiled and updated regularly. Governance of a vaccine APT should be fully integrated into supranational pandemic response mechanisms. DISCUSSION A broad range of adaptive features can be applied in platform trials on vaccines. Faster knowledge generation comes with increased complexity of trial design. Design complexity should not preclude simple execution at trial sites. Continuously generated evidence represents a return on investment that will garner societal support for sustainable funding. Adaptive design features will naturally find their way into platform trials on vaccines.
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Affiliation(s)
- Ullrich Bethe
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Herderstrasse 52, 50931, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Department I of Internal Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
- Partner Site Bonn-Cologne, German Centre for Infection Research (DZIF), Cologne, Germany
| | - Zoi D Pana
- Medical School, European University of Cyprus, Nicosia, Cyprus
| | - Christian Drosten
- Institute of Virology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute and Biobank Antwerp, University of Antwerp, Wilrijk, Belgium
| | - Franz König
- Center for Medical Data Science, Institute of Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Arnaud Marchant
- European Plotkin Institute for Vaccinology, Université libre de Bruxelles, Brussels, Belgium
| | - Geert Molenberghs
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics, Data Science Institute, KU Leuven and Hasselt University, Wilrijk, Belgium
| | - Martin Posch
- Center for Medical Data Science, Institute of Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, VACCINOPOLIS, Vaccine and Infectious Disease Institute, University of Antwerp, Wilrijk, Belgium
| | - Oliver A Cornely
- Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Herderstrasse 52, 50931, Cologne, Germany.
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), Department I of Internal Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany.
- Partner Site Bonn-Cologne, German Centre for Infection Research (DZIF), Cologne, Germany.
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3
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Tare D, Coenen S, De Sutter A, Heytens S, Devroey D, Buret L, Schoenmakers B, Delvaux N, Verbakel JY, Bogaerts K, van den Bruel A. The DAWN antivirals trial: process evaluation of a COVID-19 trial in general practice. BJGP Open 2024; 8:BJGPO.2023.0109. [PMID: 37984980 PMCID: PMC11300998 DOI: 10.3399/bjgpo.2023.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The DAWN antivirals trial was a multicentric, randomised placebo-controlled trial evaluating antiviral medication for COVID-19 in general practice. The trial was prematurely terminated because of insufficient recruitment. AIM To explore which factors contributed to the premature termination. DESIGN & SETTING General practice in Belgium. METHOD Patients were randomised to camostat or placebo (patients and physicians blinded) between June 2021 and July 2022; a third arm evaluating molnupiravir (open label) was opened in March 2022. The outcome assessor was blinded for all comparisons except for the patient reported outcomes in case of molnupiravir. The authors analysed available trial data and evaluated trial context, implementation, and mechanisms of impact based on semi-structured interviews with trial stakeholders. RESULTS The trial recruited 44 participants; 19 were allocated to camostat (median age 55 years), 8 to molnupiravir (median age 60 years), and 17 to placebo (median age 56 years). There were no serious adverse events in either group. Most difficulties were related to the pandemic context: disruption to routine clinical services; multiple changes to the service model for COVID-19 patients; overwhelmed clinical staff; delays of trial medication; and staff shortages in the sponsor and clinical team. In addition, regulatory approval processes were lengthy and led to additional study procedures. It was felt that the trial started too late, when vaccinations had already begun. CONCLUSION The DAWN antivirals trial was stopped prematurely. Although many barriers were related to the pandemic itself, hurdles such as a small and inexperienced sponsor and clinical teams, delays in regulatory processes, and research capacity in routine settings could be overcome by established research infrastructure and standardisation of processes.
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Affiliation(s)
- Dajana Tare
- Academic Centre for General Practice, KU Leuven, Belgium
| | - Samuel Coenen
- Centre for General Practice, Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerpen, Belgium
| | - An De Sutter
- Department of Public Health and Primary Care, Ghent University, KU Leuven, Belgium
| | - Stefan Heytens
- Department of Public Health and Primary Care, Ghent University, KU Leuven, Belgium
| | - Dirk Devroey
- Primary Care, Vrije Universiteit Brussel, Ixelles, Belgium
| | - Laetitia Buret
- Department of General Medicine, University of Liège, Liège, Belgium
| | | | | | - Jan Y Verbakel
- Academic Centre for General Practice, KU Leuven, Belgium
| | - Kris Bogaerts
- Department of Public Health and Primary Care, I-BioStat, KU Leuven, Leuven, Belgium
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Demotes J, Simensen VC, Ueda K, Javaid S, Garcia P, Aydin B, Røttingen JA. Coordination of COVID-19 platform trials in Europe. Trials 2024; 25:278. [PMID: 38659031 PMCID: PMC11044280 DOI: 10.1186/s13063-024-08126-5] [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: 12/19/2023] [Accepted: 04/18/2024] [Indexed: 04/26/2024] Open
Abstract
To ensure optimal coordination of the EU-funded COVID-19 platform trials, a double coordination mechanism was established. It included the Trial Coordination Board (TCB) to promote the dialogue between investigators and relevant public health stakeholders and the Joint Access Advisory Mechanism (JAAM) to streamline access of new intervention arms to the platform trials. Both the TCB and the JAAM emerged as efficient instruments to promote cooperation and optimise the use of resources within EU-funded adaptive platform trials. In addition, an adaptive platform trial toolbox was developed to collect information and literature on challenges and solutions identified to date. The recently funded 'Coordination MEchanism for Cohorts and Trials' (CoMeCT) project will endeavour to make this model sustainable, with a further expansion to other emerging infectious diseases, as part of the governance of the current and future platform trials for pandemic preparedness. This example could serve as a model for platform trial coordination in other disease areas.
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Affiliation(s)
- Jacques Demotes
- European Clinical Research Infrastructure Network, ECRIN, 30 Boulevard Saint-Jacques, Paris, 75014, France.
| | - Victoria Charlotte Simensen
- Department of Vaccines and Immunisation, Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
| | - Keiko Ueda
- European Clinical Research Infrastructure Network, ECRIN, 30 Boulevard Saint-Jacques, Paris, 75014, France
| | - Sareema Javaid
- European Clinical Research Infrastructure Network, ECRIN, 30 Boulevard Saint-Jacques, Paris, 75014, France
| | - Paula Garcia
- European Clinical Research Infrastructure Network, ECRIN, 30 Boulevard Saint-Jacques, Paris, 75014, France
| | - Burç Aydin
- European Clinical Research Infrastructure Network, ECRIN, 30 Boulevard Saint-Jacques, Paris, 75014, France
| | - John-Arne Røttingen
- Division of Infectious Disease Control, Norwegian Institute of Public Health, Oslo, Norway
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5
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Gumber L, Agbeleye O, Inskip A, Fairbairn R, Still M, Ouma L, Lozano-Kuehne J, Bardgett M, Isaacs JD, Wason JM, Craig D, Pratt AG. Operational complexities in international clinical trials: a systematic review of challenges and proposed solutions. BMJ Open 2024; 14:e077132. [PMID: 38626966 PMCID: PMC11029458 DOI: 10.1136/bmjopen-2023-077132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 02/27/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE International trials can be challenging to operationalise due to incompatibilities between country-specific policies and infrastructures. The aim of this systematic review was to identify the operational complexities of conducting international trials and identify potential solutions for overcoming them. DESIGN Systematic review. DATA SOURCES Medline, Embase and Health Management Information Consortium were searched from 2006 to 30 January 2023. ELIGIBILITY CRITERIA All studies reporting operational challenges (eg, site selection, trial management, intervention management, data management) of conducting international trials were included. DATA EXTRACTION AND SYNTHESIS Search results were independently screened by at least two reviewers and data were extracted into a proforma. RESULTS 38 studies (35 RCTs, 2 reports and 1 qualitative study) fulfilled the inclusion criteria. The median sample size was 1202 (IQR 332-4056) and median number of sites was 40 (IQR 13-78). 88.6% of studies had an academic sponsor and 80% were funded through government sources. Operational complexities were particularly reported during trial set-up due to lack of harmonisation in regulatory approvals and in relation to sponsorship structure, with associated budgetary impacts. Additional challenges included site selection, staff training, lengthy contract negotiations, site monitoring, communication, trial oversight, recruitment, data management, drug procurement and distribution, pharmacy involvement and biospecimen processing and transport. CONCLUSIONS International collaborative trials are valuable in cases where recruitment may be difficult, diversifying participation and applicability. However, multiple operational and regulatory challenges are encountered when implementing a trial in multiple countries. Careful planning and communication between trials units and investigators, with an emphasis on establishing adequately resourced cross-border sponsorship structures and regulatory approvals, may help to overcome these barriers and realise the benefits of the approach. OPEN SCIENCE FRAMEWORK REGISTRATION NUMBER: osf-registrations-yvtjb-v1.
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Affiliation(s)
- Leher Gumber
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Northumbria Healthcare NHS Foundation Trust, Northumbria, UK
| | - Opeyemi Agbeleye
- NIHR Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Alex Inskip
- NIHR Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ross Fairbairn
- NIHR Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Madeleine Still
- NIHR Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Ouma
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jingky Lozano-Kuehne
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Michelle Bardgett
- Newcastle Clinical Trials Unit, Newcastle University, Newcastle upon Tyne, UK
| | - John D Isaacs
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Musculoskeletal Unit, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
| | - James Ms Wason
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- NIHR Innovation Observatory, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Arthur G Pratt
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Musculoskeletal Unit, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
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6
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Glasziou P, Sanders S, Byambasuren O, Thomas R, Hoffmann T, Greenwood H, van der Merwe M, Clark J. Clinical trials and their impact on policy during COVID-19: a review. Wellcome Open Res 2024; 9:20. [PMID: 38434720 PMCID: PMC10905118 DOI: 10.12688/wellcomeopenres.19305.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 03/05/2024] Open
Abstract
Background Of over 8,000 recorded randomised trials addressing COVID-19, around 80% were of treatments, and 17% have reported results. Approximately 1% were adaptive or platform trials, with 25 having results available, across 29 journal articles and 10 preprint articles. Methods We conducted an extensive literature review to address four questions about COVID-19 trials, particularly the role and impact of platform/adaptive trials and lessons learned. Results The key findings were: Q1. Social value in conducting trials and uptake into policy? COVID-19 drug treatments varied substantially and changed considerably, with drugs found effective in definitive clinical trials replacing unproven drugs. Dexamethasone has likely saved ½-2 million lives, and was cost effective across a range of countries and populations, whereas the cost effectiveness of remdesivir is uncertain. Published economic and health system impacts of COVID-19 treatments were infrequent. Q2. Issues with adaptive trial designs. Of the 77 platform trials registered, 6 major platform trials, with approximately 50 treatment arms, recruited ~135,000 participants with funding over $100 million. Q3. Models of good practice. Streamlined set-up processes such as flexible and fast-track funding, ethics, and governance approvals are vital. To facilitate recruitment, simple and streamlined research processes, and pre-existing research networks to coordinate trial planning, design, conduct and practice change are crucial to success. Q4. Potential conflicts to avoid? When treating patients through trials, balancing individual and collective rights and allocating scarce resources between healthcare and research are challenging. Tensions occur between commercial and non-commercial sectors, and academic and public health interests, such as publication and funding driven indicators and the public good. Conclusion There is a need to (i) reduce small, repetitive, single centre trials, (ii) increase coordination to ensure robust research conducted for treatments, and (iii) a wider adoption of adaptive/platform trial designs to respond to fast-evolving evidence landscape.
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Affiliation(s)
- Paul Glasziou
- IEBH, Health Science and Medicine, Bond University, Robina, Queensland, Australia
| | - Sharon Sanders
- IEBH, Health Science and Medicine, Bond University, Robina, Queensland, Australia
| | | | - Rae Thomas
- IEBH, Health Science and Medicine, Bond University, Robina, Queensland, Australia
| | - Tammy Hoffmann
- IEBH, Health Science and Medicine, Bond University, Robina, Queensland, Australia
| | - Hannah Greenwood
- IEBH, Health Science and Medicine, Bond University, Robina, Queensland, Australia
| | | | - Justin Clark
- IEBH, Health Science and Medicine, Bond University, Robina, Queensland, Australia
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7
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Modlin C, Sugarman J, Chongwe G, Kass N, Nazziwa W, Tegli J, Shrestha P, Ali J. Towards achieving transnational research partnership equity: lessons from implementing adaptive platform trials in low- and middle-income countries. Wellcome Open Res 2023; 8:120. [PMID: 38089903 PMCID: PMC10714106 DOI: 10.12688/wellcomeopenres.18915.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2023] [Indexed: 02/01/2024] Open
Abstract
Background Use of adaptive clinical trials, particularly adaptive platform trials, has grown exponentially in response to the coronavirus disease (COVID-19) pandemic. Implementation of these trials in low- and middle-income countries (LMICs) has been fostered through the formation or modification of transnational research partnerships, typically between research groups from LMICs and high-income countries (HICs). While these partnerships are important to promote collaboration and overcome the structural and economic disadvantages faced by LMIC health researchers, it is critical to focus attention on the multiple dimensions of partnership equity. Methods Based on informal literature reviews and a meeting with leaders of one of the multinational COVID-19 adaptive platform trials, we describe some important considerations about research partnership equity in this context. Results We organize these considerations into eight thematic categories: 1) epistemic structures, 2) funding, 3) ethics oversight, 4) regulatory oversight, 5) leadership, 6) post-trial access to interventions, data, and specimens, 7) knowledge translation and dissemination, and 8) research capacity strengthening and maintenance. Within each category we review normative claims that support its relevance to research partnership equity followed by discussion of how adaptive platform trials highlight new dimensions, considerations, or challenges. Conclusion In aggregate, these observations provide insight into procedural and substantive equity-building measures within transnational global health research partnerships more broadly.
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Affiliation(s)
- Chelsea Modlin
- Berman Institute for Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, Maryland, 21205, USA
| | - Jeremy Sugarman
- Berman Institute for Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland, 21205, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Gershom Chongwe
- School of Public Health, University of Zambia, Lusaka, Zambia
| | - Nancy Kass
- Berman Institute for Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Winfred Nazziwa
- Uganda National Council for Science and Technology, Kampala, Uganda
| | - Jemee Tegli
- Family Health International Clinical/Partnership for Research on Vaccines and Infectious Diseases in Liberia, Monrovia, Liberia
| | - Prakriti Shrestha
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
| | - Joseph Ali
- Berman Institute for Bioethics, Johns Hopkins University, Baltimore, MD, 21205, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, 21205, USA
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Dal-Ré R. 'Pragmatic' or 'streamlined': Which term best fits the REMAP-CAP trial. Eur J Intern Med 2023; 113:119-121. [PMID: 37030996 DOI: 10.1016/j.ejim.2023.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 03/29/2023] [Indexed: 04/10/2023]
Affiliation(s)
- Rafael Dal-Ré
- Epidemiology Unit, Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, Avda. Reyes Católicos 2, E-28040 Madrid, Spain.
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Dal-Ré R. Is it reasonable to label a trial as pragmatic whose investigators do not? The UK RECOVERY COVID-19 trial case. Clin Trials 2023; 20:319-321. [PMID: 36740750 PMCID: PMC9902778 DOI: 10.1177/17407745231152851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Rafael Dal-Ré
- Epidemiology Unit, Health Research Institute-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
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Davies A, Ormel I, Bernier A, Harriss E, Mumba N, Gobat N, Schwartz L, Cheah PY. A rapid review of community engagement and informed consent processes for adaptive platform trials and alternative design trials for public health emergencies. Wellcome Open Res 2023; 8:194. [PMID: 37654739 PMCID: PMC10465998 DOI: 10.12688/wellcomeopenres.19318.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 09/02/2023] Open
Abstract
Background : Public Health Emergencies (PHE) demand expeditious research responses to evaluate new or repurposed therapies and prevention strategies. Alternative Design Trials (ADTs) and Adaptive Platform Trials (APTs) have enabled efficient large-scale testing of biomedical interventions during recent PHEs. Design features of these trials may have implications for engagement and/or informed consent processes. We aimed to rapidly review evidence on engagement and informed consent for ADTs and APTs during PHE to consider what (if any) recommendations can inform practice. Method : In 2022, we searched 8 prominent databases for relevant peer reviewed publications and guidelines for ADTs/APTs in PHE contexts. Articles were selected based on pre-identified inclusion and exclusion criteria. We reviewed protocols and informed consent documents for a sample of large platform trials and consulted with key informants from ADTs/APT trial teams. Data were extracted and summarised using narrative synthesis. Results : Of the 49 articles included, 10 were guidance documents, 14 discussed engagement, 10 discussed informed consent, and 15 discussed both. Included articles addressed ADTs delivered during the West African Ebola epidemic and APTs delivered during COVID-19. PHE clinical research guidance documents highlight the value of ADTs/APTs and the importance of community engagement, but do not provide practice-specific guidance for engagement or informed consent. Engagement and consent practice for ADTs conducted during the West African Ebola epidemic have been well-documented. For COVID-19, engagement and consent practice was described for APTs primarily delivered in high income countries with well-developed health service structures. A key consideration is strong communication of the complexity of trial design in clear, accessible ways. Conclusion: We highlight key considerations for best practice in community engagement and informed consent relevant to ADTs and APTs for PHEs which may helpfully be included in future guidance. Protocol: The review protocol is published online at Prospero on 15/06/2022: registration number CRD42022334170.
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Affiliation(s)
- Alun Davies
- Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, Oxford, England, UK
| | - Ilja Ormel
- Faculty of Health Sciences, Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alexe Bernier
- Faculty of Social Sciences, School of Social Work, McMaster University, Hamilton, Ontario, Canada
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, England, UK
| | - Noni Mumba
- The KEMRI-Wellcome Trust Research Programme, Kilifi, 80108, Kenya
| | - Nina Gobat
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK
| | - Lisa Schwartz
- Faculty of Health Sciences, Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Salaya, Nakhon Pathom, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, England, UK
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11
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Jazbec K, Jež M, Žiberna K, Mali P, Ramšak Ž, Potokar UR, Kvrzić Z, Černilec M, Gracar M, Šprohar M, Jovanovič P, Vuletić S, Rožman P. Simple prediction of COVID-19 convalescent plasma units with high levels of neutralization antibodies. Virol J 2023; 20:53. [PMID: 36973781 PMCID: PMC10042109 DOI: 10.1186/s12985-023-02007-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Hyperimmune convalescent COVID-19 plasma (CCP) containing anti-SARS-CoV-2 neutralizing antibodies (NAbs) was proposed as a therapeutic option for patients early in the new coronavirus disease pandemic. The efficacy of this therapy depends on the quantity of neutralizing antibodies (NAbs) in the CCP units, with titers ≥ 1:160 being recommended. The standard neutralizing tests (NTs) used for determining appropriate CCP donors are technically demanding and expensive and take several days. We explored whether they could be replaced by high-throughput serology tests and a set of available clinical data. METHODS Our study included 1302 CCP donors after PCR-confirmed COVID-19 infection. To predict donors with high NAb titers, we built four (4) multiple logistic regression models evaluating the relationships of demographic data, COVID-19 symptoms, results of various serological testing, the period between disease and donation, and COVID-19 vaccination status. RESULTS The analysis of the four models showed that the chemiluminescent microparticle assay (CMIA) for the quantitative determination of IgG Abs to the RBD of the S1 subunit of the SARS-CoV-2 spike protein was enough to predict the CCP units with a high NAb titer. CCP donors with respective results > 850 BAU/ml SARS-CoV-2 IgG had a high probability of attaining sufficient NAb titers. Including additional variables such as donor demographics, clinical symptoms, or time of donation into a particular predictive model did not significantly increase its sensitivity and specificity. CONCLUSION A simple quantitative serological determination of anti-SARS-CoV-2 antibodies alone is satisfactory for recruiting CCP donors with high titer NAbs.
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Affiliation(s)
- Katerina Jazbec
- Blood Transfusion Centre of Slovenia, Šlajmerjeva 6, Ljubljana, 1000, Slovenia.
| | - Mojca Jež
- Blood Transfusion Centre of Slovenia, Šlajmerjeva 6, Ljubljana, 1000, Slovenia
| | - Klemen Žiberna
- Blood Transfusion Centre of Slovenia, Šlajmerjeva 6, Ljubljana, 1000, Slovenia
| | - Polonca Mali
- Blood Transfusion Centre of Slovenia, Šlajmerjeva 6, Ljubljana, 1000, Slovenia
| | - Živa Ramšak
- NIB-National Institute of Biology, Ljubljana, Slovenia
| | - Urška Rahne Potokar
- Blood Transfusion Centre of Slovenia, Šlajmerjeva 6, Ljubljana, 1000, Slovenia
| | - Zdravko Kvrzić
- Blood Transfusion Centre of Slovenia, Šlajmerjeva 6, Ljubljana, 1000, Slovenia
| | - Maja Černilec
- Blood Transfusion Centre of Slovenia, Šlajmerjeva 6, Ljubljana, 1000, Slovenia
| | - Melita Gracar
- Blood Transfusion Centre of Slovenia, Šlajmerjeva 6, Ljubljana, 1000, Slovenia
| | - Marjana Šprohar
- Blood Transfusion Centre of Slovenia, Šlajmerjeva 6, Ljubljana, 1000, Slovenia
| | - Petra Jovanovič
- Blood Transfusion Centre of Slovenia, Šlajmerjeva 6, Ljubljana, 1000, Slovenia
| | - Sonja Vuletić
- Blood Transfusion Centre of Slovenia, Šlajmerjeva 6, Ljubljana, 1000, Slovenia
| | - Primož Rožman
- Blood Transfusion Centre of Slovenia, Šlajmerjeva 6, Ljubljana, 1000, Slovenia
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12
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Saito H. International platform trials: as diseases cross borders, so should trials. THE LANCET. INFECTIOUS DISEASES 2023; 23:530-531. [PMID: 36966801 PMCID: PMC10036126 DOI: 10.1016/s1473-3099(23)00193-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Hiroki Saito
- Department of Emergency and Critical Care Medicine, St Marianna University Yokohama Seibu Hospital, Yokohama 241-0811, Japan.
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13
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Modlin C, Sugarman J, Chongwe G, Kass N, Nazziwa W, Tegli J, Shrestha P, Ali J. Towards achieving transnational research partnership equity: lessons from implementing adaptive platform trials in low- and middle-income countries. Wellcome Open Res 2023. [DOI: 10.12688/wellcomeopenres.18915.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Background: Use of adaptive clinical trials, particularly adaptive platform trials, has grown exponentially in response to the coronavirus disease (COVID-19) pandemic. Implementation of these trials in low- and middle-income countries (LMICs) has been fostered through the formation or modification of transnational research partnerships, typically between research groups from LMICs and high-income countries (HICs). While these partnerships are important to promote collaboration and overcome the structural and economic disadvantages faced by LMIC health researchers, it is critical to focus attention on the multiple dimensions of partnership equity. Methods: Based on informal literature reviews and meetings with leaders of one of the multinational COVID-19 adaptive platform trials, we describe what can be learned about research partnership equity from these experiences. Results: We organize these considerations into eight thematic categories: 1) epistemic structures, 2) funding, 3) ethics oversight, 4) regulatory oversight, 5) leadership, 6) post-trial access to interventions, data, and specimens, 7) knowledge translation, and 8) research capacity strengthening and maintenance. Within each category we review the normative claims that support its relevance to research partnership equity followed by discussion of how adaptive platform trials highlight new dimensions, considerations, or challenges. Conclusion: These observations provide insight into procedural and substantive equity-building measures within transnational global health research partnerships more broadly.
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14
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Pericàs JM, Derde LPG, Berry SM. Platform trials as the way forward in infectious disease' clinical research: the case of coronavirus disease 2019. Clin Microbiol Infect 2023; 29:277-280. [PMID: 36462745 PMCID: PMC9711898 DOI: 10.1016/j.cmi.2022.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Juan M Pericàs
- Liver Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades digestivas y hepáticas (CIBERehd), Madrid, Spain.
| | - Lennie P G Derde
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands
| | - Scott M Berry
- Berry Consultants, LLC, Austin, TX, USA; Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA
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15
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Hassoun-Kheir N, van Werkhoven CH, Dunning J, Jaenisch T, van Beek J, Bielicki J, Butler CC, Francois B, Harbarth S, Hernandez Padilla AC, Horby P, Koopmans M, Lee J, Rodriguez-Baño J, Tacconelli E, Themistocleous Y, van der Velden AW, Bonten M, Goossens H, de Kraker ME. Perpetual observational studies: new strategies to support efficient implementation of observational studies and randomized trials in infectious diseases. Clin Microbiol Infect 2022; 28:1528-1532. [PMID: 35940566 PMCID: PMC9354481 DOI: 10.1016/j.cmi.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Nasreen Hassoun-Kheir
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva Switzerland
| | - C. Henri van Werkhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Jake Dunning
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Thomas Jaenisch
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany
| | - Janko van Beek
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Julia Bielicki
- Institute for Infection and Immunity, St George's, University of London, London, UK,Infection Prevention and Control, Universitäts-Kinderspital Beider Basel, Basel, Switzerland
| | | | - Bruno Francois
- Medical-Surgical Intensive Care Unit and Inserm CIC 1435 & UMR 1092, CHU Limoges, Limoges, France
| | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva Switzerland
| | - Ana C. Hernandez Padilla
- Medical-Surgical Intensive Care Unit and Inserm CIC 1435 & UMR 1092, CHU Limoges, Limoges, France
| | - Peter Horby
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Marion Koopmans
- Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands,Pandemic and Disaster Preparedness Research Centre, Rotterdam, the Netherlands
| | - James Lee
- Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Jesús Rodriguez-Baño
- Infectious Diseases and Microbiology, Hospital Universitario Virgen Macarena, Department of Medicine, University of Sevilla, Biomedicine Institute of Sevilla (IBiS), CSIC, Sevilla, Spain,Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Alike W. van der Velden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Marc Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Marlieke E.A. de Kraker
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva Switzerland,Corresponding author. Marlieke E.A. de Kraker, Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
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16
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Tacconelli E, Gorska A, Carrara E, Davis RJ, Bonten M, Friedrich AW, Glasner C, Goossens H, Hasenauer J, Abad JMH, Peñalvo JL, Sanchez-Niubo A, Sialm A, Scipione G, Soriano G, Yazdanpanah Y, Vorstenbosch E, Jaenisch T. Challenges of data sharing in European Covid-19 projects: A learning opportunity for advancing pandemic preparedness and response. Lancet Reg Health Eur 2022; 21:100467. [PMID: 35942201 PMCID: PMC9351292 DOI: 10.1016/j.lanepe.2022.100467] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The COVID-19 pandemic saw a massive investment into collaborative research projects with a focus on producing data to support public health decisions. We relay our direct experience of four projects funded under the Horizon2020 programme, namely ReCoDID, ORCHESTRA, unCoVer and SYNCHROS. The projects provide insight into the complexities of sharing patient level data from observational cohorts. We focus on compliance with the General Data Protection Regulation (GDPR) and ethics approvals when sharing data across national borders. We discuss procedures for data mapping; submission of new international codes to standards organisation; federated approach; and centralised data curation. Finally, we put forward recommendations for the development of guidelines for the application of GDPR in case of major public health threats; mandatory standards for data collection in funding frameworks; training and capacity building for data owners; cataloguing of international use of metadata standards; and dedicated funding for identified critical areas.
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17
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Tuberculosis in the Russian Federation: Dynamics of the Epidemic Indicators before and after COVID-19 Pandemic. Life (Basel) 2022; 12:life12101468. [PMID: 36294903 PMCID: PMC9605375 DOI: 10.3390/life12101468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/09/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
The measures taken against tuberculosis (TB) in recent years in the Russian Federation have been highly effective. Unfortunately, the COVID-19 pandemic may seriously undermine the progress that has been made in the fight against TB. The aim of this study was to assess changes in the epidemiological rates of tuberculosis in the Russian Federation before and after the COVID-19 pandemic. Materials and methods. The analysis was conducted by considering the main epidemiological indicators of tuberculosis, according to the federal statistics for the period from 2017 to 2021. The parameters were estimated according to the data received from 11 areas in the North-Western region. Statistical analysis was carried out using the free software computing environment R (v.3.5.1) and the commercial software package Statistical Package for the Social Sciences (SPSS Statistics for Windows, version 24.0, IBM Corp., 2016). Research results. We found a positive correlation between the incidence among the overall population and the incidence among children aged 0–17, inclusively (r = 0.55 in 2017, r = 0.60 in 2020, and r = 0.53 in 2021). Along with the received regularities, a different trend is shown in the data analysis of general incidence and health X-ray examination for tuberculosis among the general population. The correlation has decreased threefold from 2017 (r = 0.72) to 2020 (r = 0.32); this negative trend might be the result of factors such as the quality of X-ray screening examinations among the general population, and the reduced assessment objectivity of the tuberculosis incidence rate. Conclusions. In assessing the correlation between general incidence and incidence in children under 17 years of age, as well as between incidence and mortality in the Russian Federation, a positive correlation was found with an increasing trend. Such a discrepancy might be due to decreases in the occupational health examination coverage among the general population. Therefore, in the years ahead, we can expect epidemiological indicators to increase incidence and mortality, including child mortality, associated with the insufficient detection of tuberculosis among the population during the COVID-19 pandemic.
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18
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Hanney SR, Straus SE, Holmes BJ. Saving millions of lives but some resources squandered: emerging lessons from health research system pandemic achievements and challenges. Health Res Policy Syst 2022; 20:99. [PMID: 36088365 PMCID: PMC9464102 DOI: 10.1186/s12961-022-00883-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/27/2022] [Indexed: 12/15/2022] Open
Abstract
During the SARS-CoV-2 pandemic, astonishingly rapid research averted millions of deaths worldwide through new vaccines and repurposed and new drugs. Evidence use informed life-saving national policies including non-pharmaceutical interventions. Simultaneously, there was unprecedented waste, with many underpowered trials on the same drugs. We identified lessons from COVID-19 research responses by applying WHO's framework for research systems. It has four functions-governance, securing finance, capacity-building, and production and use of research-and nine components. Two linked questions focused the analysis. First, to what extent have achievements in knowledge production and evidence use built on existing structures and capacity in national health research systems? Second, did the features of such systems mitigate waste? We collated evidence on seven countries, Australia, Brazil, Canada, Germany, New Zealand, the United Kingdom and the United States, to identify examples of achievements and challenges.We used the data to develop lessons for each framework component. Research coordination, prioritization and expedited ethics approval contributed to rapid identification of new therapies, including dexamethasone in the United Kingdom and Brazil. Accelerated vaccines depended on extensive funding, especially through the Operation Warp Speed initiative in the United States, and new platforms created through long-term biomedical research capacity in the United Kingdom and, for messenger ribonucleic acid (mRNA) vaccines, in Canada, Germany and the United States. Research capacity embedded in the United Kingdom's healthcare system resulted in trial acceleration and waste avoidance. Faster publication of research saved lives, but raised challenges. Public/private collaborations made major contributions to vastly accelerating new products, available worldwide, though unequally. Effective developments of living (i.e. regularly updated) reviews and guidelines, especially in Australia and Canada, extended existing expertise in meeting users' needs. Despite complexities, effective national policy responses (less evident in Brazil, the United Kingdom and the United States) also saved lives by drawing on health research system features, including collaboration among politicians, civil servants and researchers; good communications; and willingness to use evidence. Comprehensive health research strategies contributed to success in research production in the United Kingdom and in evidence use by political leadership in New Zealand. In addition to waste, challenges included equity issues, public involvement and non-COVID research. We developed recommendations, but advocate studies of further countries.
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Affiliation(s)
- Stephen R Hanney
- Health Economics Research Group, Department of Health Sciences, Brunel University London, London, United Kingdom.
| | - Sharon E Straus
- St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Bev J Holmes
- Michael Smith Health Research BC, Vancouver, BC, Canada
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19
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Agyekum RS, Abramoff BA, Wherry EJ, Meyer NJ. Building effective collaborations for the study of COVID-19 across the severity spectrum. Nat Immunol 2022; 23:1287-1290. [PMID: 35999396 DOI: 10.1038/s41590-022-01283-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Roseline S Agyekum
- Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA.,Center for Translational Lung Biology, Lung Biology Institute, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA
| | - Benjamin A Abramoff
- Department of Physical Medicine and Rehabilitation, , University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA
| | - E John Wherry
- Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA.,Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA.,Parker Institute for Cancer Immunotherapy, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA
| | - Nuala J Meyer
- Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA. .,Center for Translational Lung Biology, Lung Biology Institute, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA. .,Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Pennsylvania, PA, USA.
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20
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Schwartz IS, Boulware DR, Lee TC. Hydroxychloroquine for COVID19: The curtains close on a comedy of errors. LANCET REGIONAL HEALTH. AMERICAS 2022; 11:100268. [PMID: 35531052 PMCID: PMC9069223 DOI: 10.1016/j.lana.2022.100268] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
| | - David R Boulware
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, USA
| | - Todd C Lee
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
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21
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Stojanovic Z, Gonçalves-Carvalho F, Marín A, Abad Capa J, Domínguez J, Latorre I, Lacoma A, Prat-Aymerich C. Advances in diagnostic tools for respiratory tract infections: from tuberculosis to COVID-19 - changing paradigms? ERJ Open Res 2022; 8:00113-2022. [PMID: 36101788 PMCID: PMC9235056 DOI: 10.1183/23120541.00113-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/31/2022] [Indexed: 11/05/2022] Open
Abstract
Respiratory tract infections (RTIs) are one of the most common reasons for seeking healthcare, but are amongst the most challenging diseases in terms of clinical decision-making. Proper and timely diagnosis is critical in order to optimise management and prevent further emergence of antimicrobial resistance by misuse or overuse of antibiotics. Diagnostic tools for RTIs include those involving syndromic and aetiological diagnosis: from clinical and radiological features to laboratory methods targeting both pathogen detection and host biomarkers, as well as their combinations in terms of clinical algorithms. They also include tools for predicting severity and monitoring treatment response. Unprecedented milestones have been achieved in the context of the COVID-19 pandemic, involving the most recent applications of diagnostic technologies both at genotypic and phenotypic level, which have changed paradigms in infectious respiratory diseases in terms of why, how and where diagnostics are performed. The aim of this review is to discuss advances in diagnostic tools that impact clinical decision-making, surveillance and follow-up of RTIs and tuberculosis. If properly harnessed, recent advances in diagnostic technologies, including omics and digital transformation, emerge as an unprecedented opportunity to tackle ongoing and future epidemics while handling antimicrobial resistance from a One Health perspective.
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Affiliation(s)
- Zoran Stojanovic
- Pneumology Dept, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
- Ciber Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Co-first authors
| | - Filipe Gonçalves-Carvalho
- Pneumology Dept, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
- Ciber Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Co-first authors
| | - Alicia Marín
- Pneumology Dept, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
- Ciber Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Jorge Abad Capa
- Pneumology Dept, Hospital Universitari Germans Trias i Pujol, Institut d'Investigació Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain
- Ciber Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | - Jose Domínguez
- Ciber Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Microbiology Department, Institut d'Investigació Germans Trias i Pujol, Badalona, Spain
| | - Irene Latorre
- Ciber Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Microbiology Department, Institut d'Investigació Germans Trias i Pujol, Badalona, Spain
| | - Alicia Lacoma
- Ciber Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Microbiology Department, Institut d'Investigació Germans Trias i Pujol, Badalona, Spain
- Co-senior authors
| | - Cristina Prat-Aymerich
- Ciber Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Microbiology Department, Institut d'Investigació Germans Trias i Pujol, Badalona, Spain
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Co-senior authors
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22
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Szepessy E, Arlett P, Sweeney F, Broich K, Rys AJ. COVID-19 kick-starts a new era for clinical trials and pandemic preparedness in Europe. THE LANCET INFECTIOUS DISEASES 2022; 22:315-316. [PMID: 35218746 PMCID: PMC8865886 DOI: 10.1016/s1473-3099(22)00061-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/27/2022] [Indexed: 11/28/2022]
Affiliation(s)
| | - Peter Arlett
- European Medicines Agency, Amsterdam, Netherlands
| | | | - Karl Broich
- Bundesinstitut fur Arzneimittel und Medizinprodukte, Bonn, Germany
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23
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Depoortere E, Sowinski S, van Hengel A, Kerstiëns B, Norstedt I. COVID-19 kick-starts a new era for clinical trials and pandemic preparedness in Europe. THE LANCET INFECTIOUS DISEASES 2022; 22:315. [PMID: 35218745 PMCID: PMC8865874 DOI: 10.1016/s1473-3099(22)00059-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/27/2022] [Indexed: 10/28/2022]
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