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Zarin D, Wittes JT, Fleming TR, Rockhold F, Ellenberg S, DeMets DL. The Case for Access to Data Monitoring Committee Charters. NEJM EVIDENCE 2024; 3:EVIDctw2400058. [PMID: 39189859 DOI: 10.1056/evidctw2400058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
AbstractClinical trials investigating novel or high-risk interventions often use data monitoring committees (DMCs) to ensure that the participants' best interests are safeguarded. The typical DMC charter describes procedures by which the DMC operates, including important details concerning organizational structure, membership, meeting frequency, statistical monitoring guidelines, and contents of DMC reports for interim review. These charters, however, are not routinely publicly available; in some cases, their access could be important to the interpretation of trial results. We recommend including DMC charters for such trials in ClinicalTrials.gov at the time of trial completion; trial protocols, informed consent documents, and statistical analysis plans are already available in this repository.
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Nishtar M, Mark R, Langford DJ, McDermott MP, Markman JD, Evans SR, France FO, Park M, Sharma S, Turk DC, Dworkin RH, Gewandter JS. Evaluating the balance of benefits and harms in chronic pain clinical trials: prioritizing individual participants over individual outcomes. Reg Anesth Pain Med 2024; 49:363-367. [PMID: 37963675 PMCID: PMC11081843 DOI: 10.1136/rapm-2023-104809] [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: 06/30/2023] [Accepted: 09/26/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Randomized clinical trials (RCTs) generally assess efficacy and safety separately, with the conclusion of whether a treatment is beneficial based solely on the efficacy endpoint. However, assessing and combining efficacy and safety domains, using a single composite outcome measure, can provide a more comprehensive assessment of the overall effect of a treatment. Furthermore, composite outcomes can incorporate information regarding the relationship between the individual outcomes. In fact, such outcomes have been suggested in the clinical trials literature for at least 15 years. OBJECTIVES To (1) identify whether recent primary publications of chronic pain RCTs from major pain journals included a composite outcome measure of benefits and harms and (2) discuss the potential benefits of such outcomes in various stages of treatment development, including as outcome measures in RCTs, and to support decisions of Data and Safety Monitoring Boards and ordering of treatments in the context of treatment guidelines. EVIDENCE REVIEW RCTs published in 6 major pain journals published between 2016 and 2021 that investigated interventions for chronic pain were reviewed. FINDINGS Of 73 RCTs identified, only 2 included a composite outcome measure of benefits and harms. Both of these articles compared 2 active treatments. CONCLUSIONS Composite outcomes of benefits and harms are underutilized in chronic pain RCTs. The advantages and challenges of using such outcomes are discussed.
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Affiliation(s)
- Mahd Nishtar
- Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York, USA
| | - Remington Mark
- Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York, USA
| | - Dale J Langford
- Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, New York, USA
| | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY, USA
| | - John D Markman
- Department of Neurosurgery, University of Rochester, Rochester, NY, USA
| | - Scott R Evans
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - Fallon O France
- Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York, USA
| | - Meghan Park
- Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York, USA
| | - Sonia Sharma
- School of Medicine and Biomedical Sciences, University at Buffalo Jacobs, Buffalo, New York, USA
| | - Dennis C Turk
- Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Robert H Dworkin
- Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York, USA
| | - Jennifer S Gewandter
- Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, New York, USA
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Bou Ghanem GO, Wareham LK, Calkins DJ. Addressing neurodegeneration in glaucoma: Mechanisms, challenges, and treatments. Prog Retin Eye Res 2024; 100:101261. [PMID: 38527623 DOI: 10.1016/j.preteyeres.2024.101261] [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: 12/28/2023] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 03/27/2024]
Abstract
Glaucoma is the leading cause of irreversible blindness globally. The disease causes vision loss due to neurodegeneration of the retinal ganglion cell (RGC) projection to the brain through the optic nerve. Glaucoma is associated with sensitivity to intraocular pressure (IOP). Thus, mainstay treatments seek to manage IOP, though many patients continue to lose vision. To address neurodegeneration directly, numerous preclinical studies seek to develop protective or reparative therapies that act independently of IOP. These include growth factors, compounds targeting metabolism, anti-inflammatory and antioxidant agents, and neuromodulators. Despite success in experimental models, many of these approaches fail to translate into clinical benefits. Several factors contribute to this challenge. Firstly, the anatomic structure of the optic nerve head differs between rodents, nonhuman primates, and humans. Additionally, animal models do not replicate the complex glaucoma pathophysiology in humans. Therefore, to enhance the success of translating these findings, we propose two approaches. First, thorough evaluation of experimental targets in multiple animal models, including nonhuman primates, should precede clinical trials. Second, we advocate for combination therapy, which involves using multiple agents simultaneously, especially in the early and potentially reversible stages of the disease. These strategies aim to increase the chances of successful neuroprotective treatment for glaucoma.
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Affiliation(s)
- Ghazi O Bou Ghanem
- Vanderbilt Eye Institute, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Lauren K Wareham
- Vanderbilt Eye Institute, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - David J Calkins
- Vanderbilt Eye Institute, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
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Locher C, Laporte S, Derambure P, Chassany O, Girault C, Avakiantz A, Bahans C, Deplanque D, Fustier P, Germe AF, Kassaï B, Lacoste L, Petitpain N, Roustit M, Simon T, Train C, Cucherat M. Data Monitoring Committees and clinical trials: From scientific justification to organisation. Therapie 2024; 79:111-121. [PMID: 38103949 DOI: 10.1016/j.therap.2023.12.002] [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: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
Clinical trials often last several months or even several years. As the trial progresses, it can be tempting to find out whether the data obtained already answers the question posed at the start of the trial in order to stop inclusions or monitoring earlier. However, knowing and taking into account interim results can sometimes compromise the integrity of the results, which is counterproductive. To minimise this risk and ensure that the treatments are assessed reliably, safety and/or efficacy criteria are monitored during the study by a Data Monitoring Committee. After receiving the results confidentially, the Data Monitoring Committee assesses the benefit/risk ratio of the study treatment and recommends that the trial be continued, modified or terminated. Data Monitoring Committee members issuing these recommendations have an important responsibility: a hasty decision to end the trial may lead to inconclusive results unable to answer the initial question and, inversely, delaying the decision to end the trial may expose the subjects to potentially ineffective or even harmful interventions. The Data Monitoring Committee's task is therefore particularly complex. With this in mind, the round table discussion at the Giens workshops was a chance to review the scientific justification for creating Data Monitoring Committees and to recall the need for their members to receive comprehensive training on the complexities of multiple analyses, confidentiality requirements applying to the results and the need for them to be aware that recommendations to end a trial must be based on data that is robust enough to assess the benefit/risk ratio of the treatment studied.
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Affiliation(s)
- Clara Locher
- Inserm, UMR S 1085, service de pharmacologie clinique, Centre d'investigation clinique de Rennes (CIC1414), Institut de recherche en santé, environnement et travail (Irset), CHU de Rennes, 35000 Rennes, France.
| | - Silvy Laporte
- UMR 1059 Inserm, URC/pharmacologie clinique, université Jean-Monnet Saint-Étienne, CHU de Saint-Étienne, 42055 Saint-Étienne, France
| | | | - Olivier Chassany
- Unité de recherche clinique en économie de la santé (URC-ECO), hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - Cécile Girault
- Fédération francophone de cancérologie digestive (FFCD), 21000 Dijon, France
| | | | - Claire Bahans
- Département de pédiatrie, CHU de Limoges, 87000 Limoges, France
| | - Dominique Deplanque
- Inserm, CIC 1403, Centre d'investigation clinique, University of Lille, CHU de Lille, 59000 Lille, France
| | - Pierre Fustier
- Département de recherche et développement clinique - hématologie - BeiGene, Switzerland GmbH, 4051 Basel, Switzerland
| | | | - Behrouz Kassaï
- Inserm, UMR 5558 CNRS, service de pharmacotoxicologie, Centre d'investigation clinique 1407, hospices civils de Lyon, université de Lyon, 69000 Lyon, France
| | - Louis Lacoste
- Pôle USSAR, anesthésie réanimation, CHU de Poitiers, 86021 Poitiers, France
| | - Nadine Petitpain
- Unité de vigilance des essais cliniques, DRCI CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - Matthieu Roustit
- Inserm, CIC1406, University Grenoble Alpes, CHU de Grenoble, 38000 Grenoble, France
| | - Tabassome Simon
- Service de pharmacologie clinique, plateforme de recherche de l'est parisien (URCEST-CRCEST-CRB), hôpital Saint-Antoine, Sorbonne université, Assistance publique-Hôpitaux de Paris (AP-HP), 75000 Paris, France
| | | | - Michel Cucherat
- metaEvidence.org, service de pharmacotoxicologie, hospices civils de Lyon, 69000 Lyon, France
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Locher C, Laporte S, Derambure P, Chassany O, Girault C, Avakiantz A, Bahans C, Deplanque D, Fustier P, Germe AF, Kassaï B, Lacoste L, Petitpain N, Roustit M, Simon T, Train C, Cucherat M. Comité de surveillance indépendant dans les essais cliniques : de la justification scientifique à l’organisation. Therapie 2024; 79:99-110. [PMID: 37985309 DOI: 10.1016/j.therap.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Clara Locher
- Université de Rennes, CHU de Rennes, CIC 1414 (Centre d'investigation clinique de Rennes), 35000 Rennes, France.
| | - Silvy Laporte
- Université Jean Monnet Saint-Étienne, UMR 1059 Inserm, URC/Pharmacologie Clinique, CHU de Saint-Étienne, 42055 Saint-Étienne, France
| | | | - Olivier Chassany
- Unité de recherche clinique en économie de la santé (URC-ECO), hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - Cécile Girault
- Fédération francophone de cancérologie digestive (FFCD), faculté de médecine, 21000 Dijon, France
| | | | - Claire Bahans
- Département de pédiatrie, CHU de Limoges, 87000 Limoges, France
| | - Dominique Deplanque
- Centre d'investigation clinique, Université Lille, Inserm, CHU de Lille, CIC 1403, 59000 Lille, France
| | - Pierre Fustier
- Département de recherche et développement clinique - Hématologie - BeiGene, Switzerland GmbH, 4051 Basel, Suisse
| | | | - Behrouz Kassaï
- Service de pharmacotoxicologie, centre d'investigation clinique 1407 Inserm - Hospices civils de Lyon, UMR 5558 CNRS université de Lyon, 69000 Lyon, France
| | - Louis Lacoste
- Pôle USSAR, anesthésie réanimation, CHU de Poitiers, 86021 Poitiers, France
| | - Nadine Petitpain
- Unité de vigilance des essais cliniques, DRCI CHRU de Nancy, 54500 Vandoeuvre lès Nancy, France
| | - Matthieu Roustit
- Université Grenoble Alpes, Inserm, CHU de Grenoble, CIC1406, 38000 Grenoble, France
| | - Tabassome Simon
- Sorbonne Université, service de pharmacologie clinique, plateforme de recherche de l'est parisien (URCEST-CRCEST-CRB), Assistance publique-Hôpitaux de Paris (AP-HP), Hôpital St Antoine, 75000 Paris, France
| | | | - Michel Cucherat
- Service de pharmacotoxicologie Hospices civils de Lyon, metaEvidence.org, 69000 Lyon, France
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Bunning BJ, Hedlin H, Chen JH, Ciolino JD, Ferstad JO, Fox E, Garcia A, Go A, Johari R, Lee J, Maahs DM, Mahaffey KW, Opsahl-Ong K, Perez M, Rochford K, Scheinker D, Spratt H, Turakhia MP, Desai M. The evolving role of data & safety monitoring boards for real-world clinical trials. J Clin Transl Sci 2023; 7:e179. [PMID: 37745930 PMCID: PMC10514684 DOI: 10.1017/cts.2023.582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/20/2023] [Accepted: 06/24/2023] [Indexed: 09/26/2023] Open
Abstract
Introduction Clinical trials provide the "gold standard" evidence for advancing the practice of medicine, even as they evolve to integrate real-world data sources. Modern clinical trials are increasingly incorporating real-world data sources - data not intended for research and often collected in free-living contexts. We refer to trials that incorporate real-world data sources as real-world trials. Such trials may have the potential to enhance the generalizability of findings, facilitate pragmatic study designs, and evaluate real-world effectiveness. However, key differences in the design, conduct, and implementation of real-world vs traditional trials have ramifications in data management that can threaten their desired rigor. Methods Three examples of real-world trials that leverage different types of data sources - wearables, medical devices, and electronic health records are described. Key insights applicable to all three trials in their relationship to Data and Safety Monitoring Boards (DSMBs) are derived. Results Insight and recommendations are given on four topic areas: A. Charge of the DSMB; B. Composition of the DSMB; C. Pre-launch Activities; and D. Post-launch Activities. We recommend stronger and additional focus on data integrity. Conclusions Clinical trials can benefit from incorporating real-world data sources, potentially increasing the generalizability of findings and overall trial scale and efficiency. The data, however, present a level of informatic complexity that relies heavily on a robust data science infrastructure. The nature of monitoring the data and safety must evolve to adapt to new trial scenarios to protect the rigor of clinical trials.
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Affiliation(s)
- Bryan J. Bunning
- Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Haley Hedlin
- Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
| | - Jonathan H. Chen
- Stanford Center for Biomedical Informatics Research, Stanford University, Stanford, CA, USA
| | - Jody D. Ciolino
- Department of Preventative Medicine – Biostatistics, Northwestern University, Chicago, IL, USA
| | | | - Emily Fox
- Department of Statistics, Stanford University, Stanford, CA, USA
- Kaiser Permanente Northern California Division of Research, Kaiser Permanente, Oakland, CA, USA
| | - Ariadna Garcia
- Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
| | - Alan Go
- Department of Computer Science, Stanford University, Stanford, CA, USA
| | - Ramesh Johari
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Justin Lee
- Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
| | - David M. Maahs
- Department of Pediatrics, Stanford Medicine Children’s Hospital, Stanford, CA, USA
| | - Kenneth W. Mahaffey
- Stanford Center for Clinical Research, Stanford University, Stanford, CA, USA
| | - Krista Opsahl-Ong
- Department of Pediatrics, Stanford Medicine Children’s Hospital, Stanford, CA, USA
| | - Marco Perez
- Department of Medicine, Cardiovascular Medicine, Stanford Medicine, Stanford, CA, USA
| | - Kaylin Rochford
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - David Scheinker
- Systems Design and Collaborative Research, Stanford Medicine Children’s Hospital, Stanford, CA, USA
| | - Heidi Spratt
- Department of Preventative Medicine & Community Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Mintu P. Turakhia
- Stanford Center for Clinical Research, Stanford University, Stanford, CA, USA
| | - Manisha Desai
- Quantitative Sciences Unit, Stanford University, Stanford, CA, USA
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Hunsberger S, Ellenberg SS, Joffe S, Babiker A, Fix A, Griffin MR, Kalil J, Levine MM, Makgoba MW, Moore RH, Tsiatis AA, Whitley R. Monitoring Multiple U.S. Government-Supported Covid-19 Vaccine Trials. NEJM EVIDENCE 2023; 2:EVIDctcs2200301. [PMID: 38320019 DOI: 10.1056/evidctcs2200301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Monitoring U.S. Government-Supported Covid-19 Vaccine TrialsOperation Warp Speed was a partnership created to accelerate the development of Covid-19 vaccines. The National Institutes of Health oversaw one data and safety monitoring board to review/monitor all Operation Warp Speed trials. This article describes the challenges faced in monitoring these trials and provides ideas for future similar endeavors.
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Affiliation(s)
- Sally Hunsberger
- National Institute of Allergy and Infectious Diseases, Rockville, MD
| | - Susan S Ellenberg
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Steven Joffe
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Abdel Babiker
- Medical Research Council Clinical Trials Unit, University College London, London
| | - Alan Fix
- Center for Vaccine Innovation and Access, PATH, Washington, D.C
| | | | - Jorge Kalil
- Faculdade de Medicina, Universidade de São Paulo, São Paulo
| | | | | | - Reneé H Moore
- Dornsife School of Public Health, Drexel University, Philadelphia
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Evans SR, Zeng L, Dai W. The Data and Safety Monitoring Board: The Toughest Job in Clinical Trials. NEJM EVIDENCE 2023; 2:EVIDctw2200220. [PMID: 38320039 DOI: 10.1056/evidctw2200220] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
The DSMB: The Toughest Job in Clinical TrialsIn this review article, the authors discuss methods that DSMBs can use to compare the absolute and relative risks of benefits and adverse effects between trial interventions and illustrate how the DSMB can use this approach to evaluate the balance of these competing risks. Two approaches are discussed - the win ratio and the DOOR probability on one treatment relative to another.
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Affiliation(s)
- Scott R Evans
- Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, MD
| | - Lijuan Zeng
- Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, MD
| | - Weixiao Dai
- Biostatistics Center, Milken Institute School of Public Health, George Washington University, Rockville, MD
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Abebe KZ, Rockhold FW. The Impact of Landscape Changes on Data and Safety Monitoring Board Oversight of Clinical Trials. NEJM EVIDENCE 2022; 1:EVIDctw2100019. [PMID: 38319813 DOI: 10.1056/evidctw2100019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Impact of Landscape Changes on DSMB OversightThis Clinical Trials Workshop describes how external factors (or landscape changes) can affect monitoring of an ongoing clinical trial and discusses issues to consider to avoid stopping a trial too early while maintaining equipoise for enrolled participants. Three clinical trials in which DSMBs had to consider the effects of landscape changes on the continued performance of the monitored trial are reviewed.
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Affiliation(s)
- Kaleab Z Abebe
- Division of General Internal Medicine, Department of Medicine, Center for Clinical Trials and Data Coordination, University of Pittsburgh, Pittsburgh
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Ellenberg SS, Shaw PA. Early Termination of Clinical Trials for Futility - Considerations for a Data and Safety Monitoring Board. NEJM EVIDENCE 2022; 1:EVIDctw2100020. [PMID: 38319261 DOI: 10.1056/evidctw2100020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Early Termination of Clinical Trials for FutilityClinical trials may be stopped for futility if there is little or no chance of demonstrating the hoped-for effect. Reasons include evidence of no treatment effect, substantial missing data that would unacceptably undermine trial conclusions, or event rates too low to support meaningful comparisons. This review examines issues faced by DSMBs in such settings.
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Affiliation(s)
- Susan S Ellenberg
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Pamela A Shaw
- Biostatistics Unit, Kaiser Permanente Washington Health Research Institute, Seattle
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Sorum P, Stein C, Wales D, Pratt D. A Proposal to Increase Value and Equity in the Development and Distribution of New Pharmaceuticals. INTERNATIONAL JOURNAL OF HEALTH SERVICES : PLANNING, ADMINISTRATION, EVALUATION 2022; 52:363-371. [PMID: 35546103 PMCID: PMC9203670 DOI: 10.1177/00207314221100647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 11/30/2022]
Abstract
The process of developing and marketing new pharmaceuticals in the United States is driven by a need to maximize returns to shareholders. This results all too often in the production of new medications that are expensive and of marginal value to patients and society. In line with our heightened awareness of the importance of social justice and public health-and in light of our government's alliance with private companies in bringing us COVID-19 vaccines-we need to reconsider how new pharmaceuticals are developed and distributed. Accordingly, we propose the creation of a new agency of the Food and Drug Administration (FDA) that would direct the whole process. This agency would fund the research and development of high-value medications, closely monitor the clinical studies of these new drugs, and manage their distribution at prices that are value-based, fair, and equitable.
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Affiliation(s)
- Paul Sorum
- Internal Medicine and Pediatrics, Albany Medical College, Albany Medical Center Internal Medicine and Pediatrics, Cohoes, NY, USA
| | | | - Danielle Wales
- Internal Medicine and Pediatrics, Albany Medical College, Albany Medical Center Internal Medicine and Pediatrics, Cohoes, NY, USA
| | - David Pratt
- Schenectady County Public Health Services, Schenectady, NY, USA
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Abstract
Stopping Trials Early Due to HarmDSMBs protect clinical trial participants from harm. We describe two trials stopped for potential harm to enrollees: a DSMB recommended termination soon after enrollment began when data showed higher mortality in the experimental versus the control arm, and a trial with completed enrollment was stopped while participants were being followed and treated.
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Affiliation(s)
- Thomas Cook
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI
| | - Olive D Buhule
- National Institute of Allergy and Infectious Diseases, Bethesda, MD
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