1
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Chakraborty D. Commentary on 'Attitude and perception toward clinical trials in India among patients and patient bystanders visiting Indian ophthalmology clinical trial network: A multicentric, cross-sectional survey'. Indian J Ophthalmol 2023; 71:3342-3343. [PMID: 37787232 PMCID: PMC10683698 DOI: 10.4103/ijo.ijo_1743_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023] Open
Affiliation(s)
- Debdulal Chakraborty
- Department of Vitreo-Retinal Services, Disha Eye Hospitals, Kolkata, West Bengal, India
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2
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Perception of clinical research among patients and healthy volunteers of clinical trials. Eur J Clin Pharmacol 2022; 78:1647-1655. [PMID: 35896802 PMCID: PMC9482583 DOI: 10.1007/s00228-022-03366-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/18/2022] [Indexed: 11/03/2022]
Abstract
Purpose Clinical research relies on data from patients and volunteers, yet the target sample size is often not achieved. Here, we assessed the perception of clinical research among clinical trial participants to improve the recruitment process for future studies. Methods We conducted a single-center descriptive and exploratory study of 300 current or former participants in various phase I–III clinical trials. Questionnaires were either distributed to current clinical trial participants or emailed to former subjects. Results Subjects strongly agreed or agreed that contributing to improving medical care (> 81%), contributing to scientific research (> 79%), and trusting their treating physicians (> 77%) were motives for study participation. Among healthy volunteers, financial motives positively correlated with the number of clinical trials they had participated in (p < 0.05). Higher age positively correlated with expectation of best available treatment during study participation among patients (p < 0.05). Less than 8% of all subjects expressed “great concern” about the potential risks of sharing their personal information as part of the study. Subjects displayed “great trust” or “trust” in medical staff (86.6%) and in government research institutions (76.4%), and “very little trust” or “little trust” in pharmaceutical companies (35.4%) and health insurance companies (16.9%). Conclusion Altruistic motives and trust in treating physicians were predominant motives for clinical trial participation. Older patients expected to receive the best available treatment during participation. Healthy volunteers who reported financial motives had participated in more clinical trials. Consistent with great trust in medical staff and government research institutions, little concern was expressed about the misuse of personal data during the trial. Supplementary Information The online version contains supplementary material available at 10.1007/s00228-022-03366-3.
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3
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Li X, Cong Y. A Systematic Literature Review of Ethical Challenges Related to Medical and Public Health Data Sharing in China. J Empir Res Hum Res Ethics 2021; 16:537-554. [PMID: 34516325 DOI: 10.1177/15562646211040299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although stakeholders in China have begun promoting medical and public health data sharing, a large portion of data cannot flow freely across research teams and borders and be converted into "big data." To identify the ethical challenges that are considered to hinder medical and public health data sharing, we performed a systematic literature review pertaining to medical and health data sharing in China. A total of 2959 unique records were retrieved through the database search, 61 of which were included in the final synthesis after full-text screening. This review provides an overview of the current ethical challenges and barriers involved in data sharing for healthcare purposes in China. Through the systematic review of evidence from peer-reviewed literature and dissertations, we identified barriers and ethical challenges grouped in a taxonomy of capacity building needs, balancing different stakeholders' interests, scientific and social value, and the data subjects' rights, public trust and engagement. Best practices and educational implications were suggested based on our findings.
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Affiliation(s)
- Xiaojie Li
- Department of Medical Ethics and Law, 33133Peking University Health Science Center, Beijing, China.,National Institute of Health Data Science at Peking University, Beijing, China
| | - Yali Cong
- Department of Medical Ethics and Law, 33133Peking University Health Science Center, Beijing, China.,National Institute of Health Data Science at Peking University, Beijing, China
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4
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Lee S, Kuenzig ME, Ricciuto A, Zhang Z, Shim HH, Panaccione R, Kaplan GG, Seow CH. Smoking May Reduce the Effectiveness of Anti-TNF Therapies to Induce Clinical Response and Remission in Crohn's Disease: A Systematic Review and Meta-analysis. J Crohns Colitis 2021; 15:74-87. [PMID: 32621742 DOI: 10.1093/ecco-jcc/jjaa139] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Cigarette smoking worsens prognosis of Crohn's disease [CD]. We conducted a systematic review and meta-analysis to examine the association between smoking and induction of clinical response or remission with anti-tumour necrosis factor [TNF] therapy. METHODS MEDLINE, EMBASE, PubMed, and Cochrane CENTRAL [June 2019] were searched for studies reporting the effect of smoking on short-term clinical response and remission to anti-TNF therapy [≤16 weeks following the first treatment] in patients with CD. Risk ratios [RR] with 95% confidence intervals [CI] were calculated using random-effects models. RESULTS Eighteen observational studies and three randomised controlled trials [RCT] were included. Current smokers and non-smokers [never or former] had similar rates of clinical response [observational studies RR: 0.96; 95% CI: 0.88, 1.05; RCTs RR: 1.09; 95% CI: 0.84, 1.41]. When restricted to studies clearly defining the smoking exposure, smokers treated with anti-TNF were less likely to achieve clinical response than non-smokers [smokers defined as having ≥5 cigarettes/day for ≥6 months RR: 0.63; 95% CI: 0.48, 0.83; lifetime never smokers vs ever smokers excluding former smokers RR: 0.81; 95% CI: 0.71, 0.93]. Current smokers were also less likely to achieve clinical remission in observational studies [RR: 0.75; 95% CI: 0.57, 0.98], though this association was not seen in RCTs [RR: 1.04; 95% CI: 0.89, 1.21]. CONCLUSIONS Smoking is significantly associated with a reduction in the ability of infliximab or adalimumab to induce short-term clinical response and remission when pooling studies where smoking status was clearly defined. When patients with CD are treated with highly effective therapy, including anti-TNF agents, concurrent smoking cessation may improve clinical outcomes.
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Affiliation(s)
- Sangmin Lee
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - M Ellen Kuenzig
- CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario [CHEO] Research Institute, Ottawa, ON, Canada.,Institute for Clinical Evaluative Sciences [ICES], Toronto, ON, Canada
| | - Amanda Ricciuto
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Ziyu Zhang
- Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Hang Hock Shim
- Department of Gastroenterology Hepatology, Singapore General Hospital, Bukit Merah, Singapore
| | - Remo Panaccione
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - Gilaad G Kaplan
- Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
| | - Cynthia H Seow
- Community Health Sciences, University of Calgary, Calgary, AB, Canada.,Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Inflammatory Bowel Disease Unit, University of Calgary, Calgary, AB, Canada
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5
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Zheng H, Hampson LV, Wandel S. A robust Bayesian meta-analytic approach to incorporate animal data into phase I oncology trials. Stat Methods Med Res 2020; 29:94-110. [PMID: 30648481 DOI: 10.1177/0962280218820040] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Before a first-in-man trial is conducted, preclinical studies are performed in animals to help characterise the safety profile of the new medicine. We propose a robust Bayesian hierarchical model to synthesise animal and human toxicity data, using scaling factors to translate doses administered to different animal species onto an equivalent human scale. After scaling doses, the parameters of dose-toxicity models intrinsic to different animal species can be interpreted on a common scale. A prior distribution is specified for each translation factor to capture uncertainty about differences between toxicity of the drug in animals and humans. Information from animals can then be leveraged to learn about the relationship between dose and risk of toxicity in a new phase I trial in humans. The model allows human dose-toxicity parameters to be exchangeable with the study-specific parameters of animal species studied so far or non-exchangeable with any of them. This leads to robust inferences, enabling the model to give greatest weight to the animal data with parameters most consistent with human parameters or discount all animal data in the case of non-exchangeability. The proposed model is illustrated using a case study and simulations. Numerical results suggest that our proposal improves the precision of estimates of the toxicity rates when animal and human data are consistent, while it discounts animal data in cases of inconsistency.
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Affiliation(s)
- Haiyan Zheng
- Department of Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Lisa V Hampson
- Statistical Methodology and Consulting, Novartis Pharma AG, Basel, Switzerland
| | - Simon Wandel
- Statistical Methodology and Consulting, Novartis Pharma AG, Basel, Switzerland
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6
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Nomura S, Shinozaki T, Hamada C. Performance of randomization-based causal methods with and without integrating external data sources for adjusting overall survival in case of extensive treatment switches in placebo-controlled randomized oncology phase 3 trials. J Biopharm Stat 2019; 30:377-401. [PMID: 31820674 DOI: 10.1080/10543406.2019.1695625] [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: 10/25/2022]
Abstract
In recent placebo-controlled randomized phase 3 oncology trials, evaluation of overall survival with frequent crossover is crucial for regulatory and pricing decisions. The problem is that an intention-to-treat based analysis causes a substantial loss of power to detect causal survival effect without crossover, and performance of existing methods is not satisfactory. In this article, our aims were to evaluate properties of the existing and a proposed Bayesian power prior method where data from an external trial is available. Simulation results suggested that proposed method was the most powerful under typical scenarios where patients with better prognosis are likely to crossover.
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Affiliation(s)
- Shogo Nomura
- Center for Research and Administration and Support, National Cancer Center, Chiba, Japan
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Graduate School of Engineering, Tokyo University of Science, Tokyo, Japan
| | - Chikuma Hamada
- Department of Information and Computer Technology, Graduate School of Engineering, Tokyo University of Science, Tokyo, Japan
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7
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Nicholls SG, Carroll K, Brehaut J, Weijer C, Hey SP, Goldstein CE, Zwarenstein M, Graham ID, McKenzie JE, McIntyre L, Jairath V, Campbell MK, Grimshaw JM, Fergusson DA, Taljaard M. Stakeholder views regarding ethical issues in the design and conduct of pragmatic trials: study protocol. BMC Med Ethics 2018; 19:90. [PMID: 30458809 PMCID: PMC6247737 DOI: 10.1186/s12910-018-0332-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/08/2018] [Indexed: 12/31/2022] Open
Abstract
Background Randomized controlled trial (RCT) trial designs exist on an explanatory-pragmatic spectrum, depending on the degree to which a study aims to address a question of efficacy or effectiveness. As conceptualized by Schwartz and Lellouch in 1967, an explanatory approach to trial design emphasizes hypothesis testing about the mechanisms of action of treatments under ideal conditions (efficacy), whereas a pragmatic approach emphasizes testing effectiveness of two or more available treatments in real-world conditions. Interest in, and the number of, pragmatic trials has grown substantially in recent years, with increased recognition by funders and stakeholders worldwide of the need for credible evidence to inform clinical decision-making. This increase has been accompanied by the onset of learning healthcare systems, as well as an increasing focus on patient-oriented research. However, pragmatic trials have ethical challenges that have not yet been identified or adequately characterized. The present study aims to explore the views of key stakeholders with respect to ethical issues raised by the design and conduct of pragmatic trials. It is embedded within a large, four-year project that seeks to develop guidance for the ethical design and conduct of pragmatic trials. As a first step, this study will address important gaps in the current empirical literature with respect to identifying a comprehensive range of ethical issues arising from the design and conduct of pragmatic trials. By opening up a broad range of topics for consideration within our parallel ethical analysis, we will extend the current debate, which has largely emphasized issues of consent, to the range of ethical considerations that may flow from specific design choices. Methods Semi-structured interviews with key stakeholders (e.g. trialists, methodologists, lay members of study teams, bioethicists, and research ethics committee members), across multiple jurisdictions, identified based on their known experience and/or expertise with pragmatic trials. Discussion We expect that the study outputs will be of interest to a wide range of knowledge users including trialists, ethicists, research ethics committees, journal editors, regulators, healthcare policymakers, research funders and patient groups. All publications will adhere to the Tri-Agency Open Access Policy on Publications. Electronic supplementary material The online version of this article (10.1186/s12910-018-0332-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Civic Campus, 1053 Carling Avenue, Civic Box 693, Admin Services Building, ASB 2-013, Ottawa, ON, K1Y 4E9, Canada.
| | - Kelly Carroll
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Civic Campus, 1053 Carling Avenue, Civic Box 693, Admin Services Building, ASB 2-013, Ottawa, ON, K1Y 4E9, Canada
| | - Jamie Brehaut
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Civic Campus, 1053 Carling Avenue, Civic Box 693, Admin Services Building, ASB 2-013, Ottawa, ON, K1Y 4E9, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Charles Weijer
- Rotman Institute of Philosophy, Western University, London, ON, Canada
| | - Spencer Phillips Hey
- Center for Bioethics, Harvard Medical School, Boston, MA, USA.,Program on Regulation, Therapeutics and Law (PORTAL), Brigham and Women's Hospital, Boston, MA, USA
| | - Cory E Goldstein
- Rotman Institute of Philosophy, Western University, London, ON, Canada
| | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Ian D Graham
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Civic Campus, 1053 Carling Avenue, Civic Box 693, Admin Services Building, ASB 2-013, Ottawa, ON, K1Y 4E9, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lauralyn McIntyre
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Civic Campus, 1053 Carling Avenue, Civic Box 693, Admin Services Building, ASB 2-013, Ottawa, ON, K1Y 4E9, Canada
| | - Vipul Jairath
- Department of Medicine, Division of Gastroenterology, Western University, London, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | | | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Civic Campus, 1053 Carling Avenue, Civic Box 693, Admin Services Building, ASB 2-013, Ottawa, ON, K1Y 4E9, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Civic Campus, 1053 Carling Avenue, Civic Box 693, Admin Services Building, ASB 2-013, Ottawa, ON, K1Y 4E9, Canada.,Faculty of Medicine, University of Ottawa, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Civic Campus, 1053 Carling Avenue, Civic Box 693, Admin Services Building, ASB 2-013, Ottawa, ON, K1Y 4E9, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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8
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Taljaard M, Weijer C, Grimshaw JM, Ali A, Brehaut JC, Campbell MK, Carroll K, Edwards S, Eldridge S, Forrest CB, Giraudeau B, Goldstein CE, Graham ID, Hemming K, Hey SP, Horn AR, Jairath V, Klassen TP, London AJ, Marlin S, Marshall JC, McIntyre L, McKenzie JE, Nicholls SG, Alison Paprica P, Zwarenstein M, Fergusson DA. Developing a framework for the ethical design and conduct of pragmatic trials in healthcare: a mixed methods research protocol. Trials 2018; 19:525. [PMID: 30261933 PMCID: PMC6161426 DOI: 10.1186/s13063-018-2895-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 08/31/2018] [Indexed: 01/03/2023] Open
Abstract
Background There is a widely recognized need for more pragmatic trials that evaluate interventions in real-world settings to inform decision-making by patients, providers, and health system leaders. Increasing availability of electronic health records, centralized research ethics review, and novel trial designs, combined with support and resources from governments worldwide for patient-centered research, have created an unprecedented opportunity to advance the conduct of pragmatic trials, which can ultimately improve patient health and health system outcomes. Such trials raise ethical issues that have not yet been fully addressed, with existing literature concentrating on regulations in specific jurisdictions rather than arguments grounded in ethical principles. Proposed solutions (e.g. using different regulations in “learning healthcare systems”) are speculative with no guarantee of improvement over existing oversight procedures. Most importantly, the literature does not reflect a broad vision of protecting the core liberty and welfare interests of research participants. Novel ethical guidance is required. We have assembled a team of ethicists, trialists, methodologists, social scientists, knowledge users, and community members with the goal of developing guidance for the ethical design and conduct of pragmatic trials. Methods Our project will combine empirical and conceptual work and a consensus development process. Empirical work will: (1) identify a comprehensive list of ethical issues through interviews with a small group of key informants (e.g. trialists, ethicists, chairs of research ethics committees); (2) document current practices by reviewing a random sample of pragmatic trials and surveying authors; (3) elicit views of chairs of research ethics committees through surveys in Canada, UK, USA, France, and Australia; and (4) elicit views and experiences of community members and health system leaders through focus groups and surveys. Conceptual work will consist of an ethical analysis of identified issues and the development of new ethical solutions, outlining principles, policy options, and rationales. The consensus development process will involve an independent expert panel to develop a final guidance document. Discussion Planned output includes manuscripts, educational materials, and tailored guidance documents to inform and support researchers, research ethics committees, journal editors, regulators, and funders in the ethical design and conduct of pragmatic trials.
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Affiliation(s)
- Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada. .,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
| | - Charles Weijer
- Rotman Institute of Philosophy, Western University, 1151 Richmond Street, London, ON, N6A 5B7, Canada
| | - Jeremy M Grimshaw
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Adnan Ali
- Patient and Family Advisory Council, The Ottawa Hospital, Ottawa, ON, Canada
| | - Jamie C Brehaut
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Marion K Campbell
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Kelly Carroll
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Sarah Edwards
- Department of Science and Technology Studies, University College London, 22 Gordon Square, King's Cross, London, WC1H 0AW, UK
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| | - Christopher B Forrest
- Applied Clinical Research Center, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19146, USA
| | - Bruno Giraudeau
- Université de Tours, Université de Nantes, INSERM, SPHERE U1246, Tours, France.,INSERM CIC1415, CHRU de Tours, Tours, France
| | - Cory E Goldstein
- Rotman Institute of Philosophy, Western University, 1151 Richmond Street, London, ON, N6A 5B7, Canada
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Spencer Phillips Hey
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA.,Center for Bioethics, Harvard Medical School, Boston, MA, USA
| | - Austin R Horn
- Rotman Institute of Philosophy, Western University, 1151 Richmond Street, London, ON, N6A 5B7, Canada
| | - Vipul Jairath
- Division of Gastroenterology, Department of Medicine, Western University, London, ON, Canada.,Division of Epidemiology and Biostatistics, Western University, University Hospital, 339 Windermere Road, London, ON, N6A 5A5, Canada
| | - Terry P Klassen
- Children's Hospital Research Institute of Manitoba, 513-715 McDermot Avenue, Winnipeg, MB, R3E 3P, Canada
| | - Alex John London
- Department of Philosophy and Center for Ethics and Policy, Carnegie Mellon University, 150A Baker Hall, Pittsburgh, PA, 15213-3890, USA
| | - Susan Marlin
- Clinical Trials Ontario, 661 University Avenue, MaRS Centre, West Tower, Toronto, ON, M5G 1M1, Canada
| | - John C Marshall
- St. Michael's Hospital, Department of Surgery, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Lauralyn McIntyre
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, General Campus, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,Department of Medicine (Division of Critical Care), University of Ottawa, Ottawa, ON, Canada
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada
| | - P Alison Paprica
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Toronto, ON, M5T 3M6, Canada
| | - Merrick Zwarenstein
- Centre for Studies in Family Medicine, Department of Family Medicine Schulich School of Medicine & Dentistry Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Dean A Fergusson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute (OHRI), The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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9
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Abstract
Background Sharing of participant-level clinical trial data has potential benefits, but concerns about potential harms to research participants have led some pharmaceutical sponsors and investigators to urge caution. Little is known about clinical trial participants' perceptions of the risks of data sharing. Methods We conducted a structured survey of 771 current and recent participants from a diverse sample of clinical trials at three academic medical centers in the United States. Surveys were distributed by mail (350 completed surveys) and in clinic waiting rooms (421 completed surveys) (overall response rate, 79%). Results Less than 8% of respondents felt that the potential negative consequences of data sharing outweighed the benefits. A total of 93% were very or somewhat likely to allow their own data to be shared with university scientists, and 82% were very or somewhat likely to share with scientists in for-profit companies. Willingness to share data did not vary appreciably with the purpose for which the data would be used, with the exception that fewer participants were willing to share their data for use in litigation. The respondents' greatest concerns were that data sharing might make others less willing to enroll in clinical trials (37% very or somewhat concerned), that data would be used for marketing purposes (34%), or that data could be stolen (30%). Less concern was expressed about discrimination (22%) and exploitation of data for profit (20%). Conclusions In our study, few clinical trial participants had strong concerns about the risks of data sharing. Provided that adequate security safeguards were in place, most participants were willing to share their data for a wide range of uses. (Funded by the Greenwall Foundation.).
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Affiliation(s)
- Michelle M Mello
- From the Department of Health Research and Policy, Stanford University School of Medicine (M.M.M., V.L., S.N.G.) and Stanford Law School (M.M.M.) - both in Stanford, CA
| | - Van Lieou
- From the Department of Health Research and Policy, Stanford University School of Medicine (M.M.M., V.L., S.N.G.) and Stanford Law School (M.M.M.) - both in Stanford, CA
| | - Steven N Goodman
- From the Department of Health Research and Policy, Stanford University School of Medicine (M.M.M., V.L., S.N.G.) and Stanford Law School (M.M.M.) - both in Stanford, CA
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10
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Broes S, Lacombe D, Verlinden M, Huys I. Sharing human samples and patient data: Opening Pandora’s box. J Cancer Policy 2017. [DOI: 10.1016/j.jcpo.2017.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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11
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Abstract
Virtually all health care organizations have had at least one data breach since 2012. Most of the largest data breaches and Health Care Information Privacy and Accountability Act fines could have been prevented by the simplest of strategies. Each researcher must clearly understand his or her responsibilities and liability.
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Affiliation(s)
- Eric D Perakslis
- Takeda Pharmaceuticals International, R&D Informatics, Cambridge, MA 02139, USA. Harvard Medical School, Center for Biomedical Informatics and Countway Library of Medicine, Instructor in Pediatrics, Boston, MA 02115, USA.
| | - Martin Stanley
- Department of Homeland Security, Federal Network Resilience, U.S. Department of Homeland Security, Office of Cybersecurity and Communications, Arlington, VA 22203, USA
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12
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13
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Cheah PY, Tangseefa D, Somsaman A, Chunsuttiwat T, Nosten F, Day NPJ, Bull S, Parker M. Perceived Benefits, Harms, and Views About How to Share Data Responsibly: A Qualitative Study of Experiences With and Attitudes Toward Data Sharing Among Research Staff and Community Representatives in Thailand. J Empir Res Hum Res Ethics 2016; 10:278-89. [PMID: 26297749 PMCID: PMC4547202 DOI: 10.1177/1556264615592388] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The Thailand Major Overseas Programme coordinates large multi-center studies in tropical medicine and generates vast amounts of data. As the data sharing movement gains momentum, we wanted to understand attitudes and experiences of relevant stakeholders about what constitutes good data sharing practice. We conducted 15 interviews and three focus groups discussions involving 25 participants and found that they generally saw data sharing as something positive. Data sharing was viewed as a means to contribute to scientific progress and lead to better quality analysis, better use of resources, greater accountability, and more outputs. However, there were also important reservations including potential harms to research participants, their communities, and the researchers themselves. Given these concerns, several areas for discussion were identified: data standardization, appropriate consent models, and governance.
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Affiliation(s)
| | | | | | | | - François Nosten
- Mahidol University, Bangkok, Thailand University of Oxford, UK
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14
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“Big data” and “open data”: What kind of access should researchers enjoy? Therapie 2016; 71:97-105, 107-14. [DOI: 10.1016/j.therap.2016.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 12/21/2015] [Indexed: 11/22/2022]
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Chatellier G, Varlet V, Blachier-Poisson C, Beslay N, Behier JM, Braunstein D, Caralp M, Congard-Chassol B, Diaz I, Fournier L, Josseran A, Lechat P, Lefevre C, von Lennep F, Levesque K, Maugendre P, Marchand G, Mennecier D, Moore N, Ravoire S, Riou C. « Big data » et « open data » : quel accès pour la recherche ? Therapie 2016. [DOI: 10.1016/j.therap.2016.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Naci H, Cooper J, Mossialos E. Timely publication and sharing of trial data: opportunities and challenges for comparative effectiveness research in cardiovascular disease. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2015; 1:58-65. [PMID: 29474595 DOI: 10.1093/ehjqcco/qcv012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Indexed: 11/12/2022]
Abstract
There is growing enthusiasm for the timely publication and sharing of clinical trial data. The rationale for open access includes greater transparency, reproducibility, and efficiency of the research enterprise. In cardiovascular diseases, routinely sharing clinical trial data would create opportunities for undertaking comparative effectiveness research, providing much needed evidence on how different interventions compare to each other on key outcomes. Access to individual patient-level data would strengthen the validity of such research. Novel methodological approaches like network meta-analyses using individual patient-level data could reliably compare interventions that have not been compared with each other in head-to-head trials. However, there are significant practical, methodological, financial, and legal challenges to this utopian open access that need to be continually addressed. Sharing clinical trial data openly will only occur when the previously tolerated process of clinical research involving direct ownership and secrecy is abandoned for a new culture in which medical science is open to all of its stakeholders. With this new culture, data will be accessible, reanalysis will be considered commonplace, and comparative effectiveness research through novel synthesis approaches, such as network meta-analyses, can thrive-as long as measures are taken to adequately ensure the goal remains to promote public health.
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Affiliation(s)
- Huseyin Naci
- LSE Health, Department of Social Policy, London School of Economics and Political Science, London UK
| | - Jacob Cooper
- LSE Health, Department of Social Policy, London School of Economics and Political Science, London UK
| | - Elias Mossialos
- LSE Health, Department of Social Policy, London School of Economics and Political Science, London UK
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Parker M, Bull S. Sharing Public Health Research Data: Toward the Development of Ethical Data-Sharing Practice in Low- and Middle-Income Settings. J Empir Res Hum Res Ethics 2015; 10:217-24. [PMID: 26297744 PMCID: PMC4547199 DOI: 10.1177/1556264615593494] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
It is increasingly recognized that effective and appropriate data sharing requires the development of models of good data-sharing practice capable of taking seriously both the potential benefits to be gained and the importance of ensuring that the rights and interests of participants are respected and that risk of harms is minimized. Calls for the greater sharing of individual-level data from biomedical and public health research are receiving support among researchers and research funders. Despite its potential importance, data sharing presents important ethical, social, and institutional challenges in low-income settings. In this article, we report on qualitative research conducted in five low- and middle-income countries exploring the experiences of key research stakeholders and their views about what constitutes good data-sharing practice.
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Bull S, Roberts N, Parker M. Views of Ethical Best Practices in Sharing Individual-Level Data From Medical and Public Health Research: A Systematic Scoping Review. J Empir Res Hum Res Ethics 2015; 10:225-38. [PMID: 26297745 PMCID: PMC4548478 DOI: 10.1177/1556264615594767] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is increasing support for sharing individual-level data generated by medical and public health research. This scoping review of empirical research and conceptual literature examined stakeholders' perspectives of ethical best practices in data sharing, particularly in low- and middle-income settings. Sixty-nine empirical and conceptual articles were reviewed, of which, only five were empirical studies and eight were conceptual articles focusing on low- and middle-income settings. We conclude that support for sharing individual-level data is contingent on the development and implementation of international and local policies and processes to support ethical best practices. Further conceptual and empirical research is needed to ensure data sharing policies and processes in low- and middle-income settings are appropriately informed by stakeholders' perspectives.
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Bouder F, Way D, Löfstedt R, Evensen D. Transparency in Europe: A Quantitative Study. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2015; 35:1210-1229. [PMID: 25931009 DOI: 10.1111/risa.12386] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In recent years, European pharmaceutical regulators have increasingly committed to heightening access to raw safety-related data as part of a wave of transparency initiatives (e.g., providing public Internet-mediated access to clinical trials data). Yet, the regulators--who are under significant pressure--have not yet benefited from a systematic review of this new policy. In seeking to inject much needed evidence, this article explores the effects of new transparency policies designed to promote meaningful communication of risks and benefits to patients. Results of a cross-national European survey with respondents from Great Britain, the Netherlands, Spain, France, Germany, and Sweden (N = 5,648) shed light on how patients and the public are likely to react to the regulators' new transparency policies. The findings demonstrate clear national variations in how European citizens are likely to react and emphasize the need to develop evidence-based, reasoned transparency policies that integrate benefit-risk communication. The authors conclude by providing six specific recommendations, informed by the study, that seek to improve the European transparency model both within the medical field and across health, safety, and environmental policy domains.
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Affiliation(s)
- Frederic Bouder
- Department of Technology and Society Studies, Grote Gracht 76, 6211, SZ, Maastricht, The Netherlands
| | - Dominic Way
- King's College London, King's Centre for Risk Management, Strand London, WC2R 2LS
| | - Ragnar Löfstedt
- King's College London, King's Centre for Risk Management, Strand London, WC2R 2LS
| | - Darrick Evensen
- Oberlin College and Conservatory, A.J. Lewis Center for Environmental Studies, 122 Elm Street, Oberlin, OH, USA
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Green AK, Reeder-Hayes KE, Corty RW, Basch E, Milowsky MI, Dusetzina SB, Bennett AV, Wood WA. The project data sphere initiative: accelerating cancer research by sharing data. Oncologist 2015; 20:464-e20. [PMID: 25876994 DOI: 10.1634/theoncologist.2014-0431] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 03/20/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In this paper, we provide background and context regarding the potential for a new data-sharing platform, the Project Data Sphere (PDS) initiative, funded by financial and in-kind contributions from the CEO Roundtable on Cancer, to transform cancer research and improve patient outcomes. Given the relatively modest decline in cancer death rates over the past several years, a new research paradigm is needed to accelerate therapeutic approaches for oncologic diseases. Phase III clinical trials generate large volumes of potentially usable information, often on hundreds of patients, including patients treated with standard of care therapies (i.e., controls). Both nationally and internationally, a variety of stakeholders have pursued data-sharing efforts to make individual patient-level clinical trial data available to the scientific research community. POTENTIAL BENEFITS AND RISKS OF DATA SHARING For researchers, shared data have the potential to foster a more collaborative environment, to answer research questions in a shorter time frame than traditional randomized control trials, to reduce duplication of effort, and to improve efficiency. For industry participants, use of trial data to answer additional clinical questions could increase research and development efficiency and guide future projects through validation of surrogate end points, development of prognostic or predictive models, selection of patients for phase II trials, stratification in phase III studies, and identification of patient subgroups for development of novel therapies. Data transparency also helps promote a public image of collaboration and altruism among industry participants. For patient participants, data sharing maximizes their contribution to public health and increases access to information that may be used to develop better treatments. Concerns about data-sharing efforts include protection of patient privacy and confidentiality. To alleviate these concerns, data sets are deidentified to maintain anonymity. To address industry concerns about protection of intellectual property and competitiveness, we illustrate several models for data sharing with varying levels of access to the data and varying relationships between trial sponsors and data access sponsors. THE PROJECT DATA SPHERE INITIATIVE PDS is an independent initiative of the CEO Roundtable on Cancer Life Sciences Consortium, built to voluntarily share, integrate, and analyze comparator arms of historical cancer clinical trial data sets to advance future cancer research. The aim is to provide a neutral, broad-access platform for industry and academia to share raw, deidentified data from late-phase oncology clinical trials using comparator-arm data sets. These data are likely to be hypothesis generating or hypothesis confirming but, notably, do not take the place of performing a well-designed trial to address a specific hypothesis. Prospective providers of data to PDS complete and sign a data sharing agreement that includes a description of the data they propose to upload, and then they follow easy instructions on the website for uploading their deidentified data. The SAS Institute has also collaborated with the initiative to provide intrinsic analytic tools accessible within the website itself. As of October 2014, the PDS website has available data from 14 cancer clinical trials covering 9,000 subjects, with hopes to further expand the database to include more than 25,000 subject accruals within the next year. PDS differentiates itself from other data-sharing initiatives by its degree of openness, requiring submission of only a brief application with background information of the individual requesting access and agreement to terms of use. Data from several different sponsors may be pooled to develop a comprehensive cohort for analysis. In order to protect patient privacy, data providers in the U.S. are responsible for deidentifying data according to standards set forth by the Privacy Rule of the U.S. Health Insurance Portability and Accountability Act of 1996. USING DATA SHARING TO IMPROVE OUTCOMES IN CANCER THE "PROSTATE CANCER CHALLENGE": Control-arm data of several studies among patients with metastatic castration-resistant prostate cancer (mCRPC) are currently available through PDS. These data sets have multiple potential uses. The "Prostate Cancer Challenge" will ask the cancer research community to use clinical trial data deposited in the PDS website to address key research questions regarding mCRPC. General themes that could be explored by the cancer community are described in this article: prognostic models evaluating the influence of pretreatment factors on survival and patient-reported outcomes; comparative effectiveness research evaluating the efficacy of standard of care therapies, as illustrated in our companion article comparing mitoxantrone plus prednisone with prednisone alone; effects of practice variation in dose, frequency, and duration of therapy; level of patient adherence to elements of trial protocols to inform the design of future clinical trials; and age of subjects, regional differences in health care, and other confounding factors that might affect outcomes. POTENTIAL LIMITATIONS AND METHODOLOGICAL CHALLENGES The number of data sets available and the lack of experimental-arm data limit the potential scope of research using the current PDS. The number of trials is expected to grow exponentially over the next year and may include multiple cancer settings, such as breast, colorectal, lung, hematologic malignancy, and bone marrow transplantation. Other potential limitations include the retrospective nature of the data analyses performed using PDS and its generalizability, given that clinical trials are often conducted among younger, healthier, and less racially diverse patient populations. Methodological challenges exist when combining individual patient data from multiple clinical trials; however, advancements in statistical methods for secondary database analysis offer many tools for reanalyzing data arising from disparate trials, such as propensity score matching. Despite these concerns, few if any comparable data sets include this level of detail across multiple clinical trials and populations. CONCLUSION Access to large, late-phase, cancer-trial data sets has the potential to transform cancer research by optimizing research efficiency and accelerating progress toward meaningful improvements in cancer care. This type of platform provides opportunities for unique research projects that can examine relatively neglected areas and that can construct models necessitating large amounts of detailed data. The full potential of PDS will be realized only when multiple tumor types and larger numbers of data sets are available through the website.
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Affiliation(s)
- Angela K Green
- UNC Lineberger Comprehensive Cancer Center, School of Medicine, Division of Hematology and Oncology, Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, and Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Katherine E Reeder-Hayes
- UNC Lineberger Comprehensive Cancer Center, School of Medicine, Division of Hematology and Oncology, Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, and Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert W Corty
- UNC Lineberger Comprehensive Cancer Center, School of Medicine, Division of Hematology and Oncology, Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, and Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ethan Basch
- UNC Lineberger Comprehensive Cancer Center, School of Medicine, Division of Hematology and Oncology, Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, and Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mathew I Milowsky
- UNC Lineberger Comprehensive Cancer Center, School of Medicine, Division of Hematology and Oncology, Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, and Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stacie B Dusetzina
- UNC Lineberger Comprehensive Cancer Center, School of Medicine, Division of Hematology and Oncology, Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, and Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Antonia V Bennett
- UNC Lineberger Comprehensive Cancer Center, School of Medicine, Division of Hematology and Oncology, Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, and Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - William A Wood
- UNC Lineberger Comprehensive Cancer Center, School of Medicine, Division of Hematology and Oncology, Eshelman School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, and Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Sibener L, Zaganjor I, Snyder HM, Bain LJ, Egge R, Carrillo MC. Alzheimer's Disease prevalence, costs, and prevention for military personnel and veterans. Alzheimers Dement 2015; 10:S105-10. [PMID: 24924663 DOI: 10.1016/j.jalz.2014.04.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
By 2050, more than 13 million Americans of all ages are estimated to be living with Alzheimer's disease (AD), and the aggregate costs of care will swell to approximately $1.2 trillion. The rapidly climbing number of those affected with AD includes a growing population of aging military veterans affected who may have an added risk for the disease as a consequence of traumatic brain injury, posttraumatic stress disorder, and/or service-related injuries. The increasing number of individuals, the long duration of disability, and the rising cost of care for AD and other dementia to our society are important public health challenges facing many older adults. These challenges are further compounded by a burgeoning military veteran population that is much younger, with an increased risk of AD and other dementia, and who may experience decades-long periods of disability and care. This outlook underscores the critical need for investments in research at the federal and international levels to accelerate the pace of progress in developing breakthrough discoveries that will change the trajectory of AD and related dementia.
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Affiliation(s)
- Leslie Sibener
- Medical and Scientific Relations Division, Alzheimer's Association, Chicago, IL, USA
| | - Ibrahim Zaganjor
- Medical and Scientific Relations Division, Alzheimer's Association, Chicago, IL, USA
| | - Heather M Snyder
- Medical and Scientific Relations Division, Alzheimer's Association, Chicago, IL, USA
| | - Lisa J Bain
- Independent Science Writer, Philadelphia, PA, USA
| | - Robert Egge
- Public Policy and Advocacy Division, Alzheimer's Association, Washington, DC, USA
| | - Maria C Carrillo
- Medical and Scientific Relations Division, Alzheimer's Association, Chicago, IL, USA.
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Villar J, Blanco J, del Campo R, Andaluz-Ojeda D, Díaz-Domínguez FJ, Muriel A, Córcoles V, Suárez-Sipmann F, Tarancón C, González-Higueras E, López J, Blanch L, Pérez-Méndez L, Fernández RL, Kacmarek RM. Assessment of PaO₂/FiO₂ for stratification of patients with moderate and severe acute respiratory distress syndrome. BMJ Open 2015; 5:e006812. [PMID: 25818272 PMCID: PMC4386240 DOI: 10.1136/bmjopen-2014-006812] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES A recent update of the definition of acute respiratory distress syndrome (ARDS) proposed an empirical classification based on ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO₂/FiO₂) at ARDS onset. Since the proposal did not mandate PaO₂/FiO₂ calculation under standardised ventilator settings (SVS), we hypothesised that a stratification based on baseline PaO₂/FiOv would not provide accurate assessment of lung injury severity. DESIGN A prospective, multicentre, observational study. SETTING A network of teaching hospitals. PARTICIPANTS 478 patients with eligible criteria for moderate (100<PaO₂/FiO₂≤200) and severe (PaO₂/FiO₂≤100) ARDS and followed until hospital discharge. INTERVENTIONS We examined physiological and ventilator parameters in association with the PaO₂/FiO₂ at ARDS onset, after 24 h of usual care and at 24 h under a SVS. At 24 h, patients were reclassified as severe, moderate, mild (200<PaO₂/FiO₂≤300) ARDS and non-ARDS (PaO₂/FiO₂>300). PRIMARY AND SECONDARY OUTCOMES Group severity and hospital mortality. RESULTS At ARDS onset, 173 patients had a PaO₂/FiO₂≤100 but only 38.7% met criteria for severe ARDS at 24 h under SVS. When assessed under SVS, 61.3% of patients with severe ARDS were reclassified as moderate, mild and non-ARDS, while lung severity and hospital mortality changed markedly with every PaO₂/FiO₂ category (p<0.000001). Our model of risk stratification outperformed the stratification using baseline PaO₂/FiO₂ and non-standardised PaO₂/FiO₂ at 24 h, when analysed by the predictive receiver operating characteristic (ROC) curve: area under the ROC curve for stratification at baseline was 0.583 (95% CI 0.525 to 0.636), 0.605 (95% CI 0.552 to 0.658) at 24 h without SVS and 0.693 (95% CI 0.645 to 0.742) at 24 h under SVS (p<0.000001). CONCLUSIONS Our findings support the need for patient assessment under SVS at 24 h after ARDS onset to assess disease severity, and have implications for the diagnosis and management of ARDS patients. TRIAL REGISTRATION NUMBERS NCT00435110 and NCT00736892.
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Affiliation(s)
- Jesús Villar
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr Negrín, Las Palmas, Spain
| | - Jesús Blanco
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Intensive Care Unit, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Rafael del Campo
- Intensive Care Unit, Hospital General de Ciudad Real, Ciudad Real, Spain
| | - David Andaluz-Ojeda
- Intensive Care Unit, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Arturo Muriel
- Intensive Care Unit, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Virgilio Córcoles
- Intensive Care Unit, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Fernando Suárez-Sipmann
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Department of Surgical Sciences, Anesthesiology & Critical Care, Hedenstierna Laboratory, Uppsala University Hospital, Uppsala, Sweden
| | | | | | - Julia López
- Intensive Care Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Lluis Blanch
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Critical Care Center, Corporació Sanitaria Parc Taulí, Sabadell, Spain
| | - Lina Pérez-Méndez
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Research Unit, Hospital Universitario NS de Candelaria, Tenerife, Spain
| | - Rosa Lidia Fernández
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Multidisciplinary Organ Dysfunction Evaluation Research Network, Research Unit, Hospital Universitario Dr Negrín, Las Palmas, Spain
| | - Robert M Kacmarek
- Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Anesthesiology, Harvard University, Boston, Massachusetts, USA
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Neville J, Kopko S, Broadbent S, Avilés E, Stafford R, Solinsky CM, Bain LJ, Cisneroz M, Romero K, Stephenson D. Development of a unified clinical trial database for Alzheimer's disease. Alzheimers Dement 2015; 11:1212-21. [PMID: 25676387 DOI: 10.1016/j.jalz.2014.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 10/10/2014] [Accepted: 11/20/2014] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Data obtained in completed Alzheimer's disease (AD) clinical trials can inform decision making for future trials. Recognizing the importance of sharing these data, the Coalition Against Major Diseases created an Online Data Repository for AD (CODR-AD) with the aim of supporting accelerated drug development. The aim of this study was to build an open access, standardized database from control arm data collected across many clinical trials. METHODS Comprehensive AD-specific data standards were developed to enable the pooling of data from different sources. Nine member organizations contributed patient-level data from 24 clinical trials of AD treatments. RESULTS CODR-AD consists of control arm pooled and standardized data from 24 trials currently numbered at 6500 subjects; Alzheimer's Disease Assessment Scale-cognitive subscale 11 is the main outcome and specific covariates are also included. DISCUSSION CODR-AD represents a unique integrated standardized clinical trials database available to qualified researchers. The pooling of data across studies facilitates a more comprehensive understanding of disease heterogeneity.
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Affiliation(s)
- Jon Neville
- Coalition Against Major Diseases (CAMD), Critical Path Institute, Tucson, AZ, USA
| | | | - Steve Broadbent
- Coalition Against Major Diseases (CAMD), Critical Path Institute, Tucson, AZ, USA
| | - Enrique Avilés
- Coalition Against Major Diseases (CAMD), Critical Path Institute, Tucson, AZ, USA
| | - Robert Stafford
- Coalition Against Major Diseases (CAMD), Critical Path Institute, Tucson, AZ, USA
| | | | - Lisa J Bain
- Independent Science Writer, Elverson, PA, USA
| | - Martin Cisneroz
- Coalition Against Major Diseases (CAMD), Critical Path Institute, Tucson, AZ, USA
| | - Klaus Romero
- Coalition Against Major Diseases (CAMD), Critical Path Institute, Tucson, AZ, USA
| | - Diane Stephenson
- Coalition Against Major Diseases (CAMD), Critical Path Institute, Tucson, AZ, USA.
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Mintzes B, Lexchin J, Quintano AS. Clinical trial transparency: many gains but access to evidence for new medicines remains imperfect. Br Med Bull 2015; 116:43-53. [PMID: 26493102 DOI: 10.1093/bmb/ldv042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although selective and incomplete publication is widely acknowledged to be a problem, full access to clinical trial data remains illusive. SOURCES OF DATA Authors' personal files, key documents from Food and Drug Administration and European Medicines Agency and focussed searches of PubMed. AREAS OF AGREEMENT Existing sources of information provide an incomplete overview of scientific research. AREAS OF CONTROVERSY Persistent arguments about commercial confidentiality and the potential difficulties in de-identifying raw data can block important progress. Current industry efforts are voluntary and only partially satisfy the need for complete data. GROWING POINTS Requirements for trial registration are increasing. Important regulatory changes in particular in Europe have the potential to result in the release of more information. AREAS TIMELY FOR DEVELOPING RESEARCH Documenting the effects of prospective trial registration and requirements for proactive clinical trial publication on healthcare decisions, public health and rational resource allocation.
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Affiliation(s)
- Barbara Mintzes
- Charles Perkins Centre and Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - Joel Lexchin
- School of Health Policy and Management, York University, York, UK University Health Network, Toronto, Canada Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Bonini S, Eichler HG, Wathion N, Rasi G. Transparency and the European Medicines Agency--sharing of clinical trial data. N Engl J Med 2014; 371:2452-5. [PMID: 25539105 DOI: 10.1056/nejmp1409464] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Sergio Bonini
- From the European Medicines Agency (S.B., H.-G.E., N.W., G.R.), London; the Second University of Naples, Naples, Italy (S.B.); the Institute of Translational Pharmacology, Italian National Research Council (S.B.), and the University of Rome Tor Vergata (G.R.) - both in Rome; and the Medical University of Vienna, Vienna (H.-G.E.)
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European regulatory experience with drugs for central nervous system disorders. Nat Rev Drug Discov 2014; 14:89-90. [PMID: 25524018 DOI: 10.1038/nrd4511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Computational target fishing: what should chemogenomics researchers expect for the future of in silico drug design and discovery? Future Med Chem 2014; 6:247-9. [PMID: 24575960 DOI: 10.4155/fmc.14.5] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Naci H, Ioannidis JPA. How good is "evidence" from clinical studies of drug effects and why might such evidence fail in the prediction of the clinical utility of drugs? Annu Rev Pharmacol Toxicol 2014; 55:169-89. [PMID: 25149917 DOI: 10.1146/annurev-pharmtox-010814-124614] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Promising evidence from clinical studies of drug effects does not always translate to improvements in patient outcomes. In this review, we discuss why early evidence is often ill suited to the task of predicting the clinical utility of drugs. The current gap between initially described drug effects and their subsequent clinical utility results from deficits in the design, conduct, analysis, reporting, and synthesis of clinical studies-often creating conditions that generate favorable, but ultimately incorrect, conclusions regarding drug effects. There are potential solutions that could improve the relevance of clinical evidence in predicting the real-world effectiveness of drugs. What is needed is a new emphasis on clinical utility, with nonconflicted entities playing a greater role in the generation, synthesis, and interpretation of clinical evidence. Clinical studies should adopt strong design features, reflect clinical practice, and evaluate outcomes and comparisons that are meaningful to patients. Transformative changes to the research agenda may generate more meaningful and accurate evidence on drug effects to guide clinical decision making.
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Affiliation(s)
- Huseyin Naci
- LSE Health, London School of Economics and Political Science, London WC2A 2AE, United Kingdom;
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Affiliation(s)
- Lynn M. Etheredge
- Lynn M. Etheredge ( ) is director of the Rapid Learning Project, in Chevy Chase, Maryland
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Herder M, Gibson E, Graham J, Lexchin J, Mintzes B. Regulating prescription drugs for patient safety: does Bill C-17 go far enough? CMAJ 2014; 186:E287-92. [PMID: 24616135 DOI: 10.1503/cmaj.131850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Pérez-Villacastín J. First, let's see where we stand. Then, let's see how far we can or want to go. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2014; 67:249-250. [PMID: 24774585 DOI: 10.1016/j.rec.2014.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 11/24/2013] [Indexed: 06/03/2023]
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Pérez-Villacastín J. Primero conocer la realidad. A partir de ahí, hasta donde queramos o podamos. Rev Esp Cardiol (Engl Ed) 2014. [DOI: 10.1016/j.recesp.2013.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Prasad SM, Sartor O, Bennett CL. Reply to W. Read. J Clin Oncol 2014; 32:604-5. [DOI: 10.1200/jco.2013.53.7225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Oliver Sartor
- Tulane University School of Medicine, New Orleans, LA
| | - Charles L. Bennett
- South Carolina College of Pharmacy, Medical University of South Carolina and the University of South Carolina, Columbia, SC
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Kanters S, Mills E, Thorlund K, Bucher H, Ioannidis J. Antiretroviral therapy for initial human immunodeficiency virus/AIDS treatment: critical appraisal of the evidence from over 100 randomized trials and 400 systematic reviews and meta-analyses. Clin Microbiol Infect 2014; 20:114-22. [DOI: 10.1111/1469-0691.12475] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Affiliation(s)
- Hal Barron
- Hoffmann-La Roche, South San Francisco, CA
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Time to ensure that clinical trial appropriate results are actually published. Eur J Clin Pharmacol 2014; 70:491-3. [DOI: 10.1007/s00228-013-1635-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
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Herder M. Toward a jurisprudence of drug regulation. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2014; 42:244-262. [PMID: 25040387 DOI: 10.1111/jlme.12139] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Efforts to foster transparency in biopharmaceutical regulation are well underway: drug manufacturers are, for example, legally required to register clinical trials and share research results in the United States and Europe. Recently, the policy conversation has shifted toward the disclosure of clinical trial data, not just trial designs and basic results. Here, I argue that clinical trial registration and disclosure of clinical trial data are necessary but insufficient. There is also a need to ensure that regulatory decisions that flow from clinical trials - whether positive (i.e., product approvals) or negative (i.e., abandoned products, product refusals, and withdrawals) - are open to outside scrutiny. Further, a jurisprudence of drug regulation is needed. I develop two arguments motivated by (1) innovation concerns and (2) the value of good governance in support of openly publishing all final decisions for approved, abandoned, refused, and withdrawn products. After articulating why greater transparency in regulatory decision-making is needed, I distil four essential features of a jurisprudence of drug regulation that prescribe policy changes in terms not only of the transparency of regulatory outcomes and the underlying reasoning, but also regulatory organization.
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Affiliation(s)
- Matthew Herder
- Assistant Professor in the Faculties of Medicine and Law at Dalhousie University
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