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Komorowski AS, Lo CKL, Kapoor AK, Smieja M, Loeb M, Mertz D, Bai AD. More Than a Decade Since the Latest CONSORT Non-inferiority Trials Extension: Do Infectious Diseases Trials Do Enough? Clin Infect Dis 2024; 78:324-329. [PMID: 37739456 DOI: 10.1093/cid/ciad574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/05/2023] [Accepted: 09/20/2023] [Indexed: 09/24/2023] Open
Abstract
More than a decade after the Consolidated Standards of Reporting Trials group released a reporting items checklist for non-inferiority randomized controlled trials, the infectious diseases literature continues to underreport these items. Trialists, journals, and peer reviewers should redouble their efforts to ensure infectious diseases studies meet these minimum reporting standards.
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Affiliation(s)
- Adam S Komorowski
- Medical Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methodology, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Carson K L Lo
- Transplant Infectious Diseases and Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Andrew K Kapoor
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Marek Smieja
- Medical Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methodology, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Mark Loeb
- Medical Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methodology, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Dominik Mertz
- Department of Health Research Methodology, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anthony D Bai
- Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, Ontario, Canada
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Lo CKL, Komorowski AS, Hall CW, Sandstrom TS, Alamer AAM, Mourad O, Li XX, Al Ohaly R, Benoit MÈ, Duncan DB, Fuller CA, Shaw S, Suresh M, Smaill F, Kapoor AK, Smieja M, Mertz D, Bai AD. Methodological and Reporting Quality of Noninferiority Randomized Controlled Trials Comparing Antiretroviral Therapies: A Systematic Review. Clin Infect Dis 2023; 77:1023-1031. [PMID: 37243351 DOI: 10.1093/cid/ciad308] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/15/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND It is unclear whether the reporting quality of antiretroviral (ARV) noninferiority (NI) randomized controlled trials (RCTs) has improved since the CONSORT guideline release in 2006. The primary objective of this systematic review was assessing the methodological and reporting quality of ARV NI-RCTs. We also assessed reporting quality by funding source and publication year. METHODS We searched Medline, Embase, and Cochrane Central from inception to 14 November 2022. We included NI-RCTs comparing ≥2 ARV regimens used for human immunodeficiency virus treatment or prophylaxis. We used the Cochrane Risk of Bias 2.0 tool to assess risk of bias. Screening and data extraction were performed blinded and in duplicate. Descriptive statistics were used to summarize data; statistical tests were 2 sided, with significance defined as P < .05. The systematic review was prospectively registered (PROSPERO CRD42022328586), and not funded. RESULTS We included 160 articles reporting 171 trials. Of these articles, 101 (63.1%) did not justify the NI margin used, and 28 (17.5%) did not provide sufficient information for sample size calculation. Eighty-nine of 160 (55.6%) reported both intention-to-treat and per-protocol analyses, while 118 (73.8%) described missing data handling. Ten of 171 trials (5.9%) reported potentially misleading results. Pharmaceutical industry-funded trials were more likely to be double-blinded (28.1% vs 10.3%; P = .03) and to describe missing data handling (78.5% vs 59.0%; P = .02). The overall risk of bias was low in 96 of 160 studies (60.0%). CONCLUSIONS ARV NI-RCTs should improve NI margin justification, reporting of intention-to-treat and per-protocol analyses, and missing data handling to increase CONSORT adherence.
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Affiliation(s)
- Carson K L Lo
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Transplant Infectious Diseases and Ajmera Transplant Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Adam S Komorowski
- Division of Medical Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methodology, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Clayton W Hall
- Division of Medical Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Teslin S Sandstrom
- Division of Medical Microbiology, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Amnah A M Alamer
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Internal Medicine, King Faisal University, Hofuf, Saudi Arabia
| | - Omar Mourad
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Xena X Li
- Division of Medical Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Shared Hospital Laboratory, Toronto, Ontario, Canada
| | - Rand Al Ohaly
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Marie-Ève Benoit
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Medical Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - D Brody Duncan
- Division of Medical Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Charlotte A Fuller
- Division of Medical Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Shazeema Shaw
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Infectious Diseases, Georgetown Public Hospital Corporation, Georgetown, Guyana
| | - Mallika Suresh
- Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Fiona Smaill
- Division of Medical Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Andrew K Kapoor
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Marek Smieja
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Medical Microbiology, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methodology, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Dominik Mertz
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methodology, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Anthony D Bai
- Department of Health Research Methodology, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, Ontario, Canada
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Menendez ME, Sudah SY, Cohn MR, Narbona P, Lädermann A, Barth J, Denard PJ. Defining Minimal Clinically Important Difference and Patient Acceptable Symptom State After the Latarjet Procedure. Am J Sports Med 2022; 50:2761-2766. [PMID: 35850119 DOI: 10.1177/03635465221107939] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Latarjet procedure is one of the most well-established treatment options for anterior shoulder instability. However, meaningful clinical outcomes after this surgery have not been defined. PURPOSE This study aimed to establish the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) for commonly used outcome measures in patients undergoing the Latarjet procedure and determine correlations between preoperative patient characteristics and achievement of MCID or PASS. STUDY DESIGN Case series; Level of evidence, 4. METHODS A multicenter retrospective review at 4 institutions was performed to identify patients undergoing primary open Latarjet procedure with minimum 2-year follow-up. Data collected included patient characteristics (age, sex, sports participation), radiological parameters (glenoid bone loss, off-track Hill-Sachs lesion), and 4 patient-reported outcome measures (collected preoperatively and 2 years postoperatively): the American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation (SANE), the visual analog scale (VAS) for pain, and the Western Ontario Shoulder Instability Index (WOSI). The MCID and PASS for each outcome measure were calculated, and Pearson and Spearman coefficient analyses were used to identify correlations between MCID or PASS and preoperative variables (age, sex, sports participation, glenoid bone loss, off-track Hill-Sachs lesion). RESULTS A total of 156 patients were included in the study. The MCID values for ASES, SANE, VAS pain, and WOSI were calculated to be 9.6, 12.4, 1.7, and 254.9, respectively. The PASS values for ASES, SANE, VAS pain, and WOSI were 86.0, 82.5, 2.5, and 571.0, respectively. The rates of patients achieving MCID were 61.1% for VAS pain, 71.6% for ASES, 74.1% for SANE, and 84.2% for WOSI. The rates of achieving PASS ranged from 78.4% for WOSI to 84.0% for VAS pain. There was no correlation between any of the studied preoperative variables and the likelihood of achieving MCID or PASS. CONCLUSION This study defined MCID and PASS values for 4 commonly used outcome measures in patients undergoing the Latarjet procedure. These findings are essential for incorporating patient perspectives into the clinical effectiveness of the Latarjet procedure and provide valuable parameters for the design and interpretation of future clinical trials.
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Affiliation(s)
- Mariano E Menendez
- Oregon Shoulder Institute at Southern Oregon Orthopedics, Medford, Oregon, USA.,Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Suleiman Y Sudah
- Department of Orthopedics, Monmouth Medical Center, Long Branch, New Jersey, USA
| | - Matthew R Cohn
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Pablo Narbona
- Department of Shoulder Surgery, Sanatorio Allende, Córdoba, Argentina
| | - Alexandre Lädermann
- Division of Orthopaedics and Trauma Surgery, La Tour Hospital, Meyrin, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Division of Orthopaedics and Trauma Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Johannes Barth
- Centre Ostéo-Articulaire des Cèdres, Parc Sud Galaxie, Echirolles, France
| | - Patrick J Denard
- Oregon Shoulder Institute at Southern Oregon Orthopedics, Medford, Oregon, USA
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