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Siedlecki E, Remiszewski P, Stec R. The Role of circHIPK3 in Tumorigenesis and Its Potential as a Biomarker in Lung Cancer. Cells 2024; 13:1483. [PMID: 39273053 PMCID: PMC11393915 DOI: 10.3390/cells13171483] [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: 07/29/2024] [Revised: 08/27/2024] [Accepted: 08/31/2024] [Indexed: 09/15/2024] Open
Abstract
Lung cancer treatment and detection can be improved by the identification of new biomarkers. Novel approaches in investigating circular RNAs (circRNAs) as biomarkers have yielded promising results. A circRNA molecule circHIPK3 was found to be widely expressed in non-small-cell lung cancer (NSCLC) cells, where it plays a crucial role in lung cancer tumorigenesis. CircHIPK3 promotes lung cancer progression by sponging oncosuppressive miRNAs such as miR-124, miR-381-3p, miR-149, and miR-107, which results in increased cell proliferation, migration, and resistance to therapies. Inhibiting circHIPK3 has been demonstrated to suppress tumour growth and induce apoptosis, which suggests its potential use in the development of new lung cancer treatment strategies targeting circHIPK3-related pathways. As a biomarker, circHIPK3 shows promise for early detection and monitoring of lung cancer. CircHIPK3 increased expression levels in lung cancer cells, and its potential link to metastasis risk highlights its clinical relevance. Given the promising preliminary findings, more clinical trials are needed to validate circHIPK3 efficacy as a biomarker. Moreover, future research should determine if the mechanisms discovered in NSCLC apply to small cell lung cancer (SCLC) to investigate circHIPK3-targeted therapies for SCLC.
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Affiliation(s)
- Eryk Siedlecki
- Department of Oncology, Medical University of Warsaw, 02-097 Warsaw, Poland
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Piotr Remiszewski
- Department of Oncology, Medical University of Warsaw, 02-097 Warsaw, Poland
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Rafał Stec
- Department of Oncology, Medical University of Warsaw, 02-097 Warsaw, Poland
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Wang M, Ma H, Shi Y, Ni H, Qin C, Ji C. Single-arm clinical trials: design, ethics, principles. BMJ Support Palliat Care 2024:spcare-2024-004984. [PMID: 38834238 DOI: 10.1136/spcare-2024-004984] [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: 05/15/2024] [Accepted: 05/21/2024] [Indexed: 06/06/2024]
Abstract
Although randomised controlled trials are considered the gold standard in clinical research, they are not always feasible due to limitations in the study population, challenges in obtaining evidence, high costs and ethical considerations. As a result, single-arm trial designs have emerged as one of the methods to address these issues. Single-arm trials are commonly applied to study advanced-stage cancer, rare diseases, emerging infectious diseases, new treatment methods and medical devices. Single-arm trials have certain ethical advantages over randomised controlled trials, such as providing equitable treatment, respecting patient preferences, addressing rare diseases and timely management of adverse events. While single-arm trials do not adhere to the principles of randomisation and blinding in terms of scientific rigour, they still incorporate principles of control, balance and replication, making the design scientifically reasonable. Compared with randomised controlled trials, single-arm trials require fewer sample sizes and have shorter trial durations, which can help save costs. Compared with cohort studies, single-arm trials involve intervention measures and reduce external interference, resulting in higher levels of evidence. However, single-arm trials also have limitations. Without a parallel control group, there may be biases in interpreting the results. In addition, single-arm trials cannot meet the requirements of randomisation and blinding, thereby limiting their evidence capacity compared with randomised controlled trials. Therefore, researchers consider using single-arm trials as a trial design method only when randomised controlled trials are not feasible.
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Affiliation(s)
- Minyan Wang
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Huan Ma
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yun Shi
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Haojie Ni
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Chu Qin
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Conghua Ji
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
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Boleti APDA, Cardoso PHDO, Frihling BEF, de Moraes LFRN, Nunes EAC, Mukoyama LTH, Nunes EAC, Carvalho CME, Macedo MLR, Migliolo L. Pathophysiology to Risk Factor and Therapeutics to Treatment Strategies on Epilepsy. Brain Sci 2024; 14:71. [PMID: 38248286 PMCID: PMC10813806 DOI: 10.3390/brainsci14010071] [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: 12/18/2023] [Revised: 12/30/2023] [Accepted: 01/06/2024] [Indexed: 01/23/2024] Open
Abstract
Epilepsy represents a condition in which abnormal neuronal discharges or the hyperexcitability of neurons occur with synchronicity, presenting a significant public health challenge. Prognostic factors, such as etiology, electroencephalogram (EEG) abnormalities, the type and number of seizures before treatment, as well as the initial unsatisfactory effects of medications, are important considerations. Although there are several third-generation antiepileptic drugs currently available, their multiple side effects can negatively affect patient quality of life. The inheritance and etiology of epilepsy are complex, involving multiple underlying genetic and epigenetic mechanisms. Different neurotransmitters play crucial roles in maintaining the normal physiology of different neurons. Dysregulations in neurotransmission, due to abnormal transmitter levels or changes in their receptors, can result in seizures. In this review, we address the roles played by various neurotransmitters and their receptors in the pathophysiology of epilepsy. Furthermore, we extensively explore the neurological mechanisms involved in the development and progression of epilepsy, along with its risk factors. Furthermore, we highlight the new therapeutic targets, along with pharmacological and non-pharmacological strategies currently employed in the treatment of epileptic syndromes, including drug interventions employed in clinical trials related to epilepsy.
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Affiliation(s)
- Ana Paula de Araújo Boleti
- S-Inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande 79117-900, Brazil; (A.P.d.A.B.); (P.H.d.O.C.); (B.E.F.F.); (L.F.R.N.d.M.); (E.A.C.N.); (L.T.H.M.); (E.A.C.N.); (C.M.E.C.)
- Laboratório de Purificação de Proteínas e Suas Funções Biológicas, Unidade de Tecnologia de Alimentos e da Saúde Pública, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil;
| | - Pedro Henrique de Oliveira Cardoso
- S-Inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande 79117-900, Brazil; (A.P.d.A.B.); (P.H.d.O.C.); (B.E.F.F.); (L.F.R.N.d.M.); (E.A.C.N.); (L.T.H.M.); (E.A.C.N.); (C.M.E.C.)
| | - Breno Emanuel Farias Frihling
- S-Inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande 79117-900, Brazil; (A.P.d.A.B.); (P.H.d.O.C.); (B.E.F.F.); (L.F.R.N.d.M.); (E.A.C.N.); (L.T.H.M.); (E.A.C.N.); (C.M.E.C.)
| | - Luiz Filipe Ramalho Nunes de Moraes
- S-Inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande 79117-900, Brazil; (A.P.d.A.B.); (P.H.d.O.C.); (B.E.F.F.); (L.F.R.N.d.M.); (E.A.C.N.); (L.T.H.M.); (E.A.C.N.); (C.M.E.C.)
| | - Ellynes Amancio Correia Nunes
- S-Inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande 79117-900, Brazil; (A.P.d.A.B.); (P.H.d.O.C.); (B.E.F.F.); (L.F.R.N.d.M.); (E.A.C.N.); (L.T.H.M.); (E.A.C.N.); (C.M.E.C.)
- Programa de Pós-graduação em Bioquímica, Universidade Federal do Rio Grande do Norte, Natal 59078-970, Brazil
| | - Lincoln Takashi Hota Mukoyama
- S-Inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande 79117-900, Brazil; (A.P.d.A.B.); (P.H.d.O.C.); (B.E.F.F.); (L.F.R.N.d.M.); (E.A.C.N.); (L.T.H.M.); (E.A.C.N.); (C.M.E.C.)
| | - Ellydberto Amancio Correia Nunes
- S-Inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande 79117-900, Brazil; (A.P.d.A.B.); (P.H.d.O.C.); (B.E.F.F.); (L.F.R.N.d.M.); (E.A.C.N.); (L.T.H.M.); (E.A.C.N.); (C.M.E.C.)
- Programa de Pós-graduação em Bioquímica, Universidade Federal do Rio Grande do Norte, Natal 59078-970, Brazil
| | - Cristiano Marcelo Espinola Carvalho
- S-Inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande 79117-900, Brazil; (A.P.d.A.B.); (P.H.d.O.C.); (B.E.F.F.); (L.F.R.N.d.M.); (E.A.C.N.); (L.T.H.M.); (E.A.C.N.); (C.M.E.C.)
| | - Maria Lígia Rodrigues Macedo
- Laboratório de Purificação de Proteínas e Suas Funções Biológicas, Unidade de Tecnologia de Alimentos e da Saúde Pública, Universidade Federal de Mato Grosso do Sul, Campo Grande 79070-900, Brazil;
| | - Ludovico Migliolo
- S-Inova Biotech, Programa de Pós-Graduação em Biotecnologia, Universidade Católica Dom Bosco, Campo Grande 79117-900, Brazil; (A.P.d.A.B.); (P.H.d.O.C.); (B.E.F.F.); (L.F.R.N.d.M.); (E.A.C.N.); (L.T.H.M.); (E.A.C.N.); (C.M.E.C.)
- Programa de Pós-graduação em Bioquímica, Universidade Federal do Rio Grande do Norte, Natal 59078-970, Brazil
- Programa de Pós-graduação em Biologia Celular e Molecular, Universidade Federal da Paraíba, João Pessoa 58051-900, Brazil
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AlHamaly MA, Alzoubi KH, Khabour OF, Jaber RA, Aldelaimy WK. Review of Clinical Equipoise: Examples from Oncology Trials. Curr Rev Clin Exp Pharmacol 2023; 18:22-30. [PMID: 34939559 PMCID: PMC9992762 DOI: 10.2174/2772432817666211221164101] [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: 06/19/2021] [Revised: 10/28/2021] [Accepted: 11/10/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND The current standards that govern clinical research have been shaped over the years through many historical, social, and political events. The third principle of the Belmont Report, Justice, guides the scientific community toward the equal distribution of benefits and risks in research involving human subjects. Clinical equipoise is the status of genuine uncertainty by the investigator about the superiority of one treatment arm over the other. The term clinical equipoise was proposed to provide an ethical ground to conduct randomized controlled clinical trials. OBJECTIVE The objective of this review is to provide the reader with an overview of the emergence of the term equipoise and its utilization in randomized controlled trials. METHODS In the current review article, the major oncology clinical trials and relevant patents were reviewed for the application/utilization of clinical equipoise. RESULTS The concept of clinical equipoise has been challenged, and different alternatives were proposed. Yet, these alternatives received numerous critiques and failed to fully replace equipoise. In addition, several patents related to anticancer agents tested in the described studies were examined. No specific reference was made as part of the patent to the status of clinical equipoise. Alternatively, a description of the study arms was provided. CONCLUSION There is a need for revisiting the concept of equipoise and its suggested alternatives for its ethical essence while addressing related challenges.
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Affiliation(s)
- Majd A. AlHamaly
- College of Medicine, University of Kentucky, Lexington, KY, USA
- Department of Clinical Research and Development, Hikma Pharmaceuticals, Amman, Jordan
- Address correspondence to this author at the College of Medicine, University of Kentucky, Lexington, KY, USA; Department of Clinical Research and Development, Hikma Pharmaceuticals, Amman, Jordan; Tel: +962 (6)580 2960; Fax: +962 6 5802962; ;
| | - Karem H. Alzoubi
- Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar F. Khabour
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Ruba A. Jaber
- Department of Clinical Research and Development, Hikma Pharmaceuticals, Amman, Jordan
| | - Wael K. Aldelaimy
- School of Public Health, University of California San Diego, La Jolla, CA, USA
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N Chin C, Subhawong T, Grosso J, Wortman JR, McIntosh LJ, Tai R, Braschi-Amirfarzan M, Castillo P, Alessandrino F. Teaching cancer imaging in the era of precision medicine: Looking at the big picture. Eur J Radiol Open 2022; 9:100414. [PMID: 35309874 PMCID: PMC8927915 DOI: 10.1016/j.ejro.2022.100414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The role of imaging in cancer diagnosis and treatment has evolved at the same rapid pace as cancer management. Over the last twenty years, with the advancement of technology, oncology has become a multidisciplinary field that allows for researchers and clinicians not only to create individualized treatment options for cancer patients, but also to evaluate patients’ response to therapy with increasing precision. Familiarity with these concepts is a requisite for current and future radiologists, as cancer imaging studies represent a significant and growing component of any radiology practice, from tertiary cancer centers to community hospitals. In this review we provide the framework to teach cancer imaging in the era of genomic oncology. After reading this article, readers should be able to illustrate the basics cancer genomics, modern cancer genomics, to summarize the types of systemic oncologic therapies available, their patterns of response and their adverse events, to discuss the role of imaging in oncologic clinical trials and the role of tumor response criteria and to display the future directions of oncologic imaging.
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Affiliation(s)
- Christopher N Chin
- Department of Surgery, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Ty Subhawong
- Department of Radiology, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - James Grosso
- Department of Radiology, Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Jeremy R Wortman
- Department of Radiology, Lahey Health Medical Center, Beth Israel Lahey Health, Tufts University school of Medicine, Boston, MA, USA
| | - Lacey J McIntosh
- Department of Radiology, University of Massachusetts Chan Medical School, Memorial Health Care, Worcester, MA, USA
| | - Ryan Tai
- Department of Radiology, University of Massachusetts Chan Medical School, Memorial Health Care, Worcester, MA, USA
| | - Marta Braschi-Amirfarzan
- Department of Radiology, Lahey Health Medical Center, Beth Israel Lahey Health, Tufts University school of Medicine, Boston, MA, USA
| | - Patricia Castillo
- Department of Radiology, Leonard M. Miller School of Medicine, Miami, FL, USA
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Storgaard L, Tran TL, Freiberg JC, Hauser AS, Kolko M. Glaucoma Clinical Research: Trends in Treatment Strategies and Drug Development. Front Med (Lausanne) 2021; 8:733080. [PMID: 34589504 PMCID: PMC8473801 DOI: 10.3389/fmed.2021.733080] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/11/2021] [Indexed: 01/30/2023] Open
Abstract
Purpose: To investigate the trends and progresses in glaucoma research by searching two major clinical trial registries; clinicaltrials.gov, and Australianclinicaltrials.gov.au. Methods: All clinical trials with glaucoma covered by Clinicaltrials.gov, and Australianclinicaltrials.gov.au starting the study before 1 January 2021 were included. Trials evaluating glaucoma treatment were separated from non-treatment trials and divided into three major categories: "laser treatment," "surgical treatment," and "medical treatment." In the category of "medical treatment," new compounds and their individual targets were identified and subcategorized according to treatment strategy; intraocular pressure (IOP)-lowering, neuroprotective or vascular. The phase transition success rates were calculated. Results: One-thousand five hundred and thirty-seven trials were identified. Sixty-three percent (n = 971) evaluated glaucoma treatment, of which medical treatment accounted for the largest proportion (53%). The majority of medical trials evaluated IOP-lowering compounds, while trials with neuroprotective or vascular compounds accounted for only 5 and 3%, respectively. Eighty-eight new compounds were identified. Phase I, II, and III transition success rates were 63, 26, and 47%, respectively. Conclusion: The number of clinical trials in glaucoma research has increased significantly over the last 30 years. Among the most recently evaluated compounds, all three main treatment strategies were represented, but clinical trials in neuroprotection and vascular modalities are still sparse. In addition to traditional medicines, dietary supplements and growth factors are assessed for a potential anti-glaucomatous effect. Phase II and III success rates were below previously reported success rates for all diseases and ophthalmology in general. A stricter phenotyping of patients can improve the success rates in glaucoma and ophthalmological research and gain a better understanding of responders and non-responders.
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Affiliation(s)
- Line Storgaard
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Thuy Linh Tran
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | | | - Alexander S. Hauser
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Miriam Kolko
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
- Department of Ophthalmology, Copenhagen University Hospital, Rigshospitalet-Glostrup, Copenhagen, Denmark
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Lansdale N, Arthur F, Corbett HJ. Circumcision versus preputioplasty for balanitis xerotica obliterans: a randomised controlled feasibility trial. BJU Int 2021; 128:759-765. [PMID: 34110689 DOI: 10.1111/bju.15508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine: (i) feasibility for a randomised controlled trial (RCT) comparing circumcision to preputioplasty and intralesional triamcinolone (PIT) to treat balanitis xerotica obliterans (BXO) and (ii) patient outcomes to inform future study design. PATIENTS AND METHODS Approval was obtained from the UK Health Research Authority and local Research Ethics Committee (Reference 16/NW/0364) and the trial protocol registered with ClinicalTrials.gov (NCT02854995). A total of 20 boys (aged 2-16 years) with BXO were randomised to either circumcision or PIT (online parallel group 1:1 allocation, non-blinded). Exclusion criteria were: (i) previous penile surgery and (ii) contraindication for either treatment. Follow-up (including satisfaction questionnaire) was at 6 weeks, 3 and 12 months. Data are presented as median (interquartile range [IQR]), continuous variables were compared by t-test. RESULTS A total of 54 boys were approached over 18 months: 23 (45%) were recruited and randomised. The commonest reason for non-entry was treatment preference: 12 preferred circumcision, 18 preferred PIT. Four patients withdrew after randomisation, three did not want circumcision and one did not want PIT. The groups were similar in terms of age (median [IQR] 11 [6-12] vs 8 [7-10] years, P = 0.53) and duration of symptoms (median [IQR] 6 [6-15] vs 6 [2-24] months, P = 0.77). There were no protocol breaches, serious adverse events or postoperative meatal stenosis. There was one self-resolving haematoma after PIT and one suture granuloma after circumcision. Two boys went on to have a circumcision after PIT. Overall, satisfaction levels were high for both groups. CONCLUSION A definitive RCT of circumcision vs PIT for BXO appears feasible, with 39% of those approached completing the trial. More families preferred PIT. A robust comparison in the form of a multicentred RCT is required.
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Affiliation(s)
- Nick Lansdale
- Royal Manchester Children's Hospital, Manchester, UK
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Rentea RM, Oyetunji TA, Peter SDS. Ethics of randomized trials in pediatric surgery. Pediatr Surg Int 2020; 36:865-867. [PMID: 32394059 DOI: 10.1007/s00383-020-04665-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2020] [Indexed: 11/30/2022]
Abstract
To provide the best evidence-based treatment for children, and timely evaluation of innovations, the role of the pediatric surgeon's participation in randomized controlled trials (RCTs) and prospective comparative studies is required. The ethical considerations of pediatric surgical RCTs pose unique practical difficulties in the design and performance of clinical trials in children. There are several ethical issues unique to pediatric surgical RCTs: diseases with low volume, an inability to conduct Phase 1 and 2 trials, parental emotional involvement, difficulty with recruitment in surgical trials, volume, and modified study design, issues with permission vs. assent and investigator bias. This article reviews the ethical aspects unique to pediatric surgical RCTs and prospective comparative studies.Level of evidence: Level 3.
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Affiliation(s)
- Rebecca M Rentea
- Pediatric Surgery, Comprehensive Colorectal Center, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA.
| | - Tolulope A Oyetunji
- Pediatric Surgery, Comprehensive Colorectal Center, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Shawn D St Peter
- Pediatric Surgery, Comprehensive Colorectal Center, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
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Shah-Williams E, Levy KD, Zang Y, Holmes AM, Stoughton C, Dexter P, Skaar TC. Enrollment of Diverse Populations in the INGENIOUS Pharmacogenetics Clinical Trial. Front Genet 2020; 11:571. [PMID: 32670350 PMCID: PMC7330082 DOI: 10.3389/fgene.2020.00571] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/11/2020] [Indexed: 12/15/2022] Open
Abstract
Recruitment of diverse populations and subjects living in Medically Underserved Areas and Populations (MUA/P's) into clinical trials is a considerable challenge. Likewise, representation of African-Americans in pharmacogenetic trials is often inadequate, but critical for identifying genetic variation within and between populations. To identify enrollment patterns and variables that predict enrollment in a diverse underserved population, we analyzed data from the INGENIOUS (Indiana GENomics Implementation and Opportunity for the UnderServed), pharmacogenomics implementation clinical trial conducted at a community hospital for underserved subjects (Safety net hospital), and a statewide healthcare system (Academic hospital). We used a logistic regression model to identify patient variables that predicted successful enrollment after subjects were contacted and evaluated the reasons that clinical trial eligible subjects refused enrollment. In both healthcare systems, African-Americans were less likely to refuse the study than non-Hispanic Whites (Safety net, OR = 0.68, and p < 0.002; Academic hospital, OR = 0.64, and p < 0.001). At the Safety net hospital, other minorities were more likely to refuse the study than non-Hispanic Whites (OR = 1.58, p < 0.04). The odds of refusing the study once contacted increased with patient age (Safety net hospital, OR = 1.02, p < 0.001, Academic hospital, OR = 1.02, and p < 0.001). At the Academic hospital, females were less likely to refuse the study than males (OR = 0.81, p = 0.01) and those not living in MUA/P's were less likely to refuse the study than those living in MUA/P's (OR = 0.81, p = 0.007). The most frequent barriers to enrollment included not being interested, being too busy, transportation, and illness. A lack of trust was reported less frequently. In conclusion, African-Americans can be readily recruited to pharmacogenetic clinical trials once contact has been successfully initiated. However, health care initiatives and increased recruitment efforts of subjects living in MUA/Ps are needed. Enrollment could be further enhanced by improving research awareness and knowledge of clinical trials, reducing time needed for participation, and compensating for travel.
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Affiliation(s)
- Ebony Shah-Williams
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, IN, United States
| | - Kenneth D. Levy
- Department of Medicine, Indiana University, Indianapolis, IN, United States
| | - Yong Zang
- Department of Biostatistics, Indiana University, Indianapolis, IN, United States
| | - Ann M. Holmes
- Department of Health Policy and Management, Fairbanks School of Public Health, Indiana University–Purdue University Indianapolis, Indianapolis, IN, United States
| | - Christa Stoughton
- Department of Urology, Indiana University Hospital, Indianapolis, IN, United States
| | - Paul Dexter
- Department of Medicine, Indiana University, Indianapolis, IN, United States
- Regenstrief Institute for Health Care, Indianapolis, IN, United States
| | - Todd C. Skaar
- Department of Medicine, Indiana University, Indianapolis, IN, United States
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