1
|
Ni S, Yu Q, Zhong Z, Yang M, Zhao Y, Wu J, Bai J, Yu H. Risk difference, relative risk, and odds ratio for non-inferiority clinical trials with risk rate endpoint. J Biopharm Stat 2023; 33:15-30. [PMID: 35791856 DOI: 10.1080/10543406.2022.2065502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Non-inferiority (NI) clinical trials are widely used to evaluate whether the new experimental treatment is not unacceptably worse than the current active-control treatment by more than a pre-specified non-inferiority margin (NI margin). However, choosing either an absolute difference [risk difference (RD)] or a relative difference [relative risk (RR) and odds ratio (OR)] to evaluate efficacy in NI clinical trials is still controversial. In this study, we aim to evaluate the performance of abovementioned three metrics for testing NI clinical trials with risk rate endpoint. Herein, extensive Monte Carlo simulations based on various parameter settings (NI margin as well as risk rates in the experimental group and active-control group) are conducted to compare the Type I error rate, statistical power, and the necessary sample size to achieve a desired power for testing NI using RD, RR, and OR. We show that testing NI using RD not only controls well the Type I error and achieves the highest statistical power but also requires the smallest sample size compared to RR and OR. In practice, however, the choice among three metrics still needs to be based upon clinical interpretations and regulatory perspectives.
Collapse
Affiliation(s)
- Senmiao Ni
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Quanji Yu
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zihang Zhong
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Min Yang
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yang Zhao
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jingwei Wu
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | - Jianling Bai
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hao Yu
- Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| |
Collapse
|
2
|
Bockhold S, McNulty J, Abdurakman E, Bezzina P, Drey N, England A, Flinton D, Khine R, McEntee M, Mekiš N, Precht H, Rainford L, Sá Dos Reis C, Santos A, Syrgiamiotis V, Willis S, Woodley J, Beardmore C, Harris R, O'Regan T, Malamateniou C. Research ethics systems, processes, and awareness across Europe: Radiography research ethics standards for Europe (RRESFE). Radiography (Lond) 2022; 28:1032-1041. [PMID: 35964488 DOI: 10.1016/j.radi.2022.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 06/29/2022] [Accepted: 07/02/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION The Radiography Research Ethics Standards for Europe (RRESFE) project aims to provide a cross-sectional snapshot of current research ethics systems, processes, and awareness of such, across Europe together with identifying the associated challenges, education, and training needs. METHODS A cross-sectional online survey targeting radiography researchers in Europe was conducted. Data collection took place between April 26 and July 12, 2021, using a snowball sampling approach. Descriptive and analytical statistics were used to identify trends in research ethics frameworks across Europe. RESULTS 285 responses were received across 33 European and 23 non-European countries. Most (n = 221; 95%) European respondents stated ethics approval is required before commencing research in their country. Requirements around research ethics approval and awareness of such requirements varied by European region (X2 (2, n = 129) = 7.234, p = 0.013) and were found to differ depending on the type of research participant and study design. Additionally, European respondents reported ethics approval is a national requirement more often than their non-European counterparts (X2 (1, n = 282) = 4.316, p = 0.049). Requirements for ethics approval were also associated with the undergraduate programme duration (2-year vs. 3-year vs. 3.5 year vs. 4-year vs. multiple programme durations; X2 (4, n = 231) = 10.075, p = 0.016) and availability of postgraduate training (postgraduate training available vs. postgraduate training not available; X2 (1, n = 231) = 15.448, p = <0.001) within respondents' country. CONCLUSION Respondents from countries with longer programme durations/availability of multiple programme lengths, availability of postgraduate training, and establishment of European Qualifications Framework Level 6 were generally associated with less uncertainty and more comprehensive research ethics requirements. IMPLICATIONS FOR PRACTICE Results are informative of the current status of research ethics within evidence-based radiography.
Collapse
Affiliation(s)
- S Bockhold
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland.
| | - J McNulty
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland.
| | - E Abdurakman
- Division of Midwifery and Radiography, School of Health Sciences, City University of London, United Kingdom
| | - P Bezzina
- Radiography, Faculty of Health Sciences, L-Università ta' Malta, Malta
| | - N Drey
- Division of Nursing, School of Health Sciences, City University of London, United Kingdom
| | - A England
- Discipline of Medical Imaging and Radiation Therapy, School of Medicine, University College Cork, Ireland
| | - D Flinton
- Division of Midwifery and Radiography, School of Health Sciences, City University of London, United Kingdom
| | - R Khine
- School of Health Care and Social Work, Buckinghamshire New University, United Kingdom
| | - M McEntee
- Discipline of Medical Imaging and Radiation Therapy, School of Medicine, University College Cork, Ireland
| | - N Mekiš
- Medical Imaging and Radiotherapy, Faculty of Health Sciences, University of Ljubljana, Slovenia
| | - H Precht
- Diagnostic and Treatment and Radiography Education, Health Sciences Research Centre, UCL University College, Denmark
| | - L Rainford
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland
| | - C Sá Dos Reis
- Radiological Medical Imaging Technology, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - A Santos
- Medical Imaging and Radiotherapy, ESTESC-Coimbra Health School, Instituto Politécnico de Coimbra, Portugal
| | - V Syrgiamiotis
- CT-MRI Department, General Children's Hospital of Athens Agia Sophia, and University of West Attica, Greece
| | - S Willis
- Health Education England, National Health Service, London, United Kingdom
| | - J Woodley
- School of Health and Social Wellbeing, Faculty of Health and Applied Sciences, University of the West of England, Bristol, United Kingdom
| | - C Beardmore
- Society and College of Radiographers, London, United Kingdom
| | - R Harris
- Society and College of Radiographers, London, United Kingdom
| | - T O'Regan
- Society and College of Radiographers, London, United Kingdom
| | - C Malamateniou
- Division of Midwifery and Radiography, School of Health Sciences, City University of London, United Kingdom.
| |
Collapse
|
3
|
Liu SH, Hawkins BS, Ren M, Ng SM, Leslie L, Han G, Kuo IC. Topical Pharmacologic Interventions Versus Active Control, Placebo, or No Treatment for Epidemic Keratoconjunctivitis: Findings From a Cochrane Systematic Review. Am J Ophthalmol 2022; 240:265-275. [PMID: 35331686 PMCID: PMC9808666 DOI: 10.1016/j.ajo.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To summarize key findings from a Cochrane systematic review of the effectiveness and safety of topical pharmacologic interventions compared with active control or placebo for epidemic keratoconjunctivitis (EKC). DESIGN Systematic review. METHODS We included randomized controlled trials that compared antiseptic agents, virustatic agents, or immune-modulating topical therapies with placebo or an active control. We adhered to Cochrane methods for trial selection, data extraction, risk of bias evaluation, and data synthesis. RESULTS Ten randomized controlled trials with 892 participants with acute or chronic EKC were included. Eight trials compared interventions with artificial tears or saline (n = 4) or with steroids (n = 4); two 3-arm trials contributed data to both comparisons. Estimates suggested that compared with tears, after povidone-iodine (PVP-I) alone (2 studies, 409 participants) more participants with acute EKC had resolution of symptoms (risk ratio [RR] 1.15 [95% confidence interval {CI} 1.07-1.24]) and signs (RR 3.19 [95% CI 2.29-4.45]) within 10 days. In 2 trials comparing treatments with steroid alone or steroid with levofloxacin, fewer eyes treated with PVP-I or polyvinyl alcohol iodine (PVA-I) plus steroid developed subepithelial infiltrates within 21 days (RR 0.08 [95% CI 0.01-0.55]; 69 eyes). No treatment was shown to improve resolution of infiltrates. CONCLUSIONS Low- to very low-level certainty of evidence suggested that PVP-I or PVA-I with steroid may confer some benefit in acute EKC, but imprecision from small sample sizes, the potential risk of bias from inadequate reporting or trial design, and variability in participant selection, outcome measurement, and reporting limit the amount and quality of evidence.
Collapse
Affiliation(s)
- Su-Hsun Liu
- From the Department of Ophthalmology (S-H.L., S.M.N., L.L.), School of Medicine, University of Colorado, Aurora, Colorado
| | - Barbara S Hawkins
- Wilmer Eye Institute (B.S.H., M.R., I.C.K.), Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore
| | - Mark Ren
- Wilmer Eye Institute (B.S.H., M.R., I.C.K.), Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore
| | - Sueko M Ng
- From the Department of Ophthalmology (S-H.L., S.M.N., L.L.), School of Medicine, University of Colorado, Aurora, Colorado
| | - Louis Leslie
- From the Department of Ophthalmology (S-H.L., S.M.N., L.L.), School of Medicine, University of Colorado, Aurora, Colorado
| | - Genie Han
- Department of Epidemiology (G.H.), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Irene C Kuo
- Wilmer Eye Institute (B.S.H., M.R., I.C.K.), Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore.
| |
Collapse
|
4
|
Campbell TG, Lin M. Suprachoroidal steroids for uveitic macular oedema: Teaching an old drug new tricks? Clin Exp Ophthalmol 2022; 50:14-16. [DOI: 10.1111/ceo.14033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas Gordon Campbell
- Centre for Eye Research Australia East Melbourne Victoria Australia
- Ophthalmology, Department of Surgery University of Melbourne Melbourne Victoria Australia
- Royal Victorian Eye and Ear Hospital East Melbourne Victoria Australia
| | - Ming‐Lee Lin
- Royal Victorian Eye and Ear Hospital East Melbourne Victoria Australia
- Department of Ophthalmology Alfred Health Melbourne Victoria Australia
| |
Collapse
|
5
|
Różyńska J. Taking the principle of the primacy of the human being seriously. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:547-562. [PMID: 34318429 PMCID: PMC8557179 DOI: 10.1007/s11019-021-10043-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/23/2021] [Indexed: 06/13/2023]
Abstract
This paper targets an orphan topic in research ethics, namely the so called principle of the primacy of the human being, which states that the interests of the human subject should always take precedence over the interests of science and society. Although the principle occupies the central position in the majority of international ethical and legal standards for biomedical research, it has been commented in the literature mainly in passing. With a few notable exceptions, there is little in-depth discussion about the meaning and role of the principle. Several authors note that the principle is vogue, ambiguous and apparently conflicting with the accepted practice of conducting non-beneficial research on individuals unable to give consent. There are opinions that it is just "a vacuous figure of speech" and should be abandoned. This paper argues that the primacy principle is far from being "a vacuous figure of speech", rather it should be seen as a threefold concept: a fundamental interpretative rule, a procedural rule, and a substantive rule aimed at protecting research subjects from instrumental treatment and unacceptable risks. This interpretation tracks back to the principle regulatory and normative origins in the Declaration of Helsinki of 1975, but also acknowledges changes in research ethics and practice, which took place at the turn on the twentieth and twenty-first centuries. Thus, the proposed reading of the principle is not only original, but also historically grounded and normatively fruitful. It provides a fresh and ethically rich perspective on extensively debated, but still controversial problem of an upper limit of permissible risks in non-beneficial studies.
Collapse
Affiliation(s)
- Joanna Różyńska
- Center for Bioethics and Biolaw, Faculty of Philosophy, University of Warsaw, Krakowskie Przedmiescie 3, 00-047, Warsaw, Poland.
| |
Collapse
|
6
|
Grill JD, Karlawish J. Implications of FDA Approval of a First Disease-Modifying Therapy for a Neurodegenerative Disease on the Design of Subsequent Clinical Trials. Neurology 2021; 97:496-500. [PMID: 34088880 PMCID: PMC8448555 DOI: 10.1212/wnl.0000000000012329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/24/2021] [Indexed: 11/15/2022] Open
Abstract
The goal of clinical research is to improve clinical practice. In progressive neurodegenerative conditions without any disease-slowing therapies, this will result in eventual approval of a first disease-modifying treatment. Clinical trials will still be needed to discover treatments that are more effective, safer, or more convenient. This will generate controversies over how to design these trials; specifically, controversies about the use of a placebo control. We consider ethical guidance for these studies with attention to 3 designs: placebo-controlled trials in the absence of the new drug, placebo-controlled trials with the approved drug as background therapy, and trials with the new drug as an active control. To understand the practical implications of these designs, we examine experiences in drug development in multiple sclerosis. We conclude by contemplating the future of clinical trials in Alzheimer disease.
Collapse
Affiliation(s)
- Joshua D Grill
- From the Institute for Memory Impairments and Neurological Disorders, Departments of Psychiatry and Human Behavior and Neurobiology and Behavior (J.D.G.), University of California, Irvine; and Penn Memory Center, Departments of Medicine, Medical Ethics and Health Policy, and Neurology (J.K.), University of Pennsylvania, Philadelphia.
| | - Jason Karlawish
- From the Institute for Memory Impairments and Neurological Disorders, Departments of Psychiatry and Human Behavior and Neurobiology and Behavior (J.D.G.), University of California, Irvine; and Penn Memory Center, Departments of Medicine, Medical Ethics and Health Policy, and Neurology (J.K.), University of Pennsylvania, Philadelphia
| |
Collapse
|
7
|
Frank DM. What is the environment in environmental health research? Perspectives from the ethics of science. STUDIES IN HISTORY AND PHILOSOPHY OF SCIENCE 2021; 88:172-180. [PMID: 34218158 DOI: 10.1016/j.shpsa.2021.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/17/2021] [Accepted: 05/20/2021] [Indexed: 05/10/2023]
Abstract
Environmental health research produces scientific knowledge about environmental hazards crucial for public health and environmental justice movements that seek to prevent or reduce exposure to these hazards. The environment in environmental health research is conceptualized as the range of possible social, biological, chemical, and/or physical hazards or risks to human health, some of which merit study due to factors such as their probability and severity, the feasibility of their remediation, and injustice in their distribution. This paper explores the ethics of identifying the relevant environment for environmental health research, as judgments involved in defining an environmental hazard or risk, judgments of that hazard or risk's probability, severity, and/or injustice, as well as the feasibility of its remediation, all ought to appeal to non-epistemic as well as epistemic values. I illustrate by discussing the case of environmental lead, a housing-related hazard that remains unjustly distributed by race and class and is particularly dangerous to children. Examining a controversy in environmental health research ethics where researchers tested multiple levels of lead abatement in lead-contaminated households, I argue that the broader perspective on the ethics of environmental health research provided in the first part of this paper may have helped prevent this controversy.
Collapse
Affiliation(s)
- David M Frank
- Department of Philosophy, Cogut Institute for the Humanities, Brown University, Providence, RI 02902, USA.
| |
Collapse
|
8
|
Kaptchuk TJ, Hemond CC, Miller FG. Placebos in chronic pain: evidence, theory, ethics, and use in clinical practice. BMJ 2020; 370:m1668. [PMID: 32690477 DOI: 10.1136/bmj.m1668] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Despite their ubiquitous presence, placebos and placebo effects retain an ambiguous and unsettling presence in biomedicine. Specifically focused on chronic pain, this review examines the effect of placebo treatment under three distinct frameworks: double blind, deception, and open label honestly prescribed. These specific conditions do not necessarily differentially modify placebo outcomes. Psychological, clinical, and neurological theories of placebo effects are scrutinized. In chronic pain, conscious expectation does not reliably predict placebo effects. A supportive patient-physician relationship may enhance placebo effects. This review highlights "predictive coding" and "bayesian brain" as emerging models derived from computational neurobiology that offer a unified framework to explain the heterogeneous evidence on placebos. These models invert the dogma of the brain as a stimulus driven organ to one in which perception relies heavily on learnt, top down, cortical predictions to infer the source of incoming sensory data. In predictive coding/bayesian brain, both chronic pain (significantly modulated by central sensitization) and its alleviation with placebo treatment are explicated as centrally encoded, mostly non-conscious, bayesian biases. The review then evaluates seven ways in which placebos are used in clinical practice and research and their bioethical implications. In this way, it shows that placebo effects are evidence based, clinically relevant, and potentially ethical tools for relieving chronic pain.
Collapse
Affiliation(s)
- Ted J Kaptchuk
- Beth Israel Hospital/Harvard Medical School, Boston, MA 02139, USA
- Contributed equally
| | - Christopher C Hemond
- University of Massachusetts Medical School, Worcester, MA 01655, USA
- Contributed equally
| | | |
Collapse
|
9
|
The generalized inference on the ratio of mean differences for fraction retention noninferiority hypothesis. PLoS One 2020; 15:e0234432. [PMID: 32516350 PMCID: PMC7282653 DOI: 10.1371/journal.pone.0234432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 05/25/2020] [Indexed: 11/19/2022] Open
Abstract
The fraction retention non-inferiority hypothesis is often measured for the ratio of the effects of a new treatment to those of the control in medical research. However, the fraction retention non-inferiority test that the new treatment maintains the efficacy of control can be affected by the nuisance parameters. Herein, a heuristic procedure for testing the fraction retention non-inferiority hypothesis is proposed based on the generalized p-value (GPV) under normality assumption and heteroskedasticity. Through the simulation study, it is demonstrated that, the performance of the GPV-based method not only adequately controls the type I error rate at the nominal level but also is uniformly more powerful than the ratio test, Rothmann’s and Wang’s tests, the comparable extant methods. Finally, we illustrate the proposed method by employing a real example.
Collapse
|
10
|
Krol FJ, Hagin M, Vieta E, Harazi R, Lotan A, Strous RD, Lerer B, Popovic D. Placebo-To be or not to be? Are there really alternatives to placebo-controlled trials? Eur Neuropsychopharmacol 2020; 32:1-11. [PMID: 31959380 DOI: 10.1016/j.euroneuro.2019.12.117] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/17/2019] [Accepted: 12/20/2019] [Indexed: 12/19/2022]
Abstract
Recent success of established treatment has driven concerns about the ethics of using placebo-controlled trials in psychiatry. Active-controlled (superiority or non-inferiority) trials do not include a placebo-arm and thus avoid the associated ethical concerns but show disadvantages in other respects. The aim of this paper is to review the available literature and critically discuss the evidence regarding the use of placebo-controlled- versus active-controlled trials. A MEDLINE/PubMed and Google Scholar search was performed. Studies included focused on the deliberation on placebo-controlled- versus active-controlled trials. Twenty-six studies were included. The most cited benefits of placebo-controlled trials were greater scientific reliability of the results and no average impact on patients' health. Disadvantages were mainly related to withholding effective treatment and limited generalizability. The most frequent argument in favor of active-controlled trials is the lower chance of receiving ineffective medication during the trial. Downsides include larger sample sizes, higher costs and lower scientific reliability of results. Most authors agree that all trial designs are relevant to psychiatric research depending on study goals. Whatsoever, data does not support forgoing placebo-controlled trials. Expert consensus is warranted to permit drawing conclusions on the debate on the relevance of placebo-controlled trials.
Collapse
Affiliation(s)
- Fas Jacob Krol
- Leiden University Medical Center, the Netherlands; Bipolar Disorders Program, Sheba Medical Center, 52621 Ramat Gan, Israel
| | - Michal Hagin
- Bipolar Disorders Program, Sheba Medical Center, 52621 Ramat Gan, Israel
| | - Eduard Vieta
- Bipolar and Depressive Disorders Program, Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain
| | - Rephael Harazi
- Bipolar Disorders Program, Sheba Medical Center, 52621 Ramat Gan, Israel
| | - Amit Lotan
- Biological Psychiatry Laboratory Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Rael D Strous
- Sackler Faculty of Medicine, Tel Aviv University, Israel; Maayenei Hayeshua Medical Center
| | - Bernard Lerer
- Biological Psychiatry Laboratory Hadassah - Hebrew University Medical Center, Jerusalem, Israel
| | - Dina Popovic
- Bipolar Disorders Program, Sheba Medical Center, 52621 Ramat Gan, Israel.
| |
Collapse
|
11
|
Ju C, Spiegel R, Radecki R, Swaminathan AK. Rimegepant in the Treatment of Migraine Headache: The Importance of Comparator Treatments: November 2019 Annals of Emergency Medicine Journal Club. Ann Emerg Med 2019; 74:721-723. [PMID: 31668246 DOI: 10.1016/j.annemergmed.2019.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Christine Ju
- Emergency Department, St. Joseph's University Medical Center, Paterson, NJ
| | - Rory Spiegel
- Departments of Emergency Medicine and Critical Care, MEDStar Washington Hospital, Washington, DC
| | - Ryan Radecki
- Department of Emergency Medicine, Northwest Permanente, Portland, OR
| | | |
Collapse
|
12
|
Voicu VA, Mircioiu C, Plesa C, Jinga M, Balaban V, Sandulovici R, Costache AM, Anuta V, Mircioiu I. Effect of a New Synergistic Combination of Low Doses of Acetylsalicylic Acid, Caffeine, Acetaminophen, and Chlorpheniramine in Acute Low Back Pain. Front Pharmacol 2019; 10:607. [PMID: 31281250 PMCID: PMC6595163 DOI: 10.3389/fphar.2019.00607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/14/2019] [Indexed: 01/13/2023] Open
Abstract
The present paper continues a more complex research related to the increased synergism in terms of both anti-inflammatory and analgesic effect obtained by the addition of chlorpheniramine (CLF) to the common acetylsalicylic acid (ASA), acetaminophen (PAR), and caffeine (CAF) combination. This synergistic effect was previously highlighted both in vitro in rat models and in vivo in the treatment of migraine. The aim of the research was to further evaluate the analgesic effect of a synergistic low-dose ASA-PAR-CAF-CLF combination in the treatment of low back pain, in a parallel, multiple-dose, double-blind, active controlled clinical trial. A number of 89 patients with low back pain of at least moderate intensity were randomly assigned to receive Algopirin® (ALG), a combinational product containing 125 mg ASA, 75 mg PAR, 15 mg CAF, and 2 mg CLF, or PAR 500 mg, a drug recognized by American Pain Society as "safe and effective" in the treatment of low back pain. One tablet of the assigned product was administered three times a day for seven consecutive days. The patients evaluated their pain level using a Visual Analog Scale prior to administration, and at 1, 2, 4, and 6 h after the morning dose. Time course of effect was similar in structure and size for both treatments. Pain relief appeared rapidly and steadily increased over 4 h after drug administration. Differential pain curves of ALG and PAR were very similar and comparable with the previously determined ALG analgesia pattern in migraine. Differences between the daily mean pain scores were not statistically significant for the two treatments. Similar results were obtained for the Sum of Pain Intensity Differences (SPID) for 0-4 h and 0-6 h intervals as well as for the time course of the proportion of patients with at least 30% and at least 50% pain relief. In conclusion, in spite of very small doses of active components, ALG proved equally effective to the standard low back pain treatment and therefore a viable therapeutic alternative, mainly for patients with gastrointestinal and hepatic sensitivity. Trial Registration: www.ClinicalTrials.gov, identifier EudraCT No.: 2015-002314-74.
Collapse
Affiliation(s)
- Victor A Voicu
- Department of Clinical Pharmacology, Toxicology and Psychopharmacology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Doctoral School, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Constantin Mircioiu
- Doctoral School, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristina Plesa
- Department of Neurology, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania
| | - Mariana Jinga
- Department of Internal Medicine and Gastroenterology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Internal Medicine and Gastroenterology Clinic, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania
| | - Vasile Balaban
- Department of Internal Medicine and Gastroenterology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Internal Medicine and Gastroenterology Clinic, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, Romania
| | - Roxana Sandulovici
- Department of Applied Mathematics and Biostatistics, Titu Maiorescu University, Bucharest, Romania
| | - Ana Maria Costache
- Department of Clinical Research, CEBIS International, Bucharest, Romania
| | - Valentina Anuta
- Department of Physical and Colloidal Chemistry, Faculty of Pharmacy, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ion Mircioiu
- Department of Biopharmacy and Pharmacokinetics, Titu Maiorescu University, Bucharest, Romania
| |
Collapse
|
13
|
Yentis SM, Vashisht S. The Effect of Timing of Pc.6 Acupuncture on Post-Operative Vomiting following Major Gynaecological Surgery. Acupunct Med 2018. [DOI: 10.1136/aim.16.1.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We have studied whether the antiemetic effect of PC.6 (Neiguan) acupuncture at the wrist in preventing post-operative nausea and vomiting is affected by the timing of its administration in fifty patients undergoing major gynaecological surgery. Patients were randomly assigned to receive PC.6 acupuncture either five minutes before induction of anaesthesia (Group 1), five minutes after induction of anaesthesia (Group 2) or when awake in the recovery room post-operatively (Group 3). There were no significant differences in emetic sequelae amongst the three groups, with respective incidences of vomiting of 29%, 24% and 25% within the first 6 hours post-operatively. In order to have an 80% power of detecting a difference between groups of the magnitude found, over 3600 patients would need to be studied. We conclude that general anaesthesia does not affect the antiemetic action of PC.6 acupuncture.
Collapse
|
14
|
Rust G. Cardiac Outcomes After Treatment for Depression in Patients With Acute Coronary Syndrome. JAMA 2018; 320:2152. [PMID: 30480721 DOI: 10.1001/jama.2018.15934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- George Rust
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee
| |
Collapse
|
15
|
Bąbel P, Bajcar EA, Marchewka K, Sikora K. Placebo Groups in Research on the Effectiveness of ABA Therapeutic Techniques. Front Psychol 2018; 9:1899. [PMID: 30459666 PMCID: PMC6232887 DOI: 10.3389/fpsyg.2018.01899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 09/18/2018] [Indexed: 11/13/2022] Open
Abstract
Behavior analysts have shown that a single-subject experimental design (SSED) is a useful tool for identifying the effectiveness of specific therapeutic techniques, whereas researchers outside applied behavior analysis (ABA) maintain that randomized placebo-controlled trials (RPCT) provide the most definite test of efficacy. In this paper the possible benefits that could result from supporting SSED studies by placebo control groups are discussed. However, the use of placebo groups in psychotherapy research arouses considerable controversy and many researchers argue against it. The main aim of this paper is to clarify theoretical and methodological problems associated with using placebo groups in psychotherapy research and to demonstrate that these problems can be solved if the assumptions on which they are based are reformulated. The article also discusses ethical issues about the use of placebo groups in research on the effectiveness of psychotherapy.
Collapse
Affiliation(s)
- Przemysław Bąbel
- Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland
| | - Elżbieta Anita Bajcar
- Pain Research Group, Institute of Psychology, Jagiellonian University, Kraków, Poland
| | - Katarzyna Marchewka
- Institute of Psychology, Jagiellonian University, Kraków, Poland.,Institute of Philosophy, Jagiellonian University, Kraków, Poland
| | - Katarzyna Sikora
- Institute of Psychology, Jagiellonian University, Kraków, Poland.,Institute of Psychology, Jesuit University Ignatianum, Kraków, Poland
| |
Collapse
|
16
|
Skierka AS, Michels KB. Ethical principles and placebo-controlled trials - interpretation and implementation of the Declaration of Helsinki's placebo paragraph in medical research. BMC Med Ethics 2018; 19:24. [PMID: 29544543 PMCID: PMC5856313 DOI: 10.1186/s12910-018-0262-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 03/01/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In October 2013, the Declaration of Helsinki was revised a seventh time in its 50 year history. While it is the most widely accepted set of ethical principles for the protection of patients participating in medical research, the Declaration of Helsinki has also been subject of constant controversy. In particular, its paragraph on the use of placebo controls in clinical trials divides the research community into active-control and placebo orthodox proponents, both continuously demanding revisions of the Declaration of Helsinki in favour of their position. The goal of the present project is to compare the mainly theoretical controversy with regulatory implementation. METHODS We distributed a questionnaire to national drug regulatory authorities from different countries to collect information on the authorities' respective approaches to interpretation and implementation of the Declarations' placebo paragraph in the conduct of medical research. RESULTS Our findings suggest that the majority of drug regulatory authorities have established a practice of a middle ground, allowing placebo controls in some instances. Various interpretations of "serious harm" and "methodological reasons" are proposed as well as safeguards to avoid abuse of the option to use placebo-controls. CONCLUSION Leaving the placebo paragraph open to various interpretation is a result of the Declaration of Helsinki's character as a guidance document. With the current version controversy will continue. The Declaration should be continued to be strengthened to enforce the appreciation of conducting medical research with the highest ethical standard.
Collapse
Affiliation(s)
| | - Karin B Michels
- Institute for Prevention and Cancer Epidemiology, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany.
- Department of Obstetrics, Gynecology and Reproductive Biology, Obstetrics and Gynecology Epidemiology Center, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
| |
Collapse
|
17
|
Lieber SR, Rice JP, Lucey MR, Bataller R. Controversies in clinical trials for alcoholic hepatitis. J Hepatol 2018; 68:586-592. [PMID: 28966126 PMCID: PMC6709528 DOI: 10.1016/j.jhep.2017.09.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 08/18/2017] [Accepted: 09/20/2017] [Indexed: 12/13/2022]
Abstract
Alcoholic hepatitis (AH) is the most severe form of alcoholic liver disease, contributing to significant morbidity and mortality. Yet, the only available therapies that improve survival are corticosteroids and liver transplantation, with no new drugs successfully developed for decades. This article briefly describes the current state of affairs in AH therapy and examines the practical and ethical challenges of conducting controlled trials in patients with severe AH. While prednisolone is considered standard of care in severe AH, this recommendation remains controversial given the marginal benefits and questionable long-term safety of steroids. Placebo-controlled trials without steroids may be necessary and ethically justified in certain populations with AH who have not been adequately investigated. Ultimately, we suggest that the field will advance with the development of a plausible animal model of true AH, a consensus on a composite clinical endpoint that does not rely solely on mortality, as well as the adoption of the NIAAA Alcoholic Hepatitis Consortia recommendations regarding standard definitions and when to request a liver biopsy prior to study entry.
Collapse
Affiliation(s)
- Sarah R Lieber
- Division of Gastroenterology and Hepatology and Biochemistry Departments of Medicine and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John P Rice
- Division of Gastroenterology and Hepatology, Departments of Medicine and Public Health, University of Wisconsin, WI, USA
| | - Michael R Lucey
- Division of Gastroenterology and Hepatology, Departments of Medicine and Public Health, University of Wisconsin, WI, USA.
| | - Ramon Bataller
- Division of Gastroenterology, Hepatology and Nutrition, Pittsburgh Liver Research Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| |
Collapse
|
18
|
Abstract
The placebo effect is a fascinating phenomenon in clinical practice. Studies have shown that there is a significant placebo effect in a wide range of medical conditions including psychiatric disorders. This article looks at the background of the placebo effect, defines the common terms used, describes the various hypotheses that have been put forward to explain this seemingly inexplicable phenomenon and also covers the issue of using placebos in research trials, highlighting the important ethical dilemmas involved. Throughout, specific emphasis is given to psychiatry.
Collapse
|
19
|
Nawata K, Sekizawa Y, Kimura M. Evaluation of Blood Pressure Control Medicines Using Health and Medical Checkup Data in Japan: Alternative Methods for Randomized Controlled Trials. Health (London) 2018. [DOI: 10.4236/health.2018.105047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
20
|
Describing Placebo Phenomena in Medicine: A Linguistic Approach. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2018; 139:49-83. [DOI: 10.1016/bs.irn.2018.07.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
21
|
Yardley MM, Ray LA. Medications development for the treatment of alcohol use disorder: insights into the predictive value of animal and human laboratory models. Addict Biol 2017; 22:581-615. [PMID: 26833803 DOI: 10.1111/adb.12349] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 11/09/2015] [Accepted: 11/13/2015] [Indexed: 12/20/2022]
Abstract
Development of effective treatments for alcohol use disorder (AUD) represents an important public health goal. This review provides a summary of completed preclinical and clinical studies testing pharmacotherapies for the treatment of AUD. We discuss opportunities for improving the translation from preclinical findings to clinical trial outcomes, focusing on the validity and predictive value of animal and human laboratory models of AUD. Specifically, while preclinical studies of medications development have offered important insights into the neurobiology of the disorder and alcohol's molecular targets, limitations include the lack of standardized methods and streamlined processes whereby animal studies can readily inform human studies. Behavioral pharmacology studies provide a less expensive and valuable opportunity to assess the feasibility of a pharmacotherapy prior to initiating larger scale clinical trials by providing insights into the mechanism of the drug, which can then inform recruitment, analyses, and assessments. Summary tables are provided to illustrate the wide range of preclinical, human laboratory, and clinical studies of medications development for alcoholism. Taken together, this review highlights the challenges associated with animal paradigms, human laboratory studies, and clinical trials with the overarching goal of advancing treatment development and highlighting opportunities to bridge the gap between preclinical and clinical research.
Collapse
Affiliation(s)
- Megan M. Yardley
- Department of Psychology; University of California, Los Angeles; Los Angeles CA USA
| | - Lara A. Ray
- Department of Psychology; University of California, Los Angeles; Los Angeles CA USA
- Department of Psychiatry and Biobehavioral Sciences; University of California, Los Angeles; Los Angeles CA USA
| |
Collapse
|
22
|
Teshome EM, Otieno W, Terwel SR, Osoti V, Demir AY, Andango PEA, Prentice AM, Verhoef H. Comparison of home fortification with two iron formulations among Kenyan children: Rationale and design of a placebo-controlled non-inferiority trial. Contemp Clin Trials Commun 2017; 7:1-10. [PMID: 29696163 PMCID: PMC5898495 DOI: 10.1016/j.conctc.2017.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/11/2017] [Accepted: 04/08/2017] [Indexed: 10/24/2022] Open
Abstract
Introduction Home fortification powders containing iron and other micronutrients have been recommended by World Health Organisation to prevent iron deficiency anaemia in areas of high prevalence. There is evidence, however, that home fortification at this iron dose may cause gastrointestinal adverse events including diarrhoea. Providing a low dose of highly absorbable iron (3 mg iron as NaFeEDTA) may be safer because the decreased amount of iron in the gut lumen can possibly reduce the burden of these adverse effects whilst resulting in similar or higher amounts of absorbed iron. Objective To show non-inferiority of home fortification with 3 mg iron as NaFeEDTA compared with 12.5 mg iron as encapsulated ferrous fumarate, with haemoglobin response as the primary outcome. Design 338 Kenyan children aged 12-36 months will be randomly allocated to daily home fortification with either: a) 3 mg iron as NaFeEDTA (experimental treatment), b) 12.5 mg iron as encapsulated ferrous fumarate (reference), or c) placebo. At baseline, after 30 days of intervention and within 100 days post-intervention, blood samples will be assessed for primary outcome (haemoglobin concentration), iron status markers, Plasmodium parasitaemia and inflammation markers. Urine and stool samples will be assessed for hepcidin concentrations and inflammation, respectively. Adherence will be assessed by self-reporting, sachet counts and by an electronic monitoring device. Conclusion If daily home fortification with a low dose of iron (3 mg NaFeEDTA) has similar or superior efficacy to a high dose (12.5 mg ferrous fumarate) then it would be the preferred choice for treatment of iron deficiency anaemia in children.
Collapse
Affiliation(s)
- Emily M Teshome
- MRCG Keneba, MRC Unit The Gambia, Banjul, Gambia.,MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Walter Otieno
- Maseno University, School of Medicine, Maseno, Kenya
| | - Sofie R Terwel
- Wageningen University, Cell Biology and Immunology Group, Division of Human Nutrition, Wageningen, The Netherlands
| | - Victor Osoti
- International Centre of Insect Physiology and Ecology, Nairobi, Kenya
| | - Ayşe Y Demir
- Meander Medical Centre, Laboratory for Clinical Chemistry, Amersfoort, The Netherlands
| | - Pauline E A Andango
- Maseno University, School of Public Health and Community Development, Maseno, Kenya
| | - Andrew M Prentice
- MRCG Keneba, MRC Unit The Gambia, Banjul, Gambia.,MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Hans Verhoef
- MRCG Keneba, MRC Unit The Gambia, Banjul, Gambia.,MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, London, UK.,Wageningen University, Cell Biology and Immunology Group, Division of Human Nutrition, Wageningen, The Netherlands
| |
Collapse
|
23
|
Teshome EM, Andang'o PEA, Osoti V, Terwel SR, Otieno W, Demir AY, Prentice AM, Verhoef H. Daily home fortification with iron as ferrous fumarate versus NaFeEDTA: a randomised, placebo-controlled, non-inferiority trial in Kenyan children. BMC Med 2017; 15:89. [PMID: 28449690 PMCID: PMC5408380 DOI: 10.1186/s12916-017-0839-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/20/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND We aimed to show the non-inferiority of home fortification with a daily dose of 3 mg iron in the form of iron as ferric sodium ethylenediaminetetraacetate (NaFeEDTA) compared with 12.5 mg iron as encapsulated ferrous fumarate in Kenyan children aged 12-36 months. In addition, we updated a recent meta-analysis to assess the efficacy of home fortification with iron-containing powders, with a view to examining diversity in trial results. METHODS We gave chemoprevention by dihydroartemisinin-piperaquine, albendazole and praziquantel to 338 afebrile children with haemoglobin concentration ≥70 g/L. We randomly allocated them to daily home fortification for 30 days with either placebo, 3 mg iron as NaFeEDTA or 12.5 mg iron as encapsulated ferrous fumarate. We assessed haemoglobin concentration (primary outcome), plasma iron markers, plasma inflammation markers and Plasmodium infection in samples collected at baseline and after 30 days of intervention. We conducted a meta-analysis of randomised controlled trials in pre-school children to assess the effect of home fortification with iron-containing powders on anaemia and haemoglobin concentration at end of intervention. RESULTS A total of 315 children completed the 30-day intervention period. At baseline, 66.9% of children had inflammation (plasma C-reactive protein concentration >5 mg/L or plasma α 1-acid glycoprotein concentration >1.0 g/L); in those without inflammation, 42.5% were iron deficient. There was no evidence, either in per protocol analysis or intention-to-treat analysis, that home fortification with either of the iron interventions improved haemoglobin concentration, plasma ferritin concentration, plasma transferrin receptor concentration or erythrocyte zinc protoporphyrin-haem ratio. We also found no evidence of effect modification by iron status, anaemia status and inflammation status at baseline. In the meta-analysis, the effect on haemoglobin concentration was highly heterogeneous between trials (I 2: 84.1%; p value for test of heterogeneity: <0.0001). CONCLUSIONS In this population, home fortification with either 3 mg iron as NaFeEDTA or 12.5 mg iron as encapsulated ferrous fumarate was insufficiently efficacious to assess non-inferiority of 3 mg iron as NaFeEDTA compared to 12.5 mg iron as encapsulated ferrous fumarate. Our finding of heterogeneity between trial results should stimulate subgroup analysis or meta-regression to identify population-specific factors that determine efficacy. TRIAL REGISTRATION The trial was registered with ClinicalTrials.gov ( NCT02073149 ) on 25 February 2014.
Collapse
Affiliation(s)
- Emily M Teshome
- MRCG Keneba at MRC Unit, Banjul, The Gambia.
- MRC International Nutrition Group, Faculty of Epidemiology and Population Heath, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, England, UK.
| | - Pauline E A Andang'o
- Maseno University, School of Public Health and Community Development, Maseno, Kenya
| | - Victor Osoti
- International Centre of Insect Physiology and Ecology, Nairobi, Kenya
| | - Sofie R Terwel
- Division of Human Nutrition and Cell Biology and Immunology Group, Wageningen University, Wageningen, The Netherlands
| | - Walter Otieno
- Maseno University, School of Medicine, Maseno, Kenya
| | - Ayşe Y Demir
- Meander Medical Centre, Laboratory for Clinical Chemistry and Haematology, Amersfoort, The Netherlands
| | - Andrew M Prentice
- MRCG Keneba at MRC Unit, Banjul, The Gambia
- MRC International Nutrition Group, Faculty of Epidemiology and Population Heath, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, England, UK
| | - Hans Verhoef
- MRCG Keneba at MRC Unit, Banjul, The Gambia
- MRC International Nutrition Group, Faculty of Epidemiology and Population Heath, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, England, UK
- Division of Human Nutrition and Cell Biology and Immunology Group, Wageningen University, Wageningen, The Netherlands
| |
Collapse
|
24
|
Desselas E, Pansieri C, Leroux S, Bonati M, Jacqz-Aigrain E. Drug versus placebo randomized controlled trials in neonates: A review of ClinicalTrials.gov registry. PLoS One 2017; 12:e0171760. [PMID: 28192509 PMCID: PMC5305102 DOI: 10.1371/journal.pone.0171760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 01/25/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Despite specific initiatives and identified needs, most neonatal drugs are still used off-label, with variable dosage administrations and schedules. In high risk preterm and term neonates, drug evaluation is challenging and randomized controlled trials (RCT) are difficult to conduct and even more is the use of a placebo, required in the absence of a reference validated drug to be used as comparator. METHODS We analyzed the complete ClinicalTrials.gov registry 1) to describe neonatal RCT involving a placebo, 2) to report on the medical context and ethical aspects of placebo use. RESULTS Placebo versus drug RCT (n = 146), either prevention trials (n = 57, 39%) or therapeutic interventions (n = 89, 61%), represent more than a third of neonatal trials registered in the National Institute of Health clinical trial database (USA) since 1999. They mainly concerned preterm infants, evaluating complications of prematurity. Most trials were conducted in the USA, were single centered, and funded by non-profit organizations. For the three top drug trials evaluating steroids (n = 13, 9.6%), erythropoietin (EPO, n = 10, 6.8%) and nitric oxide (NO, n = 9, 6.2%), the objectives of the trial and follow-up were analyzed in more details. CONCLUSION Although a matter of debate, the use of placebo should be promoted in neonates to evaluate a potential new treatment, in the absence of reference drug. Analysis of the trials evaluating steroids showed that long-term follow-up of exposed patients, although required by international guidelines, is frequently missing and should be planned to collect additional information and optimize drug evaluation in these high-risk patients.
Collapse
Affiliation(s)
- Emilie Desselas
- Department of Pediatric Pharmacology and Pharmacogenetics, Hopital Robert Debré, Paris, France
- Clinical Investigation Center INSERM CIC1426, Hopital Robert Debré, Paris, France
| | - Claudia Pansieri
- Department of Public Health, Laboratory for Mother and Child Health, IRCCS-Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy
| | - Stephanie Leroux
- Department of Pediatric Pharmacology and Pharmacogenetics, Hopital Robert Debré, Paris, France
- Clinical Investigation Center INSERM CIC1426, Hopital Robert Debré, Paris, France
| | - Maurizio Bonati
- Department of Public Health, Laboratory for Mother and Child Health, IRCCS-Istituto di Ricerche Farmacologiche “Mario Negri”, Milan, Italy
| | - Evelyne Jacqz-Aigrain
- Department of Pediatric Pharmacology and Pharmacogenetics, Hopital Robert Debré, Paris, France
- Clinical Investigation Center INSERM CIC1426, Hopital Robert Debré, Paris, France
- Université Paris 7 Diderot, Paris, France
| |
Collapse
|
25
|
Mütze T, Konietschke F, Munk A, Friede T. A studentized permutation test for three-arm trials in the ‘gold standard’ design. Stat Med 2016; 36:883-898. [DOI: 10.1002/sim.7176] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 10/18/2016] [Accepted: 10/28/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Tobias Mütze
- Department of Medical Statistics; University Medical Center Göttingen; Humboldtallee 32 Göttingen 37073 Germany
| | - Frank Konietschke
- Department of Medical Statistics; University Medical Center Göttingen; Humboldtallee 32 Göttingen 37073 Germany
- Department of Mathematical Sciences; University of Texas at Dallas; Richardson 75080 TX U.S.A
| | - Axel Munk
- Institute for Mathematical Stochastics; Georg-August-University of Göttingen; Goldschmidtstraße 7 Göttingen 37077 Germany
- Max Planck Institute for Biophysical Chemistry; Am Faßberg 11 Göttingen 37077 Germany
| | - Tim Friede
- Department of Medical Statistics; University Medical Center Göttingen; Humboldtallee 32 Göttingen 37073 Germany
| |
Collapse
|
26
|
Amoroso T, Workman M. Treating posttraumatic stress disorder with MDMA-assisted psychotherapy: A preliminary meta-analysis and comparison to prolonged exposure therapy. J Psychopharmacol 2016; 30:595-600. [PMID: 27118529 DOI: 10.1177/0269881116642542] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Since the wars in Iraq and Afghanistan, posttraumatic stress disorder (PTSD) has become a major area of research and development. The most widely accepted treatment for PTSD is prolonged exposure (PE) therapy, but for many patients it is intolerable or ineffective. ±3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy (MDMA-AP) has recently re-emerged as a new treatment option, with two clinical trials having been published and both producing promising results. However, these results have yet to be compared to existing treatments. The present paper seeks to bridge this gap in the literature. Often the statistical significance of clinical trials is overemphasized, while the magnitude of the treatment effects is overlooked. The current meta-analysis aims to provide a comparison of the cumulative effect size of the MDMA-AP studies with those of PE. Effect sizes were calculated for primary and secondary outcome measures in the MDMA-AP clinical trials and compared to those of a meta-analysis including several PE clinical trials. It was found that MDMA-AP had larger effect sizes in both clinician-observed outcomes than PE did (Hedges' g=1.17 vs. g=1.08, respectively) and patient self-report outcomes (Hedges' g=0.87 vs. g=0.77, respectively). The dropout rates of PE and MDMA-AP were also compared, revealing that MDMA-AP had a considerably lower percentage of patients dropping out than PE did. These results suggest that MDMA-AP offers a promising treatment for PTSD.
Collapse
Affiliation(s)
- Timothy Amoroso
- Department of Psychology, University of New Hampshire, Durham, NH, USA
| | - Michael Workman
- Department of Biological Sciences, University of New Hampshire, Durham, NH, USA
| |
Collapse
|
27
|
Safety of research into severe and treatment-resistant mood disorders: analysis of outcome data from 12 years of clinical trials at the US National Institute of Mental Health. Lancet Psychiatry 2016; 3:436-42. [PMID: 26971192 PMCID: PMC4860062 DOI: 10.1016/s2215-0366(16)00006-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/16/2015] [Accepted: 12/21/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Placebo-controlled trials in drug-free patients have long been considered a key research component in the study of mood disorders and relevant treatment mechanisms. However, concerns have been raised about the ethics of such research, leading to an ongoing debate as to whether placebo controls are ethically acceptable. We aimed to assess the cumulative effects of research in individuals with mood disorders and to provide data to address ethical concerns regarding research in this population. METHODS We obtained empirical data for patients screened between between Dec 13, 2001, and Jan 31, 2014, with either major depressive disorder or bipolar disorder who were enrolled in one or more of 18 clinical trials at a US National Institute of Mental Health (NIMH) inpatient or outpatient behavioural health research clinic. We assessed the cumulative effects of research in our patient population, including the effects of drug taper, drug washout, and placebo administration on mood state. Two subgroups were examined: patients enrolled in trials explicitly requiring treatment resistance and patients with a current or past history of suicidal ideation or behaviour. We used the percentage change from screening as the primary outcome measure for statistical analysis of change in mood over study periods. This study is registered with ClinicalTrials.gov, number NCT00024635. FINDINGS We obtained data for 540 patients; 360 (71%) patients were enrolled in trials requiring treatment resistance, 58 (12%) of 465 patients had suicidal ideation at screening, and 191 (60%) of 321 patients had a history of suicidal ideation. Mean mood severity at screening was in the moderate to severe range. Full participation in research, including drug tapers, drug-free periods, and placebo-controlled trials, had a low risk of symptom exacerbation. Patients undergoing drug taper had a mean increase in symptom severity of 4·2% (SD 19·56, tdegrees of freedom 96=1·85; p=0·036). We recorded modest increases in the subgroup who tapered to no medications (mean percentage change 5·1% [SD 18·10], t56=2·12; p=0·039), but increases were not significant in participants enrolled in trials requiring treatment resistance (4·3% [18·60], t72=1·96; p=0·054) and those with a current or past history of suicidal ideation or behaviour (1·8% [18·78], t51=0·68; p=0·50). Six serious adverse events were reported, including one suicide attempt that occurred during the standard treatment phase and not during the clinical trial. INTERPRETATION In general, research participation at the NIMH was not detrimental to health and safety, and conferred benefit in many cases. This finding was true not only in our entire research population, but also in treatment-resistant subgroups and subgroups with a history of suicidality. Our study provides evidence to guide ethical analysis of issues in psychiatric research, and to support continued scientific investigation. FUNDING Intramural Research Program, NIMH, National Institutes of Health.
Collapse
|
28
|
Shelton RC. Are placebo-controlled trials of depression safe? Lancet Psychiatry 2016; 3:393-5. [PMID: 26971193 DOI: 10.1016/s2215-0366(16)00019-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 01/08/2016] [Accepted: 01/11/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Richard C Shelton
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
| |
Collapse
|
29
|
Cota GF, de Sousa MR, Fereguetti TO, Saleme PS, Alvarisa TK, Rabello A. The Cure Rate after Placebo or No Therapy in American Cutaneous Leishmaniasis: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0149697. [PMID: 26894430 PMCID: PMC4760744 DOI: 10.1371/journal.pone.0149697] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/02/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION There are few drugs with proven efficacy in cutaneous leishmaniasis (CL), and pentavalent antimonial derivatives are still the main first-line therapeutic agents worldwide, despite their recognized high toxicities. Randomized controlled clinical trials assessing the efficacy and safety of new therapeutic modalities are of high priority, and the definition of the design of such trials raises debate about the use of placebo as a comparator. To support the use of placebo as a comparator, two main points need to be addressed: 1--the cure rate without any therapeutic intervention and 2--the damage caused by CL and its impact on patients. OBJECTIVE The aim of this study was to systematically assess the spontaneous cure rate for American CL and to broaden the discussion about placebo use in CL trials. METHODS The PRISMA guidelines for systematic reviews and the Cochrane manual were followed. The sources used were the PubMed and LILACS databases. Studies were included if they reported cure rates using placebo or no treatment in American CL. RESULTS Thirteen studies of a total of 352 patients were ultimately included in this review. The summarized global cure rates for all Leishmania species according to the intention-to-treat analyses performed at approximately three ("initial cure") and nine ("definitive cure") months after "no treatment" or placebo use were 26% (CI95%: 16 to 40%) and 26% (CI95%:16 to 38%), respectively. Notably, a significantly lower cure rate was observed for L. braziliensis infection (6.4%, CI95%:0.2 to 20%) than for L. mexicana infection (44%, CI95%:19 to 72%), p = 0.002. Of note, relapse occurred in 20% of patients with initial healing (CI95%:9.2 to 38.9%). CONCLUSION These results clearly demonstrate a low spontaneous cure rate following no-treatment or placebo use, confirming that this strategy for the control group in CL studies expose patients to greater morbidity, especially for CL caused by L. braziliensis. Therefore, from this point, the crucial question to consider regarding placebo use is the seriousness of the suffering caused by this disease.
Collapse
Affiliation(s)
- Gláucia Fernandes Cota
- Clinical Research and Public Policy in Infectious and Parasitic Diseases, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| | - Marcos Roberto de Sousa
- Post-Graduate Program in Adult Health Sciences, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Tatiani Oliveira Fereguetti
- Hospital Eduardo de Menezes, Fundação Hospitalar do Estado de Minas Gerais-FHEMIG, Belo Horizonte, Minas Gerais, Brazil
| | - Priscila Said Saleme
- Hospital Eduardo de Menezes, Fundação Hospitalar do Estado de Minas Gerais-FHEMIG, Belo Horizonte, Minas Gerais, Brazil
| | - Thais Kawagoe Alvarisa
- Hospital Eduardo de Menezes, Fundação Hospitalar do Estado de Minas Gerais-FHEMIG, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Rabello
- Clinical Research and Public Policy in Infectious and Parasitic Diseases, Centro de Pesquisas René Rachou, Fundação Oswaldo Cruz, Fiocruz, Belo Horizonte, Minas Gerais, Brazil
| |
Collapse
|
30
|
Ndebele P, Wassenaar D, Masiye F, Munalula-Nkandu E. Trial participants' understanding of randomization, double-blinding, and placebo use in low literacy populations: findings from a study conducted within a microbicide trial in Malawi. J Empir Res Hum Res Ethics 2016; 9:2-10. [PMID: 25746781 DOI: 10.1177/1556264614540592] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Concerns have been raised about the limits of understanding of consent by clinical trial participants in developing countries. Consequently, this empirical study was conducted in Malawi to assess microbicide trial participants' understanding of randomization, double-blinding, and placebo use. The study used a combination of quantitative and qualitative methods, including structured questionnaire interviews with a random sample of 203 individual participants, four in-depth interviews with research nurses, and two focus group discussions with 18 study participants. Most respondents earned high scores on questions related to randomization (85%) and placebo use (72%), while a greater proportion of the same respondents obtained low scores on questions related to double-blinding (68%) and personal implications of the study procedures (63%). Overall, most respondents (61%; n = 124) obtained low scores on combined understanding of all the three concepts under study.
Collapse
Affiliation(s)
- Paul Ndebele
- Medical Research Council of Zimbabwe, Harare, Zimbabwe
| | | | - Francis Masiye
- University of Malawi, College of Medicine, Blantyre, Malawi
| | | |
Collapse
|
31
|
Lin J, Gamalo-Siebers M, Tiwari R. Non-inferiority and networks: inferring efficacy from a web of data. Pharm Stat 2015; 15:54-67. [DOI: 10.1002/pst.1729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 08/26/2015] [Accepted: 10/29/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Junjing Lin
- Department of Statistics and Applied Probability; University of California, Santa Barbara; Santa Barbara CA USA
| | - Margaret Gamalo-Siebers
- Mathematical Statistician, Office of Analytics and Outreach, Center for Food Safety and Applied Nutrition; Food and Drug Administration; College Park 20740 MD USA
| | - Ram Tiwari
- Office of Biostatistics; Food and Drug Administration; Silver Spring MD USA
| |
Collapse
|
32
|
Comparison of efficacy and safety of lateral-to-medial continuous transversus abdominis plane block with thoracic epidural analgesia in patients undergoing abdominal surgery. Eur J Anaesthesiol 2015; 32:797-804. [DOI: 10.1097/eja.0000000000000345] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
33
|
Reporting of sources of funding in systematic reviews in periodontology and implant dentistry. Br Dent J 2015; 216:109-12. [PMID: 24504292 DOI: 10.1038/sj.bdj.2014.47] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 01/08/2023]
Abstract
Industry-supported clinical trials may present better outcomes than those supported by other sources. The aim of this paper was to assess whether systematic reviews (SRs) published in periodontology and implant dentistry report and discuss the influence of funding sources on study results. Two reviewers conducted a comprehensive search in PubMed and the Cochrane Database of Systematic Reviews independently and in duplicate to identify SRs published up to 11 November 2012. Speciality dental journals and the reference lists of included SRs were also scrutinised. Information on the reporting and discussion of funding sources of primary studies included in the SRs was extracted independently and in duplicate. Any disagreement regarding SR selection or data extraction was discussed until consensus was achieved. Of 146 SRs included in the assessment, only 45 (31%) reported the funding sources of primary studies. Fourteen (10%) SRs discussed the potential influence of funding sources on study results, that is, sponsorship bias. Funding sources are inadequately reported and discussed in SRs in periodontology and implant dentistry. Assessment, reporting, and critical appraisal of potential sponsorship bias of meta-analytic estimates are paramount to provide proper guidance for clinical treatments.
Collapse
|
34
|
Mütze T, Munk A, Friede T. Design and analysis of three-arm trials with negative binomially distributed endpoints. Stat Med 2015; 35:505-21. [DOI: 10.1002/sim.6738] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/27/2015] [Accepted: 09/01/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Tobias Mütze
- GlaxoSmithKline; 7030 Kit Creek Road Morrisville NC 27560 U.S.A
- Institut für Medizinische Statistik; Universitätsmedizin Göttingen; Humboldtallee 32 Göttingen 37073 Germany
| | - Axel Munk
- Institut für Mathematische Stochastik; Georg-August-Universität Göttingen; Goldschmitdstrasse 7 Göttingen 37077 Germany
- Max Planck Institute for Biophysical Chemistry; Am Fassberg 11 Göttingen 37077 Germany
| | - Tim Friede
- Institut für Medizinische Statistik; Universitätsmedizin Göttingen; Humboldtallee 32 Göttingen 37073 Germany
| |
Collapse
|
35
|
Gamalo-Siebers M, Gao A, Lakshminarayanan M, Liu G, Natanegara F, Railkar R, Schmidli H, Song G. Bayesian methods for the design and analysis of noninferiority trials. J Biopharm Stat 2015; 26:823-41. [PMID: 26247350 DOI: 10.1080/10543406.2015.1074920] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The gold standard for evaluating treatment efficacy of a medical product is a placebo-controlled trial. However, when the use of placebo is considered to be unethical or impractical, a viable alternative for evaluating treatment efficacy is through a noninferiority (NI) study where a test treatment is compared to an active control treatment. The minimal objective of such a study is to determine whether the test treatment is superior to placebo. An assumption is made that if the active control treatment remains efficacious, as was observed when it was compared against placebo, then a test treatment that has comparable efficacy with the active control, within a certain range, must also be superior to placebo. Because of this assumption, the design, implementation, and analysis of NI trials present challenges for sponsors and regulators. In designing and analyzing NI trials, substantial historical data are often required on the active control treatment and placebo. Bayesian approaches provide a natural framework for synthesizing the historical data in the form of prior distributions that can effectively be used in design and analysis of a NI clinical trial. Despite a flurry of recent research activities in the area of Bayesian approaches in medical product development, there are still substantial gaps in recognition and acceptance of Bayesian approaches in NI trial design and analysis. The Bayesian Scientific Working Group of the Drug Information Association provides a coordinated effort to target the education and implementation issues on Bayesian approaches for NI trials. In this article, we provide a review of both frequentist and Bayesian approaches in NI trials, and elaborate on the implementation for two common Bayesian methods including hierarchical prior method and meta-analytic-predictive approach. Simulations are conducted to investigate the properties of the Bayesian methods, and some real clinical trial examples are presented for illustration.
Collapse
Affiliation(s)
| | - Aijun Gao
- b InVentiv Health Clinical , Princeton , New Jersey , USA
| | - Mani Lakshminarayanan
- c Biotechnology Clinical Development Statistics, Pfizer Inc. , Collegeville , Pennsylvania , USA
| | - Guanghan Liu
- d Merck Sharp & Dohme Corp. , North Wales , Pennsylvania , USA
| | | | - Radha Railkar
- c Biotechnology Clinical Development Statistics, Pfizer Inc. , Collegeville , Pennsylvania , USA
| | | | | |
Collapse
|
36
|
Anderson BJ, Hannam JA. Considerations when using pharmacokinetic/pharmacodynamic modeling to determine the effectiveness of simple analgesics in children. Expert Opin Drug Metab Toxicol 2015; 11:1393-408. [PMID: 26155821 DOI: 10.1517/17425255.2015.1061505] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Assessment of analgesic drugs includes comparative studies to other analgesics and local anesthesia blockade, number needed to treat estimates and opioid sparing descriptions. An additional methodology is to define the concentration-response relationship using pharmacokinetic/pharmacodynamic (PK/PD) modeling. AREAS COVERED A concentration-response relationship allows analgesic effect comparison between drugs for different acute pain types. Covariates such as size, age and organ function impact greatly on PK in children. The cumulative effect of confounding factors (e.g., pharmacogenetics, placebo and changes in baseline pain over time) complicates PD. Other factors (outcome measures, method of measurement, failure to account for study attrition) impact on outcome. Population PK/PD modeling approaches allow us to account for these various factors to some extent. EXPERT OPINION Nonlinear mixed effects models help interpret analgesic data and their use is increasing. The PK is relatively well understood. The next investigative step will involve investigation into covariate effects for PD. Mathematical functions for both placebo models and dropout models are well described and should be incorporated into analgesic effectiveness studies that investigate a range of doses. Improvements in pain assessment tools and a greater understanding of pharmacogenomics factors will help individualize analgesic therapy.
Collapse
Affiliation(s)
- Brian J Anderson
- a University of Auckland School of Medicine, Department of Anaesthesiology , Auckland, New Zealand +64 9 3074903 ; +64 9 3098989 ;
| | | |
Collapse
|
37
|
Funk MJ, Landi SN. Misclassification in administrative claims data: quantifying the impact on treatment effect estimates. CURR EPIDEMIOL REP 2015. [PMID: 26085977 DOI: 10.1007/s40471‐014‐0027‐z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Misclassification is present in nearly every epidemiologic study, yet is rarely quantified in analysis in favor of a focus on random error. In this review, we discuss past and present wisdom on misclassification and what measures should be taken to quantify this influential bias, with a focus on bias in pharmacoepidemiologic studies. To date, pharmacoepidemiology primarily utilizes data obtained from administrative claims, a rich source of prescription data but susceptible to bias from unobservable factors including medication sample use, medications filled but not taken, health conditions that are not reported in the administrative billing data, and inadequate capture of confounders. Due to the increasing focus on comparative effectiveness research, we provide a discussion of misclassification in the context of an active comparator, including a demonstration of treatment effects biased away from the null in the presence of nondifferential misclassification. Finally, we highlight recently developed methods to quantify bias and offer these methods as potential options for strengthening the validity and quantifying uncertainty of results obtained from pharmacoepidemiologic research.
Collapse
Affiliation(s)
- Michele Jonsson Funk
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC
| | - Suzanne N Landi
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC
| |
Collapse
|
38
|
Almeida Montes LG, Prado Alcántara H, Portillo Cedeño BA, Hernández García AO, Fuentes Rojas PE. Persistent decrease in alpha current density in fully remitted subjects with major depressive disorder treated with fluoxetine: A prospective electric tomography study. Int J Psychophysiol 2015; 96:191-200. [PMID: 25835548 DOI: 10.1016/j.ijpsycho.2015.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/05/2015] [Accepted: 03/24/2015] [Indexed: 12/28/2022]
Abstract
Major depressive disorder (MDD) is recurrent, and its pathophysiology is not fully understood. Studies using electric tomography (ET) have identified abnormalities in the current density (CD) of MDD subjects in regions associated with the neurobiology of MDD, such as the anterior cingulate cortex (ACC) and medial orbitofrontal cortex (mOFC). However, little is known regarding the long-term CD changes in MDD subjects who respond to antidepressants. The aim of this study was to compare CD between healthy and MDD subjects who received 1-year open-label treatment with fluoxetine. Thirty-two-channel electroencephalograms (EEGs) were collected from 70 healthy controls and 74 MDD subjects at baseline (pre-treatment), 1 and 2weeks and 1, 2, 6, 9 and 12months. Variable-resolution ET (VARETA) was used to assess the CD between subject groups at each time point. The MDD group exhibited decreased alpha CD (αCD) in the occipital and parietal cortices, ACC, mOFC, thalamus and caudate nucleus at each time point. The αCD abnormalities persisted in the MDD subjects despite their achieving full remission. The low sub-alpha band was different between the healthy and MDD subjects. Differences in the amount of αCD between sexes and treatment outcomes were observed. Lack of a placebo arm and the loss of depressed patients to follow-up were significant limitations. The persistence of the decrease in αCD might suggest that the underlying pathophysiologic mechanisms of MDD are not corrected despite the asymptomatic state of MDD subjects, which could be significant in understanding the highly recurrent nature of MDD.
Collapse
Affiliation(s)
- Luis Guillermo Almeida Montes
- Centro Estatal de Salud Mental, Servicios de Salud del Estado de Querétaro (SESEQ), Avenida 5 de Febrero 105, Los Virreyes, C.P. 76170 Querétaro, México.
| | - Hugo Prado Alcántara
- Centro Estatal de Salud Mental, Servicios de Salud del Estado de Querétaro (SESEQ), Avenida 5 de Febrero 105, Los Virreyes, C.P. 76170 Querétaro, México
| | - Bertha Alicia Portillo Cedeño
- Centro Estatal de Salud Mental, Servicios de Salud del Estado de Querétaro (SESEQ), Avenida 5 de Febrero 105, Los Virreyes, C.P. 76170 Querétaro, México
| | - Ana Olivia Hernández García
- Centro Estatal de Salud Mental, Servicios de Salud del Estado de Querétaro (SESEQ), Avenida 5 de Febrero 105, Los Virreyes, C.P. 76170 Querétaro, México
| | - Patricia Elisa Fuentes Rojas
- Centro Estatal de Salud Mental, Servicios de Salud del Estado de Querétaro (SESEQ), Avenida 5 de Febrero 105, Los Virreyes, C.P. 76170 Querétaro, México
| |
Collapse
|
39
|
Sumner CR, Haynes VS, Teicher MH, Newcorn JH. Does Placebo Response Differ between Objective and Subjective Measures in Children with Attention-Deficit/Hyperactivity Disorder? Postgrad Med 2015; 122:52-61. [DOI: 10.3810/pgm.2010.09.2201] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Calvin R. Sumner
- BioBehavioral Diagnostics Company, Westford, MA, and Plymouth Meeting, PA
| | | | - Martin H. Teicher
- Department of Psychiatry, Harvard Medical School, Boston, MA
- Developmental Biopsychiatry Research Program/Laboratory of Developmental Psychopharmacology, McLean Hospital, Belmont, MA
| | | |
Collapse
|
40
|
Goldenberg MJ. Placebo orthodoxy and the double standard of care in multinational clinical research. THEORETICAL MEDICINE AND BIOETHICS 2015; 36:7-23. [PMID: 25663050 DOI: 10.1007/s11017-015-9317-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
It has been almost 20 years since the field of bioethics was galvanized by a controversial series of multinational AZT trials employing placebo controls on pregnant HIV-positive women in the developing world even though a standard of care existed in the sponsor countries. The trove of ethical investigations that followed was thoughtful and challenging, yet an important and problematic methodological assumption was left unexplored. In this article, I revisit the famous "double standard of care" case study in order to offer novel consideration of the placebo orthodoxy that underlies much of the ethical debate. This majority view found in medical research is that placebo-controlled trials are methodologically superior to comparative trials that use active controls. I challenge this orthodoxy and argue that lives were unnecessarily lost in these trials as a result. Furthermore, current HIV research on vaccines and microbicides is now poised to repeat the error of subscribing to the placebo orthodoxy.
Collapse
Affiliation(s)
- Maya J Goldenberg
- Department of Philosophy, University of Guelph, Guelph, ON, N1G 2W1, Canada,
| |
Collapse
|
41
|
Castaño-Vinyals G, Aragonés N, Pérez-Gómez B, Martín V, Llorca J, Moreno V, Altzibar JM, Ardanaz E, de Sanjosé S, Jiménez-Moleón JJ, Tardón A, Alguacil J, Peiró R, Marcos-Gragera R, Navarro C, Pollán M, Kogevinas M. Population-based multicase-control study in common tumors in Spain (MCC-Spain): rationale and study design. GACETA SANITARIA 2015; 29:308-15. [PMID: 25613680 DOI: 10.1016/j.gaceta.2014.12.003] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/11/2014] [Accepted: 12/12/2014] [Indexed: 12/28/2022]
Abstract
INTRODUCTION We present the protocol of a large population-based case-control study of 5 common tumors in Spain (MCC-Spain) that evaluates environmental exposures and genetic factors. METHODS Between 2008-2013, 10,106 subjects aged 20-85 were enrolled in 23 hospitals and primary care centres in 12 Spanish provinces including 1,112 cases with a new diagnosis of prostate cancer, 1,738 of breast cancer, 2,140 of colorectal cancer, 459 of gastro-oesophageal cancer, 559 cases with chronic lymphocytic leukaemia and 4,098 population controls frequency matched to cases by age, sex and region of residence. Participation rates ranged from 57% (stomach cancer) to 87% (CLL cases) and from 30% to 77% in controls. Participants completed a face-to-face computerized interview on sociodemographic factors, environmental exposures, occupation, medication, lifestyle, and personal and family medical history. In addition, participants completed a self-administered food-frequency questionnaire and telephone interviews. Blood samples were collected from 76% of participants while saliva samples were collected in CLL cases and participants refusing blood extractions. Clinical information was recorded for cases and paraffin blocks and/or fresh tumor samples are available in most collaborating hospitals. Genotyping was done through an exome array enriched with genetic markers in specific pathways. Multiple analyses are planned to assess the association of environmental, personal and genetic risk factors for each tumor and to identify pleiotropic effects. DISCUSSION This study, conducted within the Spanish Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), is a unique initiative to evaluate etiological factors for common cancers and will promote cancer research and prevention in Spain.
Collapse
Affiliation(s)
- Gemma Castaño-Vinyals
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - Nuria Aragonés
- Environmental and Cancer Epidemiology Unit, National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; IIS Puerta de Hierro, Majadahonda, Spain
| | - Beatriz Pérez-Gómez
- Environmental and Cancer Epidemiology Unit, National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; IIS Puerta de Hierro, Majadahonda, Spain
| | - Vicente Martín
- Universidad de León, León, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Javier Llorca
- Universidad de Cantabria, Santander, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Victor Moreno
- IDIBELL-Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Jone M Altzibar
- Subdirección de Salud Pública de Gipuzkoa, Donostia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Eva Ardanaz
- Instituto de Salud Pública de Navarra, Pamplona, Navarra; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Sílvia de Sanjosé
- IDIBELL-Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - José Juan Jiménez-Moleón
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Adonina Tardón
- Instituto Universitario de Oncología, Universidad de Oviedo, Oviedo, Asturias, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Juan Alguacil
- Centro de Investigación en Salud y Medio Ambiente (CYSMA), Universidad de Huelva, Huelva, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Rosana Peiró
- Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana FISABIO-Salud Pública, Valencia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Rafael Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona Biomedical Research Institute (IdiBGi), Girona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carmen Navarro
- Department of Epidemiology, Murcia Regional Health Authority, Murcia, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - Marina Pollán
- Environmental and Cancer Epidemiology Unit, National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; IIS Puerta de Hierro, Majadahonda, Spain
| | - Manolis Kogevinas
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; School of Public Health, Athens, Greece
| | | |
Collapse
|
42
|
Keränen T, Halkoaho A, Itkonen E, Pietilä AM. Placebo-controlled clinical trials: how trial documents justify the use of randomisation and placebo. BMC Med Ethics 2015; 16:2. [PMID: 25578433 PMCID: PMC4298117 DOI: 10.1186/1472-6939-16-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 01/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Randomised clinical trials (RCTs) involve procedures such as randomisation, blinding, and placebo use, which are not part of standard medical care. Patients asked to participate in RCTs often experience difficulties in understanding the meaning of these and their justification. METHODS We reviewed RCT protocols, statements of the principal investigator (PI), and participant-information materials, as submitted for opinion to a research ethics committee. We evaluated how the justification for the use of placebo was described in these documents and how the participants had been informed about randomisation, placebo use, and the possible risks of receiving placebo. RESULTS In total, 52 RCTs were identified. Eighteen of the study protocols (35%) provided some rationale for the use of placebo. In 15 (29%) of the statements, the PI had provided justification for its use. Possible risks related to placebo use were described in nine (17%) of the statements. An explanation as to why placebo was necessary featured in only 12 (23%) of the sets of participant-information materials, and only six (12%) of the documents discussed the possible risks associated with placebo. CONCLUSIONS The justification of placebo control was inadequately described in the RCT study protocols, by principal or national co-ordinating investigators, and in participant-information documents. Furthermore, possible health-related risks associated with the use of placebo were poorly explained in the participant-information documents. Ethics committes and study participants need to be better informed of the rationale for the use of placebo, along with the associated risks.
Collapse
Affiliation(s)
- Tapani Keränen
- />Science Service Center, Kuopio University Hospital, P.O. Box 100, Kuopio, 70029 KYS Finland
- />Department of Pharmacy, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
- />National Institute for Health and Welfare, Mannerheimintie 170, P.O. Box 30, 00271 Helsinki, Finland
| | - Arja Halkoaho
- />Science Service Center, Kuopio University Hospital, P.O. Box 100, Kuopio, 70029 KYS Finland
| | - Emmi Itkonen
- />Science Service Center, Kuopio University Hospital, P.O. Box 100, Kuopio, 70029 KYS Finland
| | - Anna-Maija Pietilä
- />Science Service Center, Kuopio University Hospital, P.O. Box 100, Kuopio, 70029 KYS Finland
- />Department of Nursing, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland
| |
Collapse
|
43
|
Ethics in clinical trials. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00027-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
44
|
Funk MJ, Landi SN. Misclassification in administrative claims data: quantifying the impact on treatment effect estimates. CURR EPIDEMIOL REP 2014; 1:175-185. [PMID: 26085977 PMCID: PMC4465810 DOI: 10.1007/s40471-014-0027-z] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Misclassification is present in nearly every epidemiologic study, yet is rarely quantified in analysis in favor of a focus on random error. In this review, we discuss past and present wisdom on misclassification and what measures should be taken to quantify this influential bias, with a focus on bias in pharmacoepidemiologic studies. To date, pharmacoepidemiology primarily utilizes data obtained from administrative claims, a rich source of prescription data but susceptible to bias from unobservable factors including medication sample use, medications filled but not taken, health conditions that are not reported in the administrative billing data, and inadequate capture of confounders. Due to the increasing focus on comparative effectiveness research, we provide a discussion of misclassification in the context of an active comparator, including a demonstration of treatment effects biased away from the null in the presence of nondifferential misclassification. Finally, we highlight recently developed methods to quantify bias and offer these methods as potential options for strengthening the validity and quantifying uncertainty of results obtained from pharmacoepidemiologic research.
Collapse
Affiliation(s)
- Michele Jonsson Funk
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC
| | - Suzanne N Landi
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill NC
| |
Collapse
|
45
|
Wong J. The History of Technology Assessment and Comparative Effectiveness Research for Drugs and Medical Devices and the Role of the Federal Government. Biotechnol Law Rep 2014; 33:221-248. [PMID: 25538377 DOI: 10.1089/blr.2014.9967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
46
|
An open labeled randomized controlled trial of pregabalin versus amitriptyline in chronic low backache. J Neurol Sci 2014; 342:127-32. [PMID: 24857356 DOI: 10.1016/j.jns.2014.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 04/11/2014] [Accepted: 05/04/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND There is no head on comparison of amitriptyline (AMT) and pregabalin (PG) in relieving pain and disability in chronic low backache (CLBA). This randomized controlled trial reports the efficacy and safety of AMT and PG in CLBA. METHODS Patients with CLBA, 15-65 years of age without specific cause and significant neurological deficit were included. Severity of pain was assessed by Visual Analogue Scale (VAS) and disability by Oswestry Disability Index (ODI). Patients were followed up at 6 and 14 weeks and their VAS score, ODI and side effect were noted. Primary outcome was pain relief (>50% improvement in VAS score) at 14 weeks and secondary outcome were reduction in ODI (>20%) and side effects. RESULTS 200 patients with CLBA were randomized to AMT (n=103) and PG (n=97) using random numbers. The VAS score and ODI improved significantly following AMT and PG at 6 and 14 weeks compared to baseline. The improvement in pain (57.3% Vs 39.2%; P=0.01) and disability (65% Vs 49.5%; P=0.03) however was more in AMT group. The composite side effects were similar in both groups. CONCLUSION AMT and PG are effective in CLBA but AMT reduced pain and disability significantly compared to PG.
Collapse
|
47
|
Zhang Z, Nie L, Soon G, Zhang B. Sensitivity analysis in non-inferiority trials with residual inconstancy after covariate adjustment. J R Stat Soc Ser C Appl Stat 2014. [DOI: 10.1111/rssc.12050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | - Lei Nie
- Food and Drug Administration; Silver Spring USA
| | | | - Bo Zhang
- Oregon State University; Corvallis USA
| |
Collapse
|
48
|
Finamor DC, Sinigaglia-Coimbra R, Neves LCM, Gutierrez M, Silva JJ, Torres LD, Surano F, Neto DJ, Novo NF, Juliano Y, Lopes AC, Coimbra CG. A pilot study assessing the effect of prolonged administration of high daily doses of vitamin D on the clinical course of vitiligo and psoriasis. DERMATO-ENDOCRINOLOGY 2014; 5:222-34. [PMID: 24494059 PMCID: PMC3897595 DOI: 10.4161/derm.24808] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 04/10/2013] [Accepted: 04/25/2013] [Indexed: 12/14/2022]
Abstract
Autoimmunity has been associated with vitamin D deficiency and resistance, with gene polymorphisms related to vitamin D metabolism frequently described in affected patients. High doses of vitamin D3 may conceivably compensate for inherited resistance to its biological effects. This study aimed to assess the efficacy and safety of prolonged high-dose vitamin D3 treatment of patients with psoriasis and vitiligo. Nine patients with psoriasis and 16 patients with vitiligo received vitamin D3 35,000 IU once daily for six months in association with a low-calcium diet (avoiding dairy products and calcium-enriched foods like oat, rice or soya “milk”) and hydration (minimum 2.5 L daily). All psoriasis patients were scored according to “Psoriasis Area and Severity Index” (PASI) at baseline and after treatment. Evaluation of clinical response of vitiligo patients required a quartile grading scale. All patients presented low vitamin D status (serum 25(OH)D3 ≤ 30 ng/mL) at baseline. After treatment 25(OH)D3 levels significantly increased (from 14.9 ± 7.4 to 106.3 ± 31.9 ng/mL and from 18.4 ± 8.9 to 132.5 ± 37.0 ng/mL) and PTH levels significantly decreased (from 57.8 ± 16.7 to 28.9 ± 8.2 pg/mL and from 55.3 ± 25.0 to 25.4 ± 10.7 pg/mL) in patients with psoriasis and vitiligo respectively. PTH and 25(OH)D3 serum concentrations correlated inversely. The PASI score significantly improved in all nine patients with psoriasis. Fourteen of 16 patients with vitiligo had 25–75% repigmentation. Serum urea, creatinine and calcium (total and ionized) did not change and urinary calcium excretion increased within the normal range. High-dose vitamin D3 therapy may be effective and safe for vitiligo and psoriasis patients.
Collapse
Affiliation(s)
- Danilo C Finamor
- Laboratório de Fisiopatologia Clínica e Experimental; Universidade Federal de São Paulo; São Paulo, Brazil
| | - Rita Sinigaglia-Coimbra
- Laboratório de Fisiopatologia Clínica e Experimental; Universidade Federal de São Paulo; São Paulo, Brazil
| | - Luiz C M Neves
- Instituto de Ciências da Saúde; Universidade Paulista; São Paulo, Brazil
| | | | - Jeferson J Silva
- Laboratório de Fisiopatologia Clínica e Experimental; Universidade Federal de São Paulo; São Paulo, Brazil
| | - Lucas D Torres
- Laboratório de Fisiopatologia Clínica e Experimental; Universidade Federal de São Paulo; São Paulo, Brazil
| | - Fernanda Surano
- Laboratório de Fisiopatologia Clínica e Experimental; Universidade Federal de São Paulo; São Paulo, Brazil
| | | | - Neil F Novo
- Disciplina de Cirurgia Plástica; Universidade Federal de São Paulo; São Paulo, Brazil
| | - Yara Juliano
- Disciplina de Cirurgia Plástica; Universidade Federal de São Paulo; São Paulo, Brazil
| | - Antonio C Lopes
- Disciplina de Clínica Médica; Universidade Federal de São Paulo; São Paulo, Brazil
| | - Cicero Galli Coimbra
- Laboratório de Fisiopatologia Clínica e Experimental; Universidade Federal de São Paulo; São Paulo, Brazil
| |
Collapse
|
49
|
|
50
|
Li Y, He Y, Sheng Y, Wang K, Wang J, Huang J, Yang J, Zheng Q. Systematic evaluation of non-inferiority and equivalence randomized trials of anti-infective drugs. Expert Rev Anti Infect Ther 2013; 11:1377-89. [PMID: 24180484 DOI: 10.1586/14787210.2013.851600] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The non-inferiority (NI) and equivalence (EQ) design is used widely in the clinical trials of anti-infective drugs, but still many arguments for, and against, conducting active control NI/EQ trials rather than simple placebo controlled trials. We searched Pubmed database and conducted a systematic literature review (1992-2011) to assess the methodological aspects of NI and EQ randomized trials of anti-infective drugs. A total of 335 publications with 337 trials were included. Of them, 235 trials reported a pre-specified margin of 10-15%. A proportion (e.g., cure, successful, failure) was used as the primary outcome in 316 trials (93.8%). Test treatments were non-inferior or equivalent to the control treatment in 325 trials (93.4%). The historical evidence for the effect of the control drug was specified in 38 trials (11.3%). For the literature of NI/EQ trials in anti-infective treatment, aspects that need improvement include the description of study participation, trial implementation, historical evidence and endpoint for the efficacy of control, inclusion of flow diagrams and figures that present margins and confidence intervals according to CONSORT criteria.
Collapse
Affiliation(s)
- Yunfei Li
- Center for Drug Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | | | | | | | | | | | | | | |
Collapse
|