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Hamilton F, Arnold D, Lilford R. Bad research is not all bad. Trials 2023; 24:680. [PMID: 37864198 PMCID: PMC10588138 DOI: 10.1186/s13063-023-07706-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 10/04/2023] [Indexed: 10/22/2023] Open
Abstract
In this commentary, we discuss a recent article in Trials that raised concerns about the number of poorly performed randomised trials in the medical literature and discuss the trials literature more widely. Although we all aim for higher methodological standards in trials, we argue that (i) the idea that 'most randomised trials are bad', which the recent article concludes is an overly simplistic representation of the situation, and (ii) the suggestion that an increased focus on methodological review during trial development (e.g. ethical boards performing some assessment of the methodologists on a trial), while well meaning, may have negative unintended consequences. We therefore propose that (a) trials should be assessed on their merits and weaknesses, including an assessment of risk of bias but placing that in a wider context; (b) we should recognise that although the methodological conduct of trials is of utmost importance, interventions that aim to improve this could have unintended consequences-such as bureaucracy-that have an overall negative effect; and (c) we should therefore generate an evidence base for policy interventions to improve conduct of trials rather than applying arbitrary rules.
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Affiliation(s)
- Fergus Hamilton
- Infection Science, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK.
- MRC Integrative Epidemiology Unit, Oakfield House, University of Bristol, Bristol, BS10 5NB, UK.
| | - David Arnold
- MRC Integrative Epidemiology Unit, Oakfield House, University of Bristol, Bristol, BS10 5NB, UK
- Academic Respiratory Unit, Southmead Hospital, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - Richard Lilford
- NIHR ARC West Midlands, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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2
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Johnson PJ. In search of an evidence base for HCC surveillance: Purity or pragmatism? J Hepatol 2021; 74:1025-1027. [PMID: 33766443 DOI: 10.1016/j.jhep.2021.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 01/27/2023]
Affiliation(s)
- Philip J Johnson
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom.
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Poordad F, Castro RE, Asatryan A, Aguilar H, Cacoub P, Dieterich D, Marinho RT, Carvalho A, Siddique A, Hu YB, Charafeddine M, Bondin M, Khan N, Cohen DE, Felizarta F. Long-term safety and efficacy results in hepatitis C virus genotype 1-infected patients receiving ombitasvir/paritaprevir/ritonavir + dasabuvir ± ribavirin in the TOPAZ-I and TOPAZ-II trials. J Viral Hepat 2020; 27:497-504. [PMID: 31954087 DOI: 10.1111/jvh.13261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 12/27/2022]
Abstract
The 3-DAA regimen consisting of ombitasvir/paritaprevir/ritonavir plus dasabuvir (OBV/PTV/r + DSV) ± ribavirin (RBV) has shown high sustained virologic response rates (~95%) in phase 3 clinical trials including >2300 HCV genotype 1-infected patients. Real-world evidence studies have confirmed the effectiveness of OBV/PTV/r ± DSV ± RBV in patients with chronic HCV genotype 1 infection and are consistent with clinical trial results. TOPAZ-I and TOPAZ-II are ongoing phase 3b trials, assessing safety, efficacy and long-term progression of liver disease and clinical outcomes for up to 5 years post-treatment in patients treated with OBV/PTV/r + DSV ± RBV. High rates of sustained virologic response (SVR) were achieved regardless of presence or absence of cirrhosis.In this report, we assessed the long-term progression of liver disease and incidence of clinical outcomes up to 3 years of post-treatment follow-up in patients with chronic HCV GT1 infection who were treated with (OBV/PTV/r + DSV) ± RBV in the TOPAZ-I and TOPAZ-II studies. Improvements were observed in liver disease markers including FIB-4, METAVIR and Child-Pugh scores as well as platelet counts. Clinical outcomes related to long-term progression of liver disease such as liver decompensation were infrequent (<1%). Hepatocellular carcinoma (HCC) occurred in 1.4% of cirrhotic patients.
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Affiliation(s)
- Fred Poordad
- The Texas Liver Institute, University of Texas Health, San Antonio, TX, USA
| | - RuiSarmento E Castro
- Hospital Centre of Porto (Portugal), Biomedical School of Medicine (University of Porto), Porto, Portugal
| | | | | | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, AP HP, Groupe hospitalier La Pitié-Salpêtrière, Paris, France.,Sorbonne Universités, UPMC Univ, Paris, France
| | - Douglas Dieterich
- Mount Sinai School of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rui Tato Marinho
- Gastroenterology and Hepatology Department, Centro Hospitalar de Universitário Lisboa Norte and Medical School of Lisbon, University of Lisbon, Lisbon, Portugal
| | - Armando Carvalho
- Internal Medicine Department, Hospitais da Universidade de Coimbra (Centro Hospitalar e Universitário de Coimbra), Coimbra, Portugal
| | - Asma Siddique
- Virginia Mason Hospital and Seattle Medical Center, Seattle, WA, USA
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Marcus JL, Hurley LB, Chamberland S, Champsi JH, Korn DG, Lai JB, Lam JO, Quesenberry CP, Ready J, Saxena V, Seo SI, Witt DJ, Silverberg MJ. Life Expectancy of Insured People With and Without Hepatitis C Virus Infection, 2007-2017. Open Forum Infect Dis 2020; 7:ofaa044. [PMID: 32128339 PMCID: PMC7043807 DOI: 10.1093/ofid/ofaa044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 02/04/2020] [Indexed: 01/04/2023] Open
Abstract
Among 25 291 and 4 921 830 people with and without hepatitis C, life expectancy at age 20 increased 1.8 years and 0.3 years from the interferon to interferon-free era, respectively. Increases were highest for racial and/or ethnic minority groups with hepatitis C.
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Affiliation(s)
- Julia L Marcus
- Kaiser Permanente Division of Research, Oakland, California, USA.,Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Leo B Hurley
- Kaiser Permanente Division of Research, Oakland, California, USA
| | - Scott Chamberland
- Kaiser Permanente Northern California Regional Pharmacy, Oakland, California, USA
| | - Jamila H Champsi
- Kaiser Permanente South San Francisco Medical Center, South San Francisco, California, USA
| | - Daniel G Korn
- Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Jennifer B Lai
- Kaiser Permanente San Rafael Medical Center, San Rafael, California, USA
| | - Jennifer O Lam
- Kaiser Permanente Division of Research, Oakland, California, USA
| | | | - Joanna Ready
- Kaiser Permanente Santa Clara Medical Center, Santa Clara, California, USA
| | - Varun Saxena
- Kaiser Permanente South San Francisco Medical Center, South San Francisco, California, USA
| | - Suk I Seo
- Kaiser Permanente Antioch Medical Center, Antioch, California.,Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California, USA
| | - David J Witt
- Kaiser Permanente San Rafael Medical Center, San Rafael, California, USA
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Alavi M, Law MG, Valerio H, Grebely J, Amin J, Hajarizadeh B, Selvey C, George J, Dore GJ. Declining hepatitis C virus-related liver disease burden in the direct-acting antiviral therapy era in New South Wales, Australia. J Hepatol 2019; 71:281-288. [PMID: 31078544 DOI: 10.1016/j.jhep.2019.04.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/27/2019] [Accepted: 04/01/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Population-level evidence for the impact of direct-acting antiviral (DAA) therapy on hepatitis C virus (HCV)-related disease burden is lacking. We aimed to evaluate trends in HCV-related decompensated cirrhosis and hepatocellular carcinoma (HCC) hospitalisation, and liver-related and all-cause mortality in the pre-DAA (2001-2014) and DAA therapy (2015-2017) eras in New South Wales, Australia. METHODS HCV notifications (1993-2016) were linked to hospital admissions (2001-2017) and mortality (1995-2017). Segmented Poisson regressions and Poisson regression were used to assess the impact of DAA era and factors associated with liver-related mortality, respectively. RESULTS Among 99,910 people with an HCV notification, 3.8% had a decompensated cirrhosis diagnosis and 1.8% had an HCC diagnosis, while 3.3% and 10.5% died of liver-related and all-cause mortality, respectively. In the pre-DAA era, the number of decompensated cirrhosis and HCC diagnoses, and liver-related and all-cause mortality consistently increased (incidence rate ratios 1.04 [95% CI 1.04-1.05], 1.08 [95% CI 1.07-1.08], 1.07 [95% CI 1.06-1.07], and 1.05 [95% CI 1.04-1.05], respectively) over each 6-monthly band. In the DAA era, decompensated cirrhosis diagnosis and liver-related mortality numbers declined (incidence rate ratios 0.97 [95% CI 0.95-0.99] and 0.96 [95% CI 0.94-0.98], respectively), and HCC diagnosis and all-cause mortality numbers plateaued (incidence rate ratio 1.00 [95% CI 0.97-1.03] and 1.01 [95% CI 1.00-1.02], respectively) over each 6-monthly band. In the DAA era, alcohol-use disorder (AUD) was common in patients diagnosed with decompensated cirrhosis and HCC (65% and 46% had a history of AUD, respectively). AUD was independently associated with liver-related mortality (incidence rate ratio 3.35; 95% CI 3.14-3.58). CONCLUSIONS In the DAA era, there has been a sharp decline in liver disease morbidity and mortality in New South Wales, Australia. AUD remains a major contributor to HCV-related liver disease burden, highlighting the need to address comorbidities. LAY SUMMARY Rising hepatitis C-related morbidity and mortality is a major public health issue. However, development of highly effective medicines against hepatitis C (called direct-acting antivirals or DAAs) means hepatitis C could be eliminated as a public health threat by 2030. This study shows a sharp decline in liver disease morbidity and mortality since the introduction of DAAs in New South Wales, Australia. Despite this, heavy alcohol use remains an important risk factor for liver disease among people with hepatitis C. To ensure that the benefits of new antiviral treatments are not compromised, management of major comorbidities, including heavy alcohol use must improve among people with hepatitis C.
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Affiliation(s)
- Maryam Alavi
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
| | - Matthew G Law
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Janaki Amin
- Department of Health Systems and Populations, Macquarie University, Sydney, NSW, Australia
| | | | - Christine Selvey
- Communicable Diseases Branch, Health Protection NSW, Sydney, NSW, Australia
| | - Jacob George
- Storr Liver Centre, Westmead Millennium Institute, University of Sydney and Westmead Hospital, Westmead, NSW, Australia
| | - Gregory J Dore
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
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Evidence-making hepatitis C cure: Towards a science that knows more carefully. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 72:40-46. [PMID: 31307851 DOI: 10.1016/j.drugpo.2019.06.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/27/2019] [Accepted: 06/28/2019] [Indexed: 11/22/2022]
Abstract
There has been some controversy concerning the curative potential of new treatments for hepatitis C. This follows a systematic review of the Cochrane Collaboration questioning the clinical benefits of direct-acting antivirals (DAAs). This controversy has been debated as a matter of methods regarding how best to evidence treatment in an evidence-based medicine (EBM) approach. Drawing from science and technology studies (STS), we offer an alternative perspective. We propose a different way of thinking with evidence; one which treats 'evidencing as performative'. Using the Cochrane review and its linked published responses as a resource for this analysis, we consider how hepatitis C cure is differently made-up through the knowledge-making practices performing it. We show how matters of apparent fact in evidence-based science are enacted as matters of clinical, social and ethico-political concern. We notice hepatitis C cure as a fluid object in negotiation. We highlight the limits of current debate to advocate a more critical and careful practice-based approach to knowing hepatitis C cure. This calls upon public health researchers to reflect on the performative work of their evidencing. We propose a 'more-than' EBM approach which treats 'evidence-based' science as an 'evidence-making intervention'. We consider the implications of such an approach for the evidencing of public health interventions and for treating hepatitis C in the DAA era of 'viral elimination'.
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Holmes JA, Rutledge SM, Chung RT. Direct-acting antiviral treatment for hepatitis C. Lancet 2019; 393:1392-1394. [PMID: 30765125 DOI: 10.1016/s0140-6736(18)32326-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/13/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Jacinta A Holmes
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA; Department of Gastroenterology, St Vincent's Hospital, University of Melbourne, Fitzroy, VIC, Australia
| | - Stephanie M Rutledge
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Raymond T Chung
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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