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Tian J, Kang S, Zhang D, Huang Y, Yao X, Zhao M, Lu Q. Selection of indicators reporting response rate in pharmaceutical trials for systemic lupus erythematosus: preference and relative sensitivity. Lupus Sci Med 2023; 10:e000942. [PMID: 37798046 PMCID: PMC10565300 DOI: 10.1136/lupus-2023-000942] [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: 04/07/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE SLE is a common multisystem autoimmune disease with chronic inflammation. Many efficacy evaluation indicators of randomised clinical trials (RCTs) for SLE have been proposed but the comparability remains unknown. We aim to explore the preference and comparability of indicators reporting response rate and provide basis for primary outcome selection when evaluating the efficacy of SLE pharmaceutical treatment. METHODS We systematically searched three databases and three registries to identify pharmacological intervention-controlled SLE RCTs. Relative discriminations between indicators were assessed by the Bayesian hierarchical linear mixed model. RESULTS 33 RCTs met our inclusion criteria and we compared eight of the most commonly used indicators reporting response rate. SLE Disease Activity Index 4 (SLEDAI-4) and SLE Responder Index 4 were considered the best recommended indicators reporting response rate to discriminate the pharmacological efficacy. Indicator preference was altered by disease severity, classification of drugs and outcome of trials, but SLEDAI-4 had robust efficacy in discriminating ability for most interventions. Of note, BILAG Index-based Combined Lupus Assessment showed efficacy in trials covering all-severity patients, as well as non-biologics RCTs. The British Isles Lupus Assessment Group response and Physician's Global Assessment response were more cautious in evaluating disease changes. Serious adverse event was often applied to evaluate the safety and tolerability of treatments rather than efficacy. CONCLUSIONS The impressionable efficacy discrimination ability of indicators highlights the importance of flexibility and comprehensiveness when choosing primary outcome(s). As for trials that are only evaluated by SLEDAI-4, attention should be paid to outcome interpretation to avoid the exaggeration of treatment efficacy. Further subgroup analyses are limited by the number of included RCTs. PROSPERO REGISTRATION NUMBER CRD42022334517.
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Affiliation(s)
- Jingru Tian
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
- Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, Nanjing, Jiangsu, China
| | - Shuntong Kang
- Department of Dermatology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Dingyao Zhang
- Graduate Program in Biological and Biomedical Sciences, Yale University, New Haven, Connecticut, USA
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut, USA
| | - Yaqing Huang
- Department of Pathology, Yale University, New Haven, Connecticut, USA
| | - Xu Yao
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Ming Zhao
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
- Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, Nanjing, Jiangsu, China
| | - Qianjin Lu
- Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, Jiangsu, China
- Key Laboratory of Basic and Translational Research on Immune-Mediated Skin Diseases, Chinese Academy of Medical Sciences, Nanjing, Jiangsu, China
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Min Y, Gao JT, Wu J, Zhai B, Han D, Liu B. Clinical Trial Assessment Principles of National Class III Medical Devices in China. Orthop Surg 2019; 11:715-719. [PMID: 31490619 PMCID: PMC6819180 DOI: 10.1111/os.12498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 11/30/2022] Open
Abstract
Class III medical devices are defined as those which are implanted inside the human body and applied to maintain normal life and retain original tissue or organic functions. Because these devices are associated with high risk, their effectiveness and safety should be strictly monitored and clinically investigated. The aim of clinical investigation of these medical devices is to ensure the acceptability of their effectiveness and safety levels. On designing the clinical trial, the investigator should determine the indices to assess the effectiveness and safety of medical devices, select reasonable data‐analyzing methods, and pay attention to several other issues. Although some guidelines on specific class III medical devices have illustrated those aspects in detail, there is still no comprehensive report that details all those principles and methodologies. This article aims to summarize the common features among the instruction principles and provide technological support for the clinical study of class III medical devices.
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Affiliation(s)
- Yue Min
- Center for Medical Device Evaluation, Center for Medical Device Evaluation NMPA, Beijing, China
| | - Jin-Tao Gao
- Center for Medical Device Evaluation, Center for Medical Device Evaluation NMPA, Beijing, China
| | - Jing Wu
- Center for Medical Device Evaluation, Center for Medical Device Evaluation NMPA, Beijing, China
| | - Bao Zhai
- Center for Medical Device Evaluation, Center for Medical Device Evaluation NMPA, Beijing, China
| | - Dan Han
- Center for Medical Device Evaluation, Center for Medical Device Evaluation NMPA, Beijing, China
| | - Bin Liu
- Center for Medical Device Evaluation, Center for Medical Device Evaluation NMPA, Beijing, China
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Iqbal U, Humayun A, Li YCJ. Healthcare quality-improvement and measurement strategies and its challenges ahead. Int J Qual Health Care 2019; 31:1. [PMID: 30753460 DOI: 10.1093/intqhc/mzz009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Usman Iqbal
- Masters Program in Global Health and Development Department, PhD Program in Global Health & Health Security Department, College of Public Health, Taipei Medical University, Taipei, Taiwan.,International Center for Health Information Technology (ICHIT), Taipei Medical University, 250-Wuxing Street, Xinyi District, Taipei, Taiwan.,Department of Public Health and Community Medicine, Shaikh Zayed Medical Complex, Lahore, Pakistan
| | - Ayesha Humayun
- Department of Public Health and Community Medicine, Shaikh Zayed Medical Complex, Lahore, Pakistan.,Department of Undergradaute Medical Education (DUME), SKZMDC, Shaikh Khalifa Bin Zayed Al-Nahyan Medical College, Shaikh Zayed Postgraduate Medical Institute, Shaikh Zayed Medical Complex, Lahore, Pakistan
| | - Yu-Chuan Jack Li
- International Center for Health Information Technology (ICHIT), Taipei Medical University, 250-Wuxing Street, Xinyi District, Taipei, Taiwan.,Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, 250-Wuxing Street, Xinyi District, Taipei, Taiwan.,Department of Dermatology, Wan Fang Hospital, Taipei, Taiwan
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Wiles LK, Hooper TD, Hibbert PD, Molloy C, White L, Jaffe A, Cowell CT, Harris MF, Runciman WB, Schmiede A, Dalton C, Hallahan AR, Dalton S, Williams H, Wheaton G, Murphy E, Braithwaite J. Clinical indicators for common paediatric conditions: Processes, provenance and products of the CareTrack Kids study. PLoS One 2019; 14:e0209637. [PMID: 30625190 PMCID: PMC6326465 DOI: 10.1371/journal.pone.0209637] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 12/10/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In order to determine the extent to which care delivered to children is appropriate (in line with evidence-based care and/or clinical practice guidelines (CPGs)) in Australia, we developed a set of clinical indicators for 21 common paediatric medical conditions for use across a range of primary, secondary and tertiary healthcare practice facilities. METHODS Clinical indicators were extracted from recommendations found through systematic searches of national and international guidelines, and formatted with explicit criteria for inclusion, exclusion, time frame and setting. Experts reviewed the indicators using a multi-round modified Delphi process and collaborative online wiki to develop consensus on what constituted appropriate care. RESULTS From 121 clinical practice guidelines, 1098 recommendations were used to draft 451 proposed appropriateness indicators. In total, 61 experts (n = 24 internal reviewers, n = 37 external reviewers) reviewed these indicators over 40 weeks. A final set of 234 indicators resulted, from which 597 indicator items were derived suitable for medical record audit. Most indicator items were geared towards capturing information about under-use in healthcare (n = 551, 92%) across emergency department (n = 457, 77%), hospital (n = 450, 75%) and general practice (n = 434, 73%) healthcare facilities, and based on consensus level recommendations (n = 451, 76%). The main reason for rejecting indicators was 'feasibility' (likely to be able to be used for determining compliance with 'appropriate care' from medical record audit). CONCLUSION A set of indicators was developed for the appropriateness of care for 21 paediatric conditions. We describe the processes (methods), provenance (origins and evolution of indicators) and products (indicator characteristics) of creating clinical indicators within the context of Australian healthcare settings. Developing consensus on clinical appropriateness indicators using a Delphi approach and collaborative online wiki has methodological utility. The final indicator set can be used by clinicians and organisations to measure and reflect on their own practice.
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Affiliation(s)
- Louise K. Wiles
- Australian Centre for Precision Health, School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Tamara D. Hooper
- Australian Centre for Precision Health, School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Peter D. Hibbert
- Australian Centre for Precision Health, School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Australian Patient Safety Foundation, Adelaide, South Australia, Australia
- Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Charlotte Molloy
- Australian Centre for Precision Health, School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Les White
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Discipline of Paediatrics, School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Children’s Hospital, Sydney Children’s Hospitals Network, Randwick, Sydney, New South Wales, Australia
- New South Wales Ministry of Health, North Sydney, Sydney, New South Wales, Australia
| | - Adam Jaffe
- Discipline of Paediatrics, School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Respiratory Medicine, Sydney Children’s Hospital, Sydney Children’s Hospitals Network, Randwick, Sydney, New South Wales, Australia
| | - Christopher T. Cowell
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Institute of Endocrinology and Diabetes, Children’s Hospital at Westmead, Sydney Children’s Hospitals Network, Westmead, Sydney, New South Wales, Australia
| | - Mark F. Harris
- Centre for Primary Health Care and Equity, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - William B. Runciman
- Australian Centre for Precision Health, School of Health Sciences, Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Australian Patient Safety Foundation, Adelaide, South Australia, Australia
| | - Annette Schmiede
- BUPA Health Foundation Australia, Sydney, New South Wales, Australia
| | - Chris Dalton
- BUPA Health Foundation Australia, Sydney, New South Wales, Australia
| | - Andrew R. Hallahan
- Children’s Health Queensland Hospital and Health Service, South Brisbane, Brisbane, Queensland, Australia
| | - Sarah Dalton
- New South Wales Ministry of Health, North Sydney, Sydney, New South Wales, Australia
- New South Wales (NSW) Agency for Clinical Innovation (ACI), Chatswood, Sydney, New South Wales, Australia
| | - Helena Williams
- Russell Clinic, Blackwood, Adelaide, South Australia, Australia
- Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
- Southern Adelaide Local Health Network, Bedford Park, Adelaide, South Australia, Australia
- Cancer Australia, Surry Hills, Sydney, New South Wales, Australia
- Adelaide Primary Health Network, Mile End, Adelaide, South Australia, Australia
- Country SA Primary Health Network, Nuriootpa, Adelaide, South Australia, Australia
| | - Gavin Wheaton
- Division of Paediatric Medicine, Women’s and Children’s Health Network, Adelaide, South Australia, Australia
| | - Elisabeth Murphy
- New South Wales Ministry of Health, North Sydney, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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