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Wang X, Long Y, Yang L, Huang J, Du L. Results Reporting and Early Termination of Childhood Obesity Trials Registered on ClinicalTrials.gov. Front Pediatr 2022; 10:860610. [PMID: 35402346 PMCID: PMC8987712 DOI: 10.3389/fped.2022.860610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Abstract
Objective Childhood obesity is one of the most severe challenges of public health in the twenty-first century and may increase the risk of various physical and psychological diseases in adulthood. The prevalence and predictors of unreported results and premature termination in pediatric obesity research are not clear. We aimed to characterize childhood obesity trials registered on ClinicalTrials.gov and identify features associated with early termination and lack of results reporting. Methods Records were downloaded and screened for all childhood obesity trials from the inception of ClinicalTrials.gov to July 29, 2021. We performed descriptive analyses of characteristics, Cox regression for early termination, and logistic regression for lack of results reporting. Results We identified 1,312 trials registered at ClinicalTrials.gov. Among clinicalTrials.gov registered childhood obesity-related intervention trials, trial unreported results were 88.5 and 4.3% of trials were prematurely terminated. Additionally, the factors that reduced the risk of unreported outcomes were US-registered clinical studies and drug intervention trials. Factors associated with a reduced risk of early termination are National Institutes of Health (NIH) or other federal agency funding and large trials. Conclusion The problem of unreported results in clinical trials of childhood obesity is serious. Therefore, timely bulletin of the results and reasons for termination remain urgent aims for childhood obesity trials.
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Affiliation(s)
- Xinyi Wang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Youlin Long
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Liu Yang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Jin Huang
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Du
- Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Medical Device Regulatory Research and Evaluation Centre, West China Hospital, Sichuan University, Chengdu, China
- West China Medical Publishers, West China Hospital, Sichuan University, Chengdu, China
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2
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Joseph PD, Caldwell PH, Barnes EH, Hynes K, Choong CS, Turner S, Vosk C, White J, Richichi K, Craig JC. Completeness of protocols for clinical trials in children submitted to ethics committees. J Paediatr Child Health 2019; 55:291-298. [PMID: 30161286 DOI: 10.1111/jpc.14189] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/20/2018] [Accepted: 07/23/2018] [Indexed: 12/11/2022]
Abstract
AIM Studies of published clinical trials involving children have shown frequent omissions in key aspects of design and conduct, but these problems may be artefactual and due to editorial processes and space limitations. To determine actual design and conduct, we analysed the completeness of key domains in trial protocols involving children submitted to Human Research Ethics Committees. METHODS The ethics committees of all eight children's hospitals in Australia were invited to participate. De-identified trial protocols submitted for review in 2012 were evaluated using a checklist derived from Consolidated Standards of Reporting Trials, the Cochrane Risk of Bias Tool and Good Clinical Practice guidelines. RESULTS Four ethics committees agreed to participate, and 69 protocols were analysed. The domains almost always reported were clustered around the background and trial plan (planned interventions for each group (99%), specific objectives (97%) and scientific background (96%)). Risk-of-bias domains such as random sequence generation and blinding of participants were often reported (75-90%). Domains least reported were clustered around the statistical analysis plan (66%), specified intention-to-treat analysis (54%), the justification for the proposed trial based upon a systematic review (48%) and age-specific outcomes (48%). CONCLUSIONS Protocols of trials involving children assessed by ethics committees generally include details on background and basic design, but many key domains in trial design and conduct are not covered. Despite widespread recognition of how problems in the design and conduct of trials may lead to unreliable results, investigators still appear to be omitting key elements in trial protocols.
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Affiliation(s)
- Pathma D Joseph
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.,Pharmacy Department, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Patrina Hy Caldwell
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Elizabeth H Barnes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Kay Hynes
- Pharmacy Department, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Catherine S Choong
- Department of Diabetes and Endocrinology, Princess Margaret Hospital, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
| | - Sean Turner
- Pharmacy Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Claire Vosk
- Pharmacy Department, Monash Health, Melbourne, Victoria, Australia
| | - Jessie White
- Clinical Research and Education, Princess Margaret Hospital, Perth, Western Australia, Australia
| | - Kate Richichi
- Flinders Medical Centre and Repatriation General Hospital, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Jonathan C Craig
- Centre for Kidney Research, Children's Hospital at Westmead, Sydney, New South Wales, Australia.,School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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3
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Rüegger CM, Dawson JA, Donath SM, Owen LS, Davis PG. Nonpublication and discontinuation of randomised controlled trials in newborns. Acta Paediatr 2017; 106:1940-1944. [PMID: 28871629 DOI: 10.1111/apa.14062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 08/31/2017] [Indexed: 12/24/2022]
Abstract
AIM To determine the rate of nonpublication and discontinuation of randomised controlled trials (RCTs) in newborns. METHODS This was a retrospective, cross-sectional study of RCTs registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR) between 2008 and 2012. RESULTS Fifty trials were identified, of which 23 (46%) were retrospectively registered. Thirty trials (60%) were published. After a median follow-up of 8.0 (range 4.6-17.4) years from Research Ethics Committee approval, 15 of 41 completed trials (37%) remained unpublished, representing 5422 neonatal trial participants. Nine trials (18%) were discontinued, including four that were published. The most frequent reason for discontinuation was poor recruitment (n = 4). Sample size discrepancies between registration and publication were found in 17 (65%) of the 26 completed, published trials. In nine (35%) of these trials, the calculated sample size in the method section of the published article differed from the planned sample size in the trial registry (relative difference -20% to +33%). CONCLUSION Nonpublication and discontinuation of RCTs conducted in newborns is common. Additional efforts are needed to minimise the number of neonatal trial participants that are exposed to interventions without subsequent publication.
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Affiliation(s)
- Christoph M. Rüegger
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Parkville VIC Australia
- Newborn Research; Department of Neonatology; University Hospital and University of Zürich; Zürich Switzerland
| | - Jennifer A. Dawson
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Parkville VIC Australia
- Murdoch Childrens Research Institute; Melbourne VIC Australia
- University of Melbourne; Melbourne VIC Australia
| | - Susan M. Donath
- Murdoch Childrens Research Institute; Melbourne VIC Australia
- University of Melbourne; Melbourne VIC Australia
| | - Louise S. Owen
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Parkville VIC Australia
- Murdoch Childrens Research Institute; Melbourne VIC Australia
- University of Melbourne; Melbourne VIC Australia
| | - Peter G. Davis
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Parkville VIC Australia
- Murdoch Childrens Research Institute; Melbourne VIC Australia
- University of Melbourne; Melbourne VIC Australia
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4
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Schandelmaier S, Tomonaga Y, Bassler D, Meerpohl JJ, von Elm E, You JJ, Bluemle A, Lamontagne F, Saccilotto R, Amstutz A, Bengough T, Stegert M, Olu KK, Tikkinen KAO, Neumann I, Carrasco-Labra A, Faulhaber M, Mulla SM, Mertz D, Akl EA, Sun X, Busse JW, Ferreira-González I, Nordmann A, Gloy V, Raatz H, Moja L, Rosenthal R, Ebrahim S, Vandvik PO, Johnston BC, Walter MA, Burnand B, Schwenkglenks M, Hemkens LG, Guyatt G, Bucher HC, Kasenda B, Briel M. Premature Discontinuation of Pediatric Randomized Controlled Trials: A Retrospective Cohort Study. J Pediatr 2017; 184:209-214.e1. [PMID: 28410086 DOI: 10.1016/j.jpeds.2017.01.071] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/30/2016] [Accepted: 01/30/2017] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To determine the proportion of pediatric randomized controlled trials (RCTs) that are prematurely discontinued, examine the reasons for discontinuation, and compare the risk for recruitment failure in pediatric and adult RCTs. STUDY DESIGN A retrospective cohort study of RCTs approved by 1 of 6 Research Ethics Committees (RECs) in Switzerland, Germany, and Canada between 2000 and 2003. We recorded trial characteristics, trial discontinuation, and reasons for discontinuation from protocols, corresponding publications, REC files, and a survey of trialists. RESULTS We included 894 RCTs, of which 86 enrolled children and 808 enrolled adults. Forty percent of the pediatric RCTs and 29% of the adult RCTs were discontinued. Slow recruitment accounted for 56% of pediatric RCT discontinuations and 43% of adult RCT discontinuations. Multivariable logistic regression analyses suggested that pediatric RCT was not an independent risk factor for recruitment failure after adjustment for other potential risk factors (aOR, 1.22; 95% CI, 0.57-2.63). Independent risk factors were acute care setting (aOR, 4.00; 95% CI, 1.72-9.31), nonindustry sponsorship (aOR, 4.45; 95% CI, 2.59-7.65), and smaller planned sample size (aOR, 1.05; 95% CI 1.01-1.09, in decrements of 100 participants). CONCLUSION Forty percent of pediatric RCTs were discontinued prematurely, owing predominately to slow recruitment. Enrollment of children was not an independent risk factor for recruitment failure.
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Affiliation(s)
- Stefan Schandelmaier
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Academy of Swiss Insurance Medicine, University Hospital Basel, Basel, Switzerland.
| | - Yuki Tomonaga
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Joerg J Meerpohl
- German Cochrane Centre, Medical Center, University of Freiburg, Freiburg, Germany; Center of Research in Epidemiology and Statistics Sorbonne Paris Cité-U1153, INSERM/Université Paris Descartes, Cochrane France, Hôpital Hôtel-Dieu, Paris Cedex 04, France
| | - Erik von Elm
- Cochrane Switzerland, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - John J You
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Anette Bluemle
- German Cochrane Centre, Medical Center, University of Freiburg, Freiburg, Germany
| | - Francois Lamontagne
- Centre de Recherche Clinique du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Ramon Saccilotto
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Alain Amstutz
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Theresa Bengough
- Department of Health and Society, Austrian Federal Institute for Health Care, Vienna, Austria
| | - Mihaela Stegert
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Kelechi K Olu
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Kari A O Tikkinen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Departments of Urology and Public Health, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ignacio Neumann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Internal Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Alonso Carrasco-Labra
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Evidence-Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Markus Faulhaber
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Sohail M Mulla
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Dominik Mertz
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Medicine, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote Institute for Infectious Diseases Research, McMaster University, Hamilton, ON, Canada
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Xin Sun
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Jason W Busse
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Anesthesia, McMaster University, Hamilton, ON, Canada; Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, ON, Canada
| | - Ignacio Ferreira-González
- Epidemiology Unit, Department of Cardiology, Vall d'Hebron Hospital and CIBER de Epidemiología y Salud Publica (CIBERESP), Barcelona, Spain
| | - Alain Nordmann
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Viktoria Gloy
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland; Institute of Nuclear Medicine, University Hospital Bern, Bern, Switzerland
| | - Heike Raatz
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Lorenzo Moja
- IRCCS Orthopedic Institute Galeazzi, Milano, Italy
| | - Rachel Rosenthal
- Department of Surgery, University Hospital Basel, Basel, Switzerland
| | - Shanil Ebrahim
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Anesthesia, McMaster University, Hamilton, ON, Canada; Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Stanford Prevention Research Center, Stanford University, Stanford, CA
| | - Per O Vandvik
- Department of Medicine, Innlandet Hospital Trust-Division Gjøvik, Oppland, Norway
| | - Bradley C Johnston
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Martin A Walter
- Institute of Nuclear Medicine, University Hospital Bern, Bern, Switzerland
| | - Bernard Burnand
- Cochrane Switzerland, Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Matthias Schwenkglenks
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Lars G Hemkens
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Gordon Guyatt
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Heiner C Bucher
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland
| | - Benjamin Kasenda
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland; Department of Haematology/Oncology and Palliative Care, Klinikum Stuttgart, Stuttgart, Germany
| | - Matthias Briel
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel, Switzerland; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Clinical Research, University of Basel, Basel, Switzerland
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5
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Gewandter JS, Kitt RA, Hunsinger MR, Poku J, Lozano J, Chaudari J, Evans S, Gross RA, McDermott MP, Rowbotham MC, Turk DC, Dworkin RH. Reporting of data monitoring boards in publications of randomized clinical trials is often deficient: ACTTION systematic review. J Clin Epidemiol 2017; 83:101-107. [PMID: 28126598 PMCID: PMC5780643 DOI: 10.1016/j.jclinepi.2016.12.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 10/07/2016] [Accepted: 12/01/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine whether primary reports of randomized clinical trials (RCTs) in six high-impact, general medical journals reported (1) whether or not a Data Monitoring Committee/Data and Safety Monitoring Board (DMC/DSMB) was used and (2) the composition of the responsibilities of the reported DSMB/DMCs. STUDY DESIGN AND SETTING Systematic review of RCTs published in 2014 in Annals of Internal Medicine, BMJ, NEJM, JAMA, JAMA Internal Medicine, and Lancet. RESULTS Of the 294 articles identified, 174 (59%) mentioned using a DMC/DSMB. Of these 174, 126 (72%) indicated at least one responsibility of the DMC/DSMB, 26% listed the names of the DMC/DSMB members, and another 14% listed both their names and affiliations. Only one article stated that a DSMB was not used. The remaining 119 articles did not report whether or not a DMC/DSMB was used, although 59 had previously stated in a clinical trials registry entry or a published protocol that a DMC/DSMB was to be used. CONCLUSIONS Considering the major role that DMC/DSMBs play in protecting participant safety, data quality, and interim analyses in RCTs, we recommend that authors of publications of RCTs report whether a DMC/DSMB was used and the responsibilities and members of DMC/DSMBs to increase transparency regarding study conduct.
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Affiliation(s)
- Jennifer S Gewandter
- Department of Anesthesiology, University of Rochester, Elmwood Avenue, Rochester, NY, USA.
| | - Rachel A Kitt
- Department of Anesthesiology, University of Rochester, Elmwood Avenue, Rochester, NY, USA
| | - Matthew R Hunsinger
- School of Graduate Psychology, Pacific University, College Way, Hillsboro, OR, USA
| | - Joseph Poku
- Department of Anesthesiology, University of Rochester, Elmwood Avenue, Rochester, NY, USA
| | - Jacqueline Lozano
- Department of Anesthesiology, University of Rochester, Elmwood Avenue, Rochester, NY, USA
| | - Jenna Chaudari
- Department of Anesthesiology, University of Rochester, Elmwood Avenue, Rochester, NY, USA
| | - Scott Evans
- Department of Biostatistics, Harvard University, Elmwood Avenue, Boston, MA, USA
| | - Robert A Gross
- Department of Neurology, University of Rochester, Elmwood Avenue, Rochester, NY, USA; Department of Pharmacology & Physiology, University of Rochester, Elmwood Avenue, Rochester, NY, USA
| | - Michael P McDermott
- Department of Biostatistics and Computational Biology, University of Rochester, Elmwood Avenue, Rochester, NY, USA
| | - Michael C Rowbotham
- California Pacific Medical Center Research Institute, Brannan St, San Francisco, CA, USA
| | - Dennis C Turk
- Department of Anesthesiology and Pain Medicine, University of Washington, NE Pacific Street, Seattle, WA, USA
| | - Robert H Dworkin
- Department of Anesthesiology, University of Rochester, Elmwood Avenue, Rochester, NY, USA
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Hoppu K. Data monitoring committees should be used more frequently and appropriately to monitor paediatric clinical trials, particularly those involving neonates. Acta Paediatr 2017; 106:7-8. [PMID: 27943437 DOI: 10.1111/apa.13628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kalle Hoppu
- Children's Hospital and Department of Clinical Pharmacology; University of Helsinki and Helsinki University Hospital; Helsinki Finland
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7
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Perrem LM, Gosling S, Ravikumar I, Khashan AS, Miletin J, Ryan CA, Dempsey E. Reporting on data monitoring committees in neonatal randomised controlled trials is inconsistent. Acta Paediatr 2017; 106:30-33. [PMID: 27637413 DOI: 10.1111/apa.13593] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 08/09/2016] [Accepted: 09/13/2016] [Indexed: 12/01/2022]
Abstract
AIM To evaluate the reported use of data monitoring committees (DMCs), the frequency of interim analysis, prespecified stopping rules and early trial termination in neonatal randomised controlled trials (RCTs). METHODS We reviewed neonatal RCTs published in four high-impact general medical journals, specifically looking at safety issues including documented involvement of a DMC, stated interim analysis, stopping rules and early trial termination. We searched all journal issues over an 11-year period (2003-2013) and recorded predefined parameters on each item for RCTs meeting inclusion criteria. RESULTS Seventy neonatal trials were identified in four general medical journals: Lancet, New England Journal of Medicine (NEJM), British Medical Journal and Journal of American Medical Association. A total of 43 (61.4%) studies reported the presence of a DMC, 36 (51.4%) explicitly mentioned interim analysis, stopping rules were reported in 15 (21.4%) RCTs and seven (10%) trials were terminated early. The NEJM most frequently reported these parameters compared to the other three journals reviewed. CONCLUSION While the majority of neonatal RCTs report on DMC involvement and interim analysis, there is still scope for improvement. Clear documentation of safety-related issues should be a central component of reporting in neonatal trials involving newborn infants.
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Affiliation(s)
- LM Perrem
- Coombe Women and Infants University Hospital; Dublin 8 Ireland
| | - S Gosling
- Department of Paediatrics and Child Health; Neonatal Intensive Care Unit; Cork Ireland
| | - I Ravikumar
- Department of Paediatrics and Child Health; Neonatal Intensive Care Unit; Cork Ireland
| | - AS Khashan
- Department of Epidemiology and Public Health; University College Cork; Cork Ireland
- Irish Centre for Fetal and Neonatal Translational Research (INFANT); University College Cork; Cork Ireland
| | - J Miletin
- Coombe Women and Infants University Hospital; Dublin 8 Ireland
| | - CA Ryan
- Department of Paediatrics and Child Health; Neonatal Intensive Care Unit; Cork Ireland
| | - E Dempsey
- Department of Paediatrics and Child Health; Neonatal Intensive Care Unit; Cork Ireland
- Irish Centre for Fetal and Neonatal Translational Research (INFANT); University College Cork; Cork Ireland
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8
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Moving toward a paradigm shift in the regulatory requirements for pediatric medicines. Eur J Pediatr 2016; 175:1881-1891. [PMID: 27646479 DOI: 10.1007/s00431-016-2781-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 07/18/2016] [Accepted: 09/08/2016] [Indexed: 12/21/2022]
Abstract
UNLABELLED Over the past two decades, there has been growing concern over the lack of proper medication for children. This review attempts to evaluate the current progress of EU Pediatric Regulation made since 2007. The lack of properly evaluated pediatric medication has for long been a source of concern in the European Union. The drugs that were used in the past were often not properly evaluated, and dosage was arbitrarily calculated. Therefore, it was necessary to establish the Pediatric Regulation (EC no. 1901/2006) in the EU which would mandate research for pediatric drugs. Current legislations in place not only require mandatory research by pharma industry but also have guidelines to direct the quality of pediatric research performed. The main aim of this regulation was to advance high-quality research and development of pediatric drugs, thereby increasing the availability of safe and effective drugs for children. It also aimed to improve the information available on existing pediatric drugs. It has been 9 years since the pediatric regulation was framed. The pharma industry now sees pediatric research as an integral process of development. Drug companies which develop plans for a new drug, new form of drug, new indication, or new route of administration for adults are obliged to integrate in their development plan similar research for pediatric populations as well. CONCLUSION It is hoped that the implementation of the current legislation will be reflected better in the future by the marketing of better and safer drugs for the pediatric population. The upcoming assessment to the European Commission in 2017 will further inform us on the impact after 10 years implementation of the legislation. What is Known: • The lack of properly evaluated pediatric medication has for long been a source of concern in the European Union. • Therefore, it was necessary to establish the EU Pediatric Regulation which would mandate research for pediatric drugs. What is New: • It has been 9 years since the pediatric regulation was framed, and the teething problems are slowly being overcome and the regulation is being used with increasing confidence. • As the Regulation is due for revision in 2017, this paper gives a current perspective on the impact of the regulation on availability and access to medicine for children.
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9
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Pedroza C, Tyson JE, Das A, Laptook A, Bell EF, Shankaran S. Advantages of Bayesian monitoring methods in deciding whether and when to stop a clinical trial: an example of a neonatal cooling trial. Trials 2016; 17:335. [PMID: 27450203 PMCID: PMC4957277 DOI: 10.1186/s13063-016-1480-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 06/21/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Decisions to stop randomized trials are often based on traditional P value thresholds and are often unconvincing to clinicians. To familiarize clinical investigators with the application and advantages of Bayesian monitoring methods, we illustrate the steps of Bayesian interim analysis using a recent major trial that was stopped based on frequentist analysis of safety and futility. METHODS We conducted Bayesian reanalysis of a factorial trial in newborn infants with hypoxic-ischemic encephalopathy that was designed to investigate whether outcomes would be improved by deeper (32 °C) or longer cooling (120 h), as compared with those achieved by standard whole body cooling (33.5 °C for 72 h). Using prior trial data, we developed neutral and enthusiastic prior probabilities for the effect on predischarge mortality, defined stopping guidelines for a clinically meaningful effect, and derived posterior probabilities for predischarge mortality. RESULTS Bayesian relative risk estimates for predischarge mortality were closer to 1.0 than were frequentist estimates. Posterior probabilities suggested increased predischarge mortality (relative risk > 1.0) for the three intervention groups; two crossed the Bayesian futility threshold. CONCLUSIONS Bayesian analysis incorporating previous trial results and different pre-existing opinions can help interpret accruing data and facilitate informed stopping decisions that are likely to be meaningful and convincing to clinicians, meta-analysts, and guideline developers. TRIAL REGISTRATION ClinicalTrials.gov NCT01192776 . Registered on 31 August 2010.
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Affiliation(s)
- Claudia Pedroza
- Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.106, Houston, TX, 77030, USA.
| | - Jon E Tyson
- Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.106, Houston, TX, 77030, USA
| | - Abhik Das
- Social, Statistical and Environmental Sciences Unit, RTI International, 6110 Executive Blvd., Suite 902, Rockville, MD, 20852-3903, USA
| | - Abbot Laptook
- Department of Pediatrics, Women & Infants Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, 101 Dudley Street, Providence, RI, 02905, USA
| | - Edward F Bell
- Department of Pediatrics, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52240, USA
| | - Seetha Shankaran
- Department of Pediatrics, Neonatal-Perinatal Medicine, Wayne State University, Children's Hospital of Michigan, 3901 Beaubien Blvd., 4H46, Detroit, MI, 48201, USA
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Clyburne-Sherin AVP, Thurairajah P, Kapadia MZ, Sampson M, Chan WWY, Offringa M. Recommendations and evidence for reporting items in pediatric clinical trial protocols and reports: two systematic reviews. Trials 2015; 16:417. [PMID: 26385379 PMCID: PMC4574457 DOI: 10.1186/s13063-015-0954-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 09/11/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Complete and transparent reporting of clinical trial protocols and reports ensures that these documents are useful to all stakeholders, that bias is minimized, and that the research is not wasted. However, current studies repeatedly conclude that pediatric trial protocols and reports are not appropriately reported. Guidelines like SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) and CONSORT (Consolidated Standards of Reporting Trials) may improve reporting, but do not offer guidance on issues unique to pediatric trials. This paper reports two systematic reviews conducted to build the evidence base for the development of pediatric reporting guideline extensions: 1) SPIRIT-Children (SPIRIT-C) for pediatric trial protocols, and 2) CONSORT-Children (CONSORT-C) for pediatric trial reports. METHOD MEDLINE, the Cochrane Methodology Register, and reference lists of included studies were searched. Publications of any type were eligible if they included explicit recommendations or empirical evidence for the reporting of potential items in a pediatric protocol (SPIRIT-C systematic review) or trial report (CONSORT-C systematic review). Study characteristics, recommendations and evidence for pediatric extension items were extracted. Recurrent themes in the recommendations and evidence were identified and synthesized. All steps were conducted by two reviewers. RESULTS For the SPIRIT-C and CONSORT-C systematic reviews 366 and 429 publications were included, respectively. Recommendations were identified for 48 of 50 original reporting items and sub-items from SPIRIT, 15 of 20 potential SPIRIT-C reporting items, all 37 original CONSORT items and sub-items, and 16 of 22 potential CONSORT-C reporting items. The following overarching themes of evidence to support or refute the utility of reporting items were identified: transparency; reproducibility; interpretability; usefulness; internal validity; external validity; reporting bias; publication bias; accountability; scientific soundness; and research ethics. CONCLUSION These systematic reviews are the first to systematically gather evidence and recommendations for the reporting of specific items in pediatric protocols and trials. They provide useful and translatable evidence on which to build pediatric extensions to the SPIRIT and CONSORT reporting guidelines. The resulting SPIRIT-C and CONSORT-C will provide guidance to the authors of pediatric protocols and reports, respectively, helping to alleviate concerns of inappropriate and inconsistent reporting, and reduce research waste.
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Affiliation(s)
- April V P Clyburne-Sherin
- The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Child Health Evaluative Sciences, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
| | - Pravheen Thurairajah
- The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Child Health Evaluative Sciences, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
| | - Mufiza Z Kapadia
- The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Child Health Evaluative Sciences, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
| | - Margaret Sampson
- Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada.
| | - Winnie W Y Chan
- The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Child Health Evaluative Sciences, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
| | - Martin Offringa
- The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, Child Health Evaluative Sciences, 686 Bay Street, Toronto, ON, M5G 0A4, Canada. .,Senior Scientist and Program Head Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, SickKids Research Institute, 686 Bay Street, Toronto, ON, M5G 0A4, Canada.
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11
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Rahbar MH, Dickerson AS, Cai C, Pedroza C, Hessabi M, Shen L, Pandurengan R, Jacobs ANM, Indupuru H, Sline MR, Delgado RI, Macdonald C, Ford GA, Grotta JC, Barreto AD. Methodological issues for designing and conducting a multicenter, international clinical trial in Acute Stroke: Experience from ARTSS-2 trial. Contemp Clin Trials 2015; 44:139-148. [PMID: 26278031 DOI: 10.1016/j.cct.2015.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/06/2015] [Accepted: 08/08/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND We describe innovations in the study design and the efficient data coordination of a randomized multicenter trial of Argatroban in Combination with Recombinant Tissue Plasminogen Activator for Acute Stroke (ARTSS-2). METHODS ARTSS-2 is a 3-arm, multisite/multiregional randomized controlled trials (RCTs) of two doses of Argatroban injection (low, high) in combination with recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke patients and rt-PA alone. We developed a covariate adaptive randomization program that balanced the study arms with respect to study site as well as hemorrhage after thrombolysis (HAT) score and presence of distal internal carotid artery occlusion (DICAO). We used simulation studies to validate performance of the randomization program before making any adaptations during the trial. For the first 90 patients enrolled in ARTSS-2, we evaluated performance of our randomization program using chi-square tests of homogeneity or extended Fisher's exact test. We also designed a four-step partly Bayesian safety stopping rule for low and high dose Argatroban arms. RESULTS Homogeneity of the study arms was confirmed with respect to distribution of study site (UK sites vs. US sites, P=0.98), HAT score (0-2 vs. 3-5, P=1.0), and DICAO (N/A vs. No vs. Yes, P=0.97). Our stopping thresholds for safety of low and high dose Argatroban were not crossed. Despite challenges, data quality was assured. CONCLUSIONS We recommend adaptive designs for randomization and Bayesian safety stopping rules for multisite Phase I/II RCTs for maintaining additional flexibility. Efficient data coordination could lead to improved data quality.
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Affiliation(s)
- Mohammad H Rahbar
- Division of Clinical and Translational Sciences, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX 77030, USA; Division of Epidemiology, Human Genetics, and Environmental Sciences (EHGES), University of Texas School of Public Health at Houston, Houston, TX 77030, USA; Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
| | - Aisha S Dickerson
- Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
| | - Chunyan Cai
- Division of Clinical and Translational Sciences, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX 77030, USA; Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
| | - Claudia Pedroza
- Center for Clinical Research and Evidence-Based Medicine, University of Texas Medical School at Houston, Houston, TX 77030, USA.
| | - Manouchehr Hessabi
- Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
| | - Loren Shen
- Department of Neurology, Stroke Program, University of Texas Medical School at Houston, Houston, TX 77030, USA.
| | - Renganayaki Pandurengan
- Biostatistics/Epidemiology/Research Design (BERD) Component, Center for Clinical and Translational Sciences (CCTS), University of Texas Health Science Center at Houston, Houston, TX 77030, USA.
| | - Amber Nicole M Jacobs
- Department of Neurology, Stroke Program, University of Texas Medical School at Houston, Houston, TX 77030, USA.
| | - Hari Indupuru
- Department of Neurology, Stroke Program, University of Texas Medical School at Houston, Houston, TX 77030, USA.
| | - Melvin R Sline
- Department of Neurology, Stroke Program, University of Texas Medical School at Houston, Houston, TX 77030, USA.
| | - Rigoberto I Delgado
- Department of Management, Policy & Community Health, University of Texas School of Public Health at Houston, Houston, TX 77030, USA.
| | - Claire Macdonald
- Newcastle Clinical Trials Unit (NCTU), Newcastle University, Newcastle upon Tyne NE2 4AE, United Kingdom.
| | - Gary A Ford
- Newcastle Clinical Trials Unit (NCTU), Newcastle University, Newcastle upon Tyne NE2 4AE, United Kingdom; Oxford Academic Health Science Network, Magdalen Centre North, Oxford Science Park, OX4 4GA, United Kingdom.
| | - James C Grotta
- Clinical Innovation and Research Institute, Memorial Hermann Hospital, Houston, TX 77030, USA.
| | - Andrew D Barreto
- Department of Neurology, Stroke Program, University of Texas Medical School at Houston, Houston, TX 77030, USA.
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12
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Van't Hoff W, Offringa M. StaR Child Health: developing evidence-based guidance for the design, conduct and reporting of paediatric trials. Arch Dis Child 2015; 100:189-92. [PMID: 25260517 DOI: 10.1136/archdischild-2012-303094] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
There has been a huge upsurge in clinical research in children in the last decade, stimulated in England by dedicated research infrastructure and support through the National Institute for Health Research. This infrastructure offering research design, expert review, trial management, research nurse, data support and dedicated facilities enables paediatricians to conduct more and better research. The challenge is how to design and conduct trials that will make a real difference to children's health. Standards for Research (StaR) in Child Health was founded in 2009 to address the paucity and shortcomings of paediatric clinical trials. This global initiative involves methodologists, clinicians, patient advocacy groups and policy makers dedicated to developing practical, evidence-based standards for enhancing the reliability and relevance of paediatric clinical research. In this overview, we highlight the contribution of StaR to this agenda, describe the international context, and suggest how StaR's future plans could be integrated with new and existing support for research.
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Affiliation(s)
- William Van't Hoff
- Somers Clinical Research Facility, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Martin Offringa
- Child Health Evaluative Sciences (CHES), Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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13
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Cohen JL. Scientific skepticism and new discoveries: an analysis of a report of zinc/phytase supplementation and the efficacy of botulinum toxins in treating cosmetic facial rhytides, hemifacial spasm and benign essential blepharospasm. J COSMET LASER THER 2014; 16:258-62. [PMID: 25105993 DOI: 10.3109/14764172.2014.948882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION A recent paper in the Journal of Drugs in Dermatology by Koshy and colleagues (2012, 11( 4 ):507-512) report on "Effect of Dietary Zinc and Phytase Supplementation on Botulinum Toxin Treatments" and conclude by claiming the discovery of "a potentially meaningful role for zinc and/or phytase supplementation in increasing the degree and duration of botulinum toxin effect in the treatment of cosmetic facial rhytids, benign essential blepharospasm, and hemifacial spasm". The purpose of this paper is to examine these published claims for possible methodological and design errors and potential sources of bias. METHODS The authors evaluated the published results in comparison to the published literature on zinc deficiency, the role of phytase, prior reports of an effect of zinc on activity of botulinum toxin, issues of study design and execution and if the reported results of the study supported the study's conclusions. RESULTS Multiple issues are present in the reported study, which appear to invalidate its conclusions. These areas include lack of direct evidence for the presence of clinical or subclinical zinc deficiency in the study population or for the level of phytate in the study population sufficient to interfere with zinc absorption in these subjects. Additionally, there is ambiguity as to the actual dose of zinc used as well as in the study design itself. Also there is a failure of the study through the "unmasking" of the crossover design. There is potential financial conflict of interest in the study execution that may have biased the reported results. Finally there is inadequate data presented to evaluate the claims made of a "new discovery" as to the three disease entities reported on and the various botulinum toxins used in each of the three treatment arms of the study. DISCUSSION Based on this evaluation, it appears that a high level of clinical and scientific skepticism is warranted concerning any claim of a beneficial effect of zinc and phytase supplementation on the efficacy or potency of any botulinum toxins in the reported conditions.
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Affiliation(s)
- Joel L Cohen
- University of California Irvine, Dept. of Dermatology , Englewood, CO , USA
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Blazeby JM. Randomized clinical trial of glutamine-supplemented versus standard parenteral nutrition in infants with surgical gastrointestinal disease (Br J Surg 2012; 99: 929-938). Br J Surg 2012; 99:939. [PMID: 22648641 DOI: 10.1002/bjs.8751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- J M Blazeby
- Academic Unit of Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK.
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15
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Hartling L, Wittmeier KDM, Caldwell P, van der Lee H, Klassen TP, Craig JC, Offringa M. StaR child health: developing evidence-based guidance for the design, conduct, and reporting of pediatric trials. Pediatrics 2012; 129 Suppl 3:S112-7. [PMID: 22661756 DOI: 10.1542/peds.2012-0055c] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Lisa Hartling
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
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