Publication and non-publication of drug trial results: a 10-year cohort of trials in Norwegian general practice

Investigator initiated trials versus industry sponsored trials - translation of randomized controlled trials into clinical practice (IMPACT)

BACKGROUND

Healthcare decisions are ideally based on clinical trial results, published in study registries, as journal articles or summarized in secondary research articles. In this research project, we investigated the impact of academically and commercially sponsored clinical trials on medical practice by measuring the proportion of trials published and cited by systematic reviews and clinical guidelines.

METHODS

We examined 691 multicenter, randomized controlled trials that started in 2005 or later and were completed by the end of 2016. To determine whether sponsorship/funding and place of conduct influence a trial's impact, we created four sub-cohorts of investigator initiated trials (IITs) and industry sponsored trials (ISTs): 120 IITs and 171 ISTs with German contribution compared to 200 IITs and 200 ISTs without German contribution. We balanced the groups for study phase and place of conduct. German IITs were funded by the German Research Foundation (DFG), the Federal Ministry of Education and Research (BMBF), or by another non-commercial research organization. All other trials were drawn from the German Clinical Trials Register or ClinicalTrials.gov. We investigated, to what extent study characteristics were associated with publication and impact using multivariable logistic regressions.

RESULTS

For 80% of the 691 trials, results were published as result articles in a medical journal and/or study registry, 52% were cited by a systematic review, and 26% reached impact in a clinical guideline. Drug trials and larger trials were associated with a higher probability to be published and to have an impact than non-drug trials and smaller trials. Results of IITs were more often published as a journal article while results of ISTs were more often published in study registries. International ISTs less often gained impact by inclusion in systematic reviews or guidelines than IITs.

CONCLUSION

An encouraging high proportion of the clinical trials were published, and a considerable proportion gained impact on clinical practice. However, there is still room for improvement. For publishing study results, study registries have become an alternative or complement to journal articles, especially for ISTs. IITs funded by governmental bodies in Germany reached an impact that is comparable to international IITs and ISTs.

Publication and associated factors of clinical trials registered in Peru

OBJECTIVE

We aim to determine the percentage of publication and its associated factors of clinical trials (CTs) registered in Peru.

METHODS

Using a cross-sectional study design, we assessed CTs registered at the CT's Peruvian Registry (REPEC) during the 2011-2016 period, and evaluated its percentage of publication and associated factors. We used a bibliographic search algorithm to determine if the CTs were published and assessed the associated factors by using a Cox regression to estimate the adjusted hazard ratios (aHR) as the magnitude of association of interest.

RESULTS

We analyzed 228 CTs, of which 63% were published. The regression analysis identified the year of registration (aHR 2012 = 1.15 [0.58-2.27]; aHR 2013 = 0.45 [0.21-0.95]; aHR 2014 = 0.89 [0.43-1.82]; aHR 2015-2016 = 0.16 [0.05-0.58]), total number of participants (aHR = 1.12; 1.05-1.18), and phase III-IV (aHR = 2.15; 0.1.16-4.03) as factors associated with the publication of the CTs.

CONCLUSIONS

The percentage of publication of CTs executed in Peru is insufficient, and it increases the older the year of its registration in the REPEC, mayor of the number of participating countries, and if it is a phase III or IV study.

Clinical trial publications

Clinical trials are observations or experiments performed in clinical research. It is customary for researchers to publish their interim findings during the course of the trial. However, publishing the final results and outcomes is imperative. The CONSORT statement was developed to aid the randomized control clinical trial's authors to standardize the reporting of the trial's design, analysis, and interpretation of the results. Readers need to understand all the trial outcomes irrespective of whether they are beneficial or harmful as these impact future research. Well-reported clinical trials are a must as these provide the basis for systemic reviews, meta-analyses, and eventual clinical guidelines.

Scientific Misconduct: A Global Concern

In today's world, evil appears to be all pervading. Medical publication is no exception. Scientific misconduct in medical writing is slowly becoming a global concern, especially over the last few decades. While the occurrence of such events is certainly rare, every researcher and reader should be aware of this entity. The researcher should ensure that no inadvertent error is construed as misconduct, and should take every effort to guard against it, and the reader should have a critical eye for the same. This article looks into various aspects of scientific misconduct and encourages awareness regarding the same.

An audit to evaluate an institute's lead researchers' knowledge of trial registries and to investigate adherence to data transparency issues in an Italian research institute registry

BACKGROUND

Clinical trial registries have been a priority topic in the past few years in promoting data transparency and accountability. In this context, in 2011, the IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri" set up a registry to collect data on all studies in which the institute's researchers are involved. In this study we present a self-audit in order to detect the lead researchers' general knowledge on registries, the completeness and quality of the randomized controlled trial (RCT) data inputted in an Italian research institute's registry, and the researchers' adherence to both registration requirements and the institute transparency goal, aiming to improve standards and leading to greater awareness of the issues involved.

METHODS

A questionnaire-based audit was conducted. To interview researchers we included questions ranging from general knowledge on registries (e.g., what are the aims of registries?) to questions about their knowledge of the Mario Negri's registry, questions on selected trials and registration, included information on the protocol, and the results.

RESULTS

The audit sample covers 12 of the 47 RCTs at the institute's Milan branch, representing all the possible lead researchers responsible for RCTs at the institute. The researchers have more than a basic knowledge of trial registries and their aims. All the researchers reported that they know of the ClinicalTrials.gov registry and most of them reported that they frequently use it; however, only a few know about the World Health Organization's registry platform (International Clinical Trials Registry Platform). The most cited registry aims reported were increased transparency and reduced publication bias. Of the studies registered in the institute's registry, 92% had at least one data item missing in the registry record. Concerning trial registration in the international registries, all 12 respondents said their trial had been registered and specified the registry name, but often they had not inputted the associated trial ID code in the corresponding field of the institute's registry. Concerning two important issues on data transparency and ethical standards, namely registration timing and result reporting, 11 stated that their trial was registered before starting recruitment, and for five of six closed trials they stated that their results have been already published-for one trial within 1 year after its completion.

CONCLUSIONS

Researchers should guarantee correct reporting of trials and their data as a rule of great ethical value. Institutional self-audits should be performed periodically in order to improve clinical trial disclosure.

Delays in the Publication of Important Clinical Trial Findings in Oncology

Importance

The complete and timely dissemination of clinical trial data is essential to all fields of medicine, with delayed or incomplete data release having potentially deleterious effects on both patient care and scientific inquiry. While prior analyses have noted a substantial lag in the reporting of final clinical study results, we sought to refine these observations through use of a novel starting point for the measurement of dissemination delays: the date of a corporate press release regarding a phase 3 study's results.

Objective

To measure the length of time elapsed between when a sponsor had results of study findings they deemed important to announce, and when the medical community had access to them.

Design and Setting

Covering the years 2011 through 2016, we measured the delay from when 8 large pharmaceutical companies issued a press release announcing completed analyses of phase 3 clinical trials in oncology, and the public sharing of those results either on ClinicalTrials.gov or in a peer-reviewed biomedical journal as found via PubMed or Google Scholar. Press releases announcing regulatory steps and presentation schedules for conferences were excluded, as were those announcing results from preclinical trials, follow-up analyses, and studies of supportive care therapies or various modes of infusion for the same therapy.

Main Outcomes and Measures

Time to public dissemination of clinical trial data.

Results

Of the 100 press releases in our sample, 70 (70%) reported positive results, but only 31 (31%) included the magnitude of study findings. Through the end of follow-up, 99 (99%) of press releases had an associated peer-reviewed publication, complete data posting to ClinicalTrials.gov, or both, with a median time to reporting of 300 days (95% CI, 263-348 days). Positive findings were reported more quickly than negative ones (median of 272; 95% CI, 211-318 days vs 407; 95% CI, 298-705 days; log-rank P < .001).

Conclusions and Relevance

Even for the most pressing study findings, median publication delays approach 1 year. As publication delays hinder research progress and advancements in clinical care, policies that enable early preprint release or public posting of completed data analysis should be pursued.

Clinical drug trials in general practice: how well are external validity issues reported?

BACKGROUND

When reading a report of a clinical trial, it should be possible to judge whether the results are relevant for your patients. Issues affecting the external validity or generalizability of a trial should therefore be reported. Our aim was to determine whether articles with published results from a complete cohort of drug trials conducted entirely or partly in general practice reported sufficient information about the trials to consider the external validity.

METHODS

A cohort of 196 drug trials in Norwegian general practice was previously identified from the Norwegian Medicines Agency archive with year of application for approval 1998-2007. After comprehensive literature searches, 134 journal articles reporting results published from 2000 to 2015 were identified. In these articles, we considered the reporting of the following issues relevant for external validity: reporting of the clinical setting; selection of patients before inclusion in a trial; reporting of patients' co-morbidity, co-medication or ethnicity; choice of primary outcome; and reporting of adverse events.

RESULTS

Of these 134 articles, only 30 (22%) reported the clinical setting of the trial. The number of patients screened before enrolment was reported in 61 articles (46%). The primary outcome of the trial was a surrogate outcome for 60 trials (45%), a clinical outcome for 39 (29%) and a patient-reported outcome for 25 (19%). Clinical details of adverse events were reported in 124 (93%) articles. Co-morbidity of included participants was reported in 54 trials (40%), co-medication in 27 (20%) and race/ethnicity in 78 (58%).

CONCLUSIONS

The clinical setting of the trials, the selection of patients before enrolment, and co-morbidity or co-medication of participants was most commonly not reported, limiting the possibility to consider the generalizability of a trial. It may therefore be difficult for readers to judge whether drug trial results are applicable to clinical decision-making in general practice or when developing clinical guidelines.

Publication of interventional phase 3 and 4 clinical trials in radiation oncology: an observational study

OBJECTIVES

Clinical trials produce the best data available for decision-making in modern evidence-based medicine. We aimed to determine the rate of non-publication of interventional phase 3 and 4 clinical trials involving patients with cancer undergoing radiotherapy.

SETTING

The ClinicalTrials.gov database was searched for interventional phase 3 and 4 trials in radiotherapy with a primary completion date before 1 January 2013. We determined how many of these registry entries have not published the compulsory deposition of their results in the database and performed a systematic search for published studies in peer-reviewed journals.

RESULTS

Of 576 trials, 484 (84.0%) did not deposit a summary result in the registry. In addition, 44.9% of them did not publish their results in a peer-reviewed journal. Similar percentages were found for most cancer subtypes: brain (41%), breast (38%), cervical (66%), colorectal (38%), lung (48%), prostate (45%), bladder (56%), head and neck (56%) and lymphoma (33%).

CONCLUSION

Our results show that most trials in radiation oncology did not report the results in the registry. Almost half of these trials have not been published in the biomedical literature. This means that a large number of study participants were exposed to the risks of trial participation without the supposed benefits that sharing and publishing of results would offer to future generations of patients.

Discontinuation and non-publication of clinical trials in cardiovascular medicine

BACKGROUND

Appropriate dissemination of clinical data is crucial for minimising bias. Despite this, high rates of study discontinuation and non-publication have been reported among clinical trials. Cardiovascular medicine receives a substantial proportion of academic funding; however, predictors of non-publication among cardiovascular trials are not well-established.

METHODS

The National Clinical Trials database was searched for cardiovascular trials completed between January 2010 and January 2014. Associated publications were identified in Medline or Embase. Relevant variables were extracted and subject to chi-squared and logistic regression to identify predictors of discontinuation and non-publication.

RESULTS

After reviewing 2035 trials, 431 trials were included, of which 82.1% (n=354; 119,233 participants) were completed. Among completed trials, 70.3% (n=249; 99,095 participants) were published. Industry funding was associated with increased likelihood of non-publication (odds ratio [OR] 2.84; 95% confidence interval [CI] 1.47-5.51; P=0.002), while non-randomised studies were more likely to remain unpublished than randomised counterparts. Industry-funded studies were over three times more likely to be discontinued than those sponsored by academic institutions (OR 3.89; CI 1.54-9.83; P=0.004). Trials studying heart failure and atrial fibrillation were more likely to be discontinued compared to trials studying coronary artery disease (OR 2.83; CI 1.23-6.51; and OR 3.10; CI 1.21-7.96, respectively). Of the total 135,714 participants, 25,565 were recruited into unpublished studies.

CONCLUSIONS

Discontinuation and non-publication of cardiovascular trials are common, resulting in data from thousands of participants remaining unpublished. Funding source and randomisation are strong predictors of non-publication, while sponsor type, phase and blinding status are key predictors of discontinuation.