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Rivero-de-Aguilar A, Pérez-Ríos M, Mascareñas-García M, Ruano-Raviña A, Ross JS, Casal-Acción B, Varela-Lema L. Discrepancies in the results reported for multiple sclerosis clinical trials: A comparison between ClinicalTrials.gov and peer-reviewed journals. Mult Scler 2024:13524585241273089. [PMID: 39189062 DOI: 10.1177/13524585241273089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
OBJECTIVE We aimed to compare the results of phase III and IV clinical trials examining drugs to treat multiple sclerosis (MS) registered at ClinicalTrials.gov to those published in peer-reviewed journals. METHODS After identifying trials registered at ClinicalTrials.gov, consecutive searches were conducted in PubMed, EMBASE and Google Scholar for matching publications. Information regarding participants and efficacy and safety results was extracted and compared. The degree of consistency was classified as 'concordant', 'discrepant' or 'not comparable'. The Kaplan-Meier method was used to model time to reporting. RESULTS In total, 65 trials were appraised. The median time from completion to reporting was shorter for ClinicalTrials.gov (16.4 vs 27.3 months; p = 0.010). Information availability was generally higher in journals except for serious adverse events (SAEs) (86.2% vs 100.0%, p = 0.029) and their description (78.2% vs 100.0%, p < 0.001). However, 45 trials had at least one reporting discrepancy (69.2%). Three studies omitted one or more primary outcomes in the matching journal publication. Regarding safety results, the lowest consistencies were found for causes of death (60.0%) and description of SAEs (27.9%). CONCLUSION Consulting both ClinicalTrials.gov and journals increases the accessibility to MS clinical trial results. Some data were frequently missing or disagreed between sources, raising concerns about transparency and generalizability of results.
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Affiliation(s)
- Alejandro Rivero-de-Aguilar
- Department of Neurology, University Hospital Complex of Pontevedra, Pontevedra, Spain
- Department of Epidemiology and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Mónica Pérez-Ríos
- Department of Epidemiology and Public Health, School of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Marta Mascareñas-García
- Department of Epidemiology and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Department of Preventive Medicine, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alberto Ruano-Raviña
- Department of Epidemiology and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Joseph S Ross
- Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | | | - Leonor Varela-Lema
- Department of Epidemiology and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Borah R, Samanta AD, Rajueni K, Vaswani V, Saberwal G. In India, most principal investigators have run very few trials over the years. Front Med (Lausanne) 2024; 11:1424570. [PMID: 39170039 PMCID: PMC11335508 DOI: 10.3389/fmed.2024.1424570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 07/26/2024] [Indexed: 08/23/2024] Open
Abstract
Background In the past, clinical trials run in India have been the subject of criticism. Among other steps to improve the trial ecosystem, for some time the government limited the number of trials that a Principal Investigator (PI) could run to three at a time. We were interested to know how many trials PIs in India tend to run at a time. Methods We accessed the 52,149 trial records hosted by the Clinical Trials Registry-India in April 2023. Of these, we shortlisted trials that had run in India, were interventional, and involved certain interventions such as drug, biological etc. We used multiple parameters, such as email ID, phone number etc. to determine whether one name always represented the same PI and whether two names corresponded to the same PI. We then determined how many trials each PI had run. Results We found that 3,916 unique PI names were associated with 6,665 trials. Of these, 2,963 (75.7%) PIs had run a single study. Only 251 (6.4%) had run more than three trials. A mere 14 PIs had run 20 or more trials. The 14 PIs were affiliated with local pharma companies (6), local or global contract research organizations (4), multinational pharma companies (3) and the Central Council for Research in Homeopathy (1). The maximum number of trials run by a single PI was 108. Of these, the largest number run in a single year, 2022, was 53. Conclusion Each PI name needs to be connected to a unique ID that does not change with time, so that it is easier to track the number of trials that a given PI has run. The number of studies run by a given PI at a given time must not be excessive and needs to be monitored more actively. The government needs to consider whether a cap on the number of trials that a PI runs at a time is required and what infrastructure needs to be in place to facilitate higher numbers of trials. Trial registry records need to be updated more regularly. Other countries may wish to do likewise.
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Affiliation(s)
- Rishima Borah
- Institute of Bioinformatics and Applied Biotechnology, Bengaluru, India
| | | | - Khujith Rajueni
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Vina Vaswani
- Yenepoya (Deemed to be University), Mangaluru, India
| | - Gayatri Saberwal
- Institute of Bioinformatics and Applied Biotechnology, Bengaluru, India
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Bhalla IS, Ravindranath AG, Vaswani R, Saberwal G. Data from the Indian drug regulator and from Clinical Trials Registry-India does not always match. Front Med (Lausanne) 2024; 11:1346208. [PMID: 38435394 PMCID: PMC10906088 DOI: 10.3389/fmed.2024.1346208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/19/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction In India, regulatory trials, which require the drug regulator's permission, must be registered with the Clinical Trials Registry-India (CTRI) as of 19 March 2019. In this study, for about 300 trials, we aimed to identify the CTRI record that matched the trial for which the regulator had given permission. After identifying 'true pairs', our goal was to determine whether the sites and Principal Investigators mentioned in the permission letter were the same as those mentioned in the CTRI record. Methods We developed a methodology to compare the regulator's permission letters with CTRI records. We manually validated 151 true pairs by comparing the titles, the drug interventions, and the indications. We then examined discrepancies in their trial sites and Principal Investigators. Results Our findings revealed substantial variations in the number and identity of sites and Principal Investigators between the permission letters and the CTRI records. Discussion These discrepancies raise concerns about the accuracy and transparency of regulatory trials in India. We recommend easier data extraction from regulatory documents, cross-referencing regulatory documents and CTRI records, making public the changes to approval letters, and enforcing oversight by Institutional Ethics Committees for site additions or deletions. These steps will increase transparency around regulatory trials running in India.
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Affiliation(s)
- Iqbal S. Bhalla
- School of Geography and the Environment, Oxford University, Oxford, United Kingdom
| | | | - Ravi Vaswani
- Yenepoya Deemed to be University, Mangaluru, India
| | - Gayatri Saberwal
- Institute of Bioinformatics and Applied Biotechnology, Bengaluru, India
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Naderi N, Mosahebi A, Williams NR. Microorganisms and Breast Cancer: An In-Depth Analysis of Clinical Studies. Pathogens 2023; 13:6. [PMID: 38276152 PMCID: PMC10819802 DOI: 10.3390/pathogens13010006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/24/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024] Open
Abstract
Breast cancer is a multifactorial disease that affects millions of women worldwide. Recent work has shown intriguing connections between microorganisms and breast cancer, which might have implications for prevention and treatment. This article analyzed 117 relevant breast cancer clinical studies listed on ClinicalTrials.gov selected using a bespoke set of 38 search terms focused on bacteria, viruses, and fungi. This was supplemented with 20 studies found from a search of PubMed. The resulting 137 studies were described by their characteristics such as geographic distribution, interventions used, start date and status, etc. The studies were then collated into thematic groups for a descriptive analysis to identify knowledge gaps and emerging trends.
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Affiliation(s)
- Naghmeh Naderi
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London NW3 2QG, UK; (N.N.); (A.M.)
- Division of Surgery & Interventional Science, University College London, London W1W 7TY, UK
| | - Afshin Mosahebi
- Department of Plastic and Reconstructive Surgery, Royal Free Hospital, London NW3 2QG, UK; (N.N.); (A.M.)
- Division of Surgery & Interventional Science, University College London, London W1W 7TY, UK
| | - Norman R. Williams
- Division of Surgery & Interventional Science, University College London, London W1W 7TY, UK
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Robinson P, Bacon CM, Lim SJ, Shaaban AM, Brierley D, Lewis I, Harrison DJ, Kendall TJ, Robinson M. Assessment of clinical trial protocols for pathology content using the SPIRIT-Path guidelines highlights areas for improvement. J Pathol Clin Res 2022; 8:411-421. [PMID: 35638866 PMCID: PMC9353656 DOI: 10.1002/cjp2.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/24/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022]
Abstract
The SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013 Statement provides evidence-based recommendations for the minimum content of clinical trial protocols. The Cellular Molecular Pathology Initiative, hosted by the UK National Cancer Research Institute, developed an extension, SPIRIT-Path, describing how to effectively incorporate pathology support into clinical trial protocols. The current study assessed the inclusion of SPIRIT-Path items in protocols of active clinical trials. Publicly available clinical trial protocols were identified for assessment against the new guidelines using a single UK hospital as the 'test site'. One hundred and ninety interventional clinical trials were identified as receiving support from the pathology department. However, only 38 had publicly available full trial protocols (20%) and following application of the inclusion/exclusion criteria, 19 were assessed against the SPIRIT-Path guidelines. The reviewed clinical trial protocols showed some areas of compliance and highlighted other items that were inadequately described. The latter lacked information about the individuals responsible for the pathology content of the trial protocol, how pathology activities and roles were organised in the trial, where the laboratory work would be carried out, and the accreditation status of the laboratory. Only one trial had information specific to digital pathology, a technology certain to become more prevalent in the future. Adoption of the SPIRIT-Path checklist will facilitate comprehensive trial protocols that address all the key cellular and molecular pathology aspects of interventional clinical trials. This study highlights once again the lack of public availability of trial protocols. Full trial protocols should be available for scrutiny by the scientific community and the public who participate in the studies, increasing the transparency of clinical trial activity and improving quality.
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Affiliation(s)
- Peter Robinson
- School of Medical EducationNewcastle UniversityNewcastle upon TyneUK
| | - Chris M Bacon
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
- Department of Cellular PathologyNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Shujing J Lim
- Department of Cellular PathologyNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Abeer M Shaaban
- Department of HistopathologyQueen Elizabeth HospitalBirminghamUK
- Institute of Cancer and Genomic SciencesUniversity of BirminghamBirminghamUK
| | - Daniel Brierley
- Unit of Oral and Maxillofacial PathologyUniversity of SheffieldSheffieldUK
| | - Ian Lewis
- National Cancer Research InstituteLondonUK
| | | | | | - Max Robinson
- Department of Cellular PathologyNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
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Jurić D, Zlatin M, Marušić A. Inadequate reporting quality of registered genome editing trials: an observational study. BMC Med Res Methodol 2022; 22:131. [PMID: 35501706 PMCID: PMC9063127 DOI: 10.1186/s12874-022-01574-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background To assess registration completeness and safety data of trials on human genome editing (HGE) reported in primary registries and published in journals, as HGE has safety and ethical problems, including the risk of undesirable and unpredictable outcomes. Registration transparency has not been evaluated for clinical trials using these novel and revolutionary techniques in human participants. Methods Observational study of trials involving engineered site-specific nucleases and long-term follow-up observations, identified from the WHO ICTRP HGE Registry in November 2020 and two comprehensive reviews published in the same year. Registration and adverse events (AEs) information were collected from public registries and matching publications. Published data were extracted in May 2021. Results Among 81 eligible trials, most were recruiting (51.9%) phase 1 trials (45.7%). Five trials were withdrawn. Most trials investigated CAR T cells therapies (45.7%) and used CRISPR/Cas9 (35.8%) ex vivo (88.9%). Among 12 trials with protocols both registered and published, eligibility criteria, sample size, and secondary outcome measures were consistently reported for less than a half. Three trials posted results in ClinicalTrials.gov, and one reported serious AEs. Conclusions Incomplete registration and published data give emphasis to the need to increase the transparency of HGE trials. Further improvements in registration requirements, including phase 1 trials, and a more controlled publication procedure, are needed to augment the implementation of this promising technology. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01574-0.
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Affiliation(s)
- Diana Jurić
- Department of Pharmacology, School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia.
| | - Michael Zlatin
- School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia
| | - Ana Marušić
- Department of Research in Biomedicine and Health, School of Medicine, University of Split, Šoltanska 2, 21000, Split, Croatia
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Hunter KE, Webster AC, Page MJ, Willson M, McDonald S, Berber S, Skeers P, Tan-Koay AG, Parkhill A, Seidler AL. Searching clinical trials registers: guide for systematic reviewers. BMJ 2022; 377:e068791. [PMID: 35473822 DOI: 10.1136/bmj-2021-068791] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Kylie E Hunter
- Evidence Integration, NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Angela C Webster
- Evidence Integration, NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
- School of Public Health, University of Sydney, Camperdown, NSW, Australia
| | - Matthew J Page
- Methods in Evidence Synthesis Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Melina Willson
- Evidence Integration, NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Steve McDonald
- Methods in Evidence Synthesis Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Slavica Berber
- Health Technology Assessment Team, NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Peta Skeers
- Evidence Integration, NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Ava G Tan-Koay
- Evidence Integration, NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Anne Parkhill
- Centre for Health Communication and Participation, La Trobe University, Melbourne, VIC, Australia
| | - Anna Lene Seidler
- Evidence Integration, NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
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8
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Song L, Jia Y, Ran S, Li B, Xu J, Huo B, Yin N, Ai M, Liu Y. Current situation of pediatric clinical trials in China: focus on trials for drug marketing application and administrative approval. BMC Pediatr 2022; 22:144. [PMID: 35303815 PMCID: PMC8931999 DOI: 10.1186/s12887-022-03208-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 03/10/2022] [Indexed: 11/12/2022] Open
Abstract
Background Research and development of pediatric drug faces many difficulties and pediatric clinical trials remain a challenge. Since 2011, a series of measures have been taken to encourage research, development of drugs for pediatric patients in China. In this study, we analyzed pediatric clinical trials conducted in China to provide reference for research and development of pediatric drugs and formulation of relevant policies. Methods We conducted a cross-sectional observational study of pediatric trials registered in the Drug Trial Registration and Information Publication Platform before Oct. 31, 2021. All trials that recruited children (under 18 years old as defined in China) were retrieved and general characteristics of the trials and the research drugs were extracted and analyzed. The data were extracted and statistically analyzed by excel 2010 and SPSS 22.0, respectively. Results There were 588 registered pediatric clinical trials, which accounted for 3.94% of the total registered trials. The overall average annual growth rate of the number of trials from 2013 to 2020 was 14.47% (P < 0.01). Of the 588 trials included, there were 312 trials (53.06%) with only children as subjects, 127 trials (21.60%) with research drugs only for children use, and the median of target subject number was 320 with the range of 8 to 600,000. The sponsors and the principal investigators were mainly located in the eastern and northern China. 325 trials were vaccine trials, and the dosage form was mainly injection. There were 98 non-vaccine biological product trials (mainly injections), 135 chemical compound drug trials (mainly tablets), 30 traditional Chinese medicine/natural drugs (mainly granules). Indications of the non-vaccine drugs were mainly diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism. Conclusion The number of pediatric clinical trials in China has increased these years. To further promote pediatric clinical trials and motivate pediatric appropriate drug marketing application and administrative approval, conducting large pediatric clinical trials, further development of dosage forms suitable for children with special attention to neonates and prematurity, and improving uneven geographical distribution of sponsors and researchers are the current challenges.
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Affiliation(s)
- Lin Song
- Department of Pharmacy, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Yuntao Jia
- Department of Pharmacy, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Sujuan Ran
- Department of Pharmacy, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Bin Li
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Jin Xu
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Bennian Huo
- Department of Pharmacy, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Nange Yin
- Department of Pharmacy, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Maolin Ai
- Department of Pharmacy, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
| | - Yao Liu
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, 400042, China.
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Chakraborty M, Choudhury MC, Chakraborty I, Saberwal G. Rare disease patients in India are rarely involved in international orphan drug trials. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000890. [PMID: 36962798 PMCID: PMC10021652 DOI: 10.1371/journal.pgph.0000890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/15/2022] [Indexed: 11/18/2022]
Abstract
We wished to determine whether rare diseases patients from India had been enrolled in international trials to develop novel orphan drugs. There are two reasons to be interested in this. (a) Different ethnic or racial groups may respond differently to a particular drug. India has huge ethnic diversity, and to exclude such participants is to severely limit the diversity of any trial; (b) Even if a suitable drug for a rare disease is available in India, it may be astronomically priced, in a country where most healthcare expenditure is out-of-pocket. We identified 63 orphan drugs, approved by the US Food and Drug Administration (FDA) after 2008, for which there were 202 trials in the US government's clinical trial registry, ClinicalTrials.gov. Only nine of these trials had run in India. These trials pertained to six drugs. The drugs were for the conditions B-cell Lymphoma, Chronic Myeloid Leukemia, Gaucher disease Type 1, Malaria, Myeloma and Pulmonary Arterial Hypertension. Further research is required as to why patients from India are not part of foreign drug development programmes for rare diseases. We then asked how many of the remaining 193 trials had recruited people of Indian origin, residing in other countries, and found that not more than 1% of these trials had done so. Also, only 11 of the 193 trials had recruited from other lower income countries. Participation from low-income countries in trials for orphan drugs is poor.
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Affiliation(s)
- Monoswi Chakraborty
- Institute of Bioinformatics and Applied Biotechnology Biotech Park, Bengaluru, India
| | | | - Indraneel Chakraborty
- Institute of Bioinformatics and Applied Biotechnology Biotech Park, Bengaluru, India
| | - Gayatri Saberwal
- Institute of Bioinformatics and Applied Biotechnology Biotech Park, Bengaluru, India
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Choudhury MC, Chakraborty I, Saberwal G. Discrepancies between FDA documents and ClinicalTrials.gov for Orphan Drug-related clinical trial data. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000261. [PMID: 36962222 PMCID: PMC10021800 DOI: 10.1371/journal.pgph.0000261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 02/17/2022] [Indexed: 11/18/2022]
Abstract
Clinical trial registries such as ClinicalTrials.gov (CTG) hold large amounts of data regarding trials. Drugs for rare diseases are known as orphan drugs (ODs), and it is particularly important that trials for ODs are registered, and the data in the trial record are accurate. However, there may be discrepancies between trial-related data that were the basis for the approval of a drug, as available from Food and Drug Administration (FDA) documents such as the Medical Review, and the data in CTG. We performed an audit of FDA-approved ODs, comparing trial-related data on phase, enrollment, and enrollment attribute (anticipated or actual) in such FDA documents and in CTG. The Medical Reviews of 63 ODs listed 422 trials. We used study identifiers in the Medical Reviews to find matches with the trial ID number, 'Other ID' or 'Acronyms' in CTG, and identified 202 trials that were registered with CTG. In comparing the phase data from the 'Table of Clinical Studies' of the Medical Review, with the data in CTG, there were exact matches in only 75% of the cases. The enrollment matched only in 70% of the cases, and the enrollment attribute in 91% of the cases. A similar trend was found for the sub-set of pivotal trials. Going forward, for all trials listed in a registry, it is important to provide the trial ID in the Medical Review. This will ensure that all trials that are the basis of a drug approval can be swiftly and unambiguously identified in CTG. Also, there continue to be discrepancies in trial data between FDA documents and CTG. Data in the trial records in CTG need to be updated when relevant.
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Affiliation(s)
| | | | - Gayatri Saberwal
- Institute of Bioinformatics and Applied Biotechnology, Bengaluru, India
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Barnett AG, Glasziou P. Target and actual sample sizes for studies from two trial registries from 1999 to 2020: an observational study. BMJ Open 2021. [PMCID: PMC8719224 DOI: 10.1136/bmjopen-2021-053377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives To investigate differences between target and actual sample sizes, and what study characteristics were associated with sample sizes. Design Observational study. Setting The large trial registries of clinicaltrials.gov (starting in 1999) and ANZCTR (starting in 2005) through to 2021. Participants Over 280 000 interventional studies excluding studies that were withheld, terminated for safety reasons or were expanded access. Main outcome measures The actual and target sample sizes, and the within-study ratio of the actual to target sample size. Results Most studies were small: the median actual sample sizes in the two databases were 60 and 52. There was a decrease over time in the target sample size of 9%–10% per 5 years, and a larger decrease of 18%–21% per 5 years for the actual sample size. The actual-to-target sample size ratio was 4.1% lower per 5 years, meaning more studies (on average) failed to hit their target sample size. Conclusion Registered studies are more often under-recruited than over-recruited and worryingly both target and actual sample sizes appear to have decreased over time, as has the within-study gap between the target and actual sample size. Declining sample sizes and ongoing concerns about underpowered studies mean more research is needed into barriers and facilitators for improving recruitment and accessing data.
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Affiliation(s)
- Adrian Gerard Barnett
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Paul Glasziou
- CREBP, Bond University, Robina, Queensland, Australia
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Antimalarial drug candidates in phase I and II drug development: a scoping review. Antimicrob Agents Chemother 2021; 66:e0165921. [PMID: 34843390 PMCID: PMC8846400 DOI: 10.1128/aac.01659-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The emergence and spread of parasite resistance to currently available antimalarials has highlighted the importance of developing novel antimalarials. This scoping review provides an overview of antimalarial drug candidates undergoing phase I and II studies between 1 January 2016 and 28 April 2021. PubMed, Web of Science, Embase, clinical trial registries, and reference lists were searched for relevant studies. Information regarding antimalarial compound details, clinical trial characteristics, study population, and drug pharmacokinetics and pharmacodynamics (PK-PD) were extracted. A total of 50 studies were included, of which 24 had published their results and 26 were unpublished. New antimalarial compounds were evaluated as monotherapy (28 studies, 14 drug candidates) and combination therapy (9 studies, 10 candidates). Fourteen active compounds were identified in the current antimalarial drug development pipeline together with 11 compounds that are inactive, 6 due to insufficient efficacy. PK-PD data were available from 24 studies published as open-access articles. Four unpublished studies have made their results publicly available on clinical trial registries. The terminal elimination half-life of new antimalarial compounds ranged from 14.7 to 483 h. The log10 parasite reduction ratio over 48 h and parasite clearance half-life for Plasmodium falciparum following a single-dose monotherapy were 1.55 to 4.1 and 3.4 to 9.4 h, respectively. The antimalarial drug development landscape has seen a number of novel compounds, with promising PK-PD properties, evaluated in phase I and II studies over the past 5 years. Timely public disclosure of PK-PD data is crucial for informative decision-making and drug development strategy.
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Huo BN, Ai ML, Jia YT, Liu Y, Wang Y, Yin NG, Song L. General characteristics and reasons for the discontinuation of drug clinical trials in mainland China. BMC Med Res Methodol 2021; 21:246. [PMID: 34773983 PMCID: PMC8590359 DOI: 10.1186/s12874-021-01443-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 10/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background Although discontinuation is common in clinical trials, no study has been conducted to analyse the current situation and reasons for the suspension or discontinuation of drug clinical trials in China. This study aims to analyse the general characteristics and reasons for the discontinuation of registered clinical trials in mainland China and to identify the associated factors. Methods We conducted a cross-sectional observational study of discontinued trials registered in the Drug Trial Registration and Information Publication Platform before March 31, 2020. All trials with a status of terminated or stopped recorded in the platform were classified as discontinued trials and included in the analysis. The basic characteristics of the discontinued trials were recorded, reasons for trial discontinuation were recorded and divided into 4 categories as drug development strategy, trial planning, trial conduct and studied drug. Pearson’s chi-square test and fisher’s exact test were used to compare the differences in reasons for discontinuation between neoplasm trials and non-neoplasm trials, and to examine the associations of trial characteristics with different reasons related to trials discontinuation. Results Three hundred twelve discontinued trials were included in this study. The studied drugs were mainly chemical drugs [229 (73.4%)], and indications of the studied drugs were mainly neoplasms [77 (24.7%)]. Geographical location of the discontinued trials were mostly in northern [114 (36.5%)] and eastern [96 (30.8%)] China. Study type of the included trials was mainly bioequivalence studies [97 (31.1%)]. The most common reason for trial discontinuation was commercial or strategic decision [84 (26.9%)], followed by futility/lack of efficacy [70 (22.4%)]. The number of trial centers, sample size and whether participants had been enrolled were significantly associated with trial discontinuation (P < 0.05). Multiple center trials showed a higher rate of trial discontinuation due to trial conduct related reasons than single center trials (P < 0.05), trials with sample size > 500 showed a higher rate of trial discontinuation due to studied drug related reasons (P < 0.05), and trials enrolled participants showed a lower rate of trial discontinuation due to commercial or strategic decision and a higher rate of trial discontinuation due to studied drug related reasons than trials without enrolled participants (P < 0.05). Besides, neoplasm trials showed a higher rate of trial discontinuation due to poor recruitment and safety comparing with non-neoplasm trials (P < 0.05). Conclusions Trial discontinuation in China mainly occurred because of commercial or strategic decision and futility/lack of efficacy of the studied drug. Clinical trials with multiple centers and a large sample size may more likely be discontinued due to trial conduct related reasons such as good clinical practice. Discontinuation due to drug safety and lack of efficacy in multiple center trials with a large sample size deserves more attention to avoid resources wastes. Full communication with regulatory authorities such as Center for Drug Evaluation and research institutes to develop a feasible protocol is important for sponsors to avoid trial discontinuation due to protocol issues.
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Affiliation(s)
- Ben-Nian Huo
- Department of Pharmacy Children' s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Clinical pharmacy Key Specialty Construction Project, Chongqing, China
| | - Mao-Lin Ai
- Department of Pharmacy Children' s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Clinical pharmacy Key Specialty Construction Project, Chongqing, China
| | - Yun-Tao Jia
- Department of Pharmacy Children' s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Clinical pharmacy Key Specialty Construction Project, Chongqing, China
| | - Yao Liu
- Department of Pharmacy, Daping Hospital, Army Medical University, Chongqing, China
| | - Yang Wang
- Department of Pharmacy Children' s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Clinical pharmacy Key Specialty Construction Project, Chongqing, China
| | - Nan-Ge Yin
- Department of Pharmacy Children' s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Clinical pharmacy Key Specialty Construction Project, Chongqing, China
| | - Lin Song
- Department of Pharmacy Children' s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing Clinical pharmacy Key Specialty Construction Project, Chongqing, China.
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Venugopal N, Saberwal G. A comparative analysis of important public clinical trial registries, and a proposal for an interim ideal one. PLoS One 2021; 16:e0251191. [PMID: 33974649 PMCID: PMC8112656 DOI: 10.1371/journal.pone.0251191] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 04/21/2021] [Indexed: 12/21/2022] Open
Abstract
Background It is an ethical and scientific obligation to register each clinical trial, and report its results, accurately, comprehensively and on time. The WHO recognizes 17 public registries as Primary Registries, and has also introduced a set of minimal standards in the International Standards for Clinical Trial Registries (ISCTR) that primary registries need to implement. These standards are categorized into nine sections—Content, Quality and Validity, Accessibility, Unambiguous Identification, Technical Capacity, Administration and Governance, the Trial Registration Data Set (TRDS), Partner registries and Data Interchange Standards. This study compared the WHO’s primary registries, and the US’s ClinicalTrials.gov, to examine the implementation of ISCTR, with the aim of defining features of an interim ideal registry. Methods and findings The websites of the 18 registries were evaluated for 14 features that map to one or more of the nine sections of ISCTR, and assigned scores for their variations of these features. The assessed features include the nature of the content; the number and nature of fields to conduct a search; data download formats; the nature of the audit trail; the health condition category; the documentation available on a registry website; etc. The registries received scores for their particular variation of a given feature based on a scoring rationale devised for each individual feature analysed. Overall, the registries received between 27% and 80% of the maximum score of 94. The results from our analysis were used to define a set of features of an interim ideal registry. Conclusions To the best of our knowledge, this is the first study to quantify the widely divergent quality of the primary registries’ compliance with the ISCTR. Even with this limited assessment, it is clear that some of the registries have much work to do, although even a few improvements would significantly improve them.
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Affiliation(s)
- Nisha Venugopal
- Institute of Bioinformatics and Applied Biotechnology, Bengaluru, Karnataka, India
| | - Gayatri Saberwal
- Institute of Bioinformatics and Applied Biotechnology, Bengaluru, Karnataka, India
- * E-mail:
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Jain NM, Culley A, Micheel CM, Osterman TJ, Levy MA. Learnings From Precision Clinical Trial Matching for Oncology Patients Who Received NGS Testing. JCO Clin Cancer Inform 2021; 5:231-238. [PMID: 33625867 PMCID: PMC8140789 DOI: 10.1200/cci.20.00142] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Tumor next-generation sequencing reports typically generate trial recommendations for patients based on their diagnosis and genomic profile. However, these require additional refinement and prescreening, which can add to physician burden. We wanted to use human prescreening efforts to efficiently refine these trial options and also elucidate the high-value parameters that have a major impact on efficient trial matching. METHODS Clinical trial recommendations were generated based on diagnosis and biomarker criteria using an informatics platform and were further refined by manual prescreening. The refined results were then compared with the initial trial recommendations and the reasons for false-positive matches were evaluated. RESULTS Manual prescreening significantly reduced the number of false positives from the informatics generated trial recommendations, as expected. We found that trial-specific criteria, especially recruiting status for individual trial arms, were a high value parameter and led to the largest number of automated false-positive matches. CONCLUSION Reflex clinical trial matching approaches that refine trial recommendations based on the clinical details as well as trial-specific criteria have the potential to help alleviate physician burden for selecting the most appropriate trial for their patient. Investing in publicly available resources that capture the recruiting status of a trial at the cohort or arm level would, therefore, allow us to make meaningful contributions to increase the clinical trial enrollments by eliminating false positives.
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Affiliation(s)
- Neha M Jain
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | - Alison Culley
- Vanderbilt-Ingram Cancer Center, Clinical Trial Shared Resource, Vanderbilt University Medical Center, Nashville, TN
| | - Christine M Micheel
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Travis J Osterman
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
| | - Mia A Levy
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN.,Department of Internal Medicine, Division of Hematology/Oncology, Rush University Medical Center, Chicago, IL.,Rush University Cancer Center, Rush University Medical Center, Chicago, IL
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16
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Gulden C, Blasini R, Nassirian A, Stein A, Altun FB, Kirchner M, Prokosch HU, Boeker M. Prototypical Clinical Trial Registry Based on Fast Healthcare Interoperability Resources (FHIR): Design and Implementation Study. JMIR Med Inform 2021; 9:e20470. [PMID: 33433393 PMCID: PMC7837997 DOI: 10.2196/20470] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/23/2020] [Accepted: 12/05/2020] [Indexed: 11/29/2022] Open
Abstract
Background Clinical trial registries increase transparency in medical research by making information and results of planned, ongoing, and completed studies publicly available. However, the registration of clinical trials remains a time-consuming manual task complicated by the fact that the same studies often need to be registered in different registries with different data entry requirements and interfaces. Objective This study investigates how Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) may be used as a standardized format for exchanging and storing clinical trial records. Methods We designed and prototypically implemented an open-source central trial registry containing records from university hospitals, which are automatically exported and updated by local study management systems. Results We provided an architecture and implementation of a multisite clinical trials registry based on HL7 FHIR as a data storage and exchange format. Conclusions The results show that FHIR resources establish a harmonized view of study information from heterogeneous sources by enabling automated data exchange between trial centers and central study registries.
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Affiliation(s)
- Christian Gulden
- Chair of Medical Informatics, Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Romina Blasini
- Institute of Medical Informatics, Justus-Liebig-University Gießen, Gießen, Germany
| | - Azadeh Nassirian
- Carl Gustav Carus Faculty of Medicine, Center for Medical Informatics, Institute for Medical Informatics and Biometry, Dresden University of Technology, Dresden, Germany
| | - Alexandra Stein
- Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Fatma Betül Altun
- Medical Informatics Group, University Hospital Frankfurt, Frankfurt, Germany
| | - Melanie Kirchner
- Medical Center for Information and Communication Technology, University Hospital Erlangen, Erlangen, Germany
| | - Hans-Ulrich Prokosch
- Chair of Medical Informatics, Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.,Medical Center for Information and Communication Technology, University Hospital Erlangen, Erlangen, Germany
| | - Martin Boeker
- Institute of Medical Biometry and Statistics, Medical Faculty and Medical Center, University of Freiburg, Freiburg, Germany
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Dutta S, Kaur R, Haque M, Bhardwaj P, Saxena D, Rahman NAA, Lugova H, Jahan D, Islam S, Chowdhury TS, Charan J. <p>Terminated Interventional Trials in the Clinical Trial Registry of India Database: An Analysis to Evaluate the Reasons for Termination</p>. OPEN ACCESS JOURNAL OF CLINICAL TRIALS 2020. [DOI: 10.2147/oajct.s285177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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18
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Goff ZD, Eric Heidel R, Hauptman PJ. Is ClinicalTrials.gov Searchable for Patients With Heart Failure? J Card Fail 2020; 27:120-122. [PMID: 32991983 DOI: 10.1016/j.cardfail.2020.09.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Zackary D Goff
- Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - R Eric Heidel
- Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Paul J Hauptman
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
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Jones CW, Woodford AL, Platts-Mills TF. Characteristics of COVID-19 clinical trials registered with ClinicalTrials.gov: cross-sectional analysis. BMJ Open 2020; 10:e041276. [PMID: 32948577 PMCID: PMC7500290 DOI: 10.1136/bmjopen-2020-041276] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/19/2020] [Accepted: 09/09/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To characterise current COVID-19-related research activities. DESIGN Cross-sectional analysis. SETTING Clinical trials registered with ClinicalTrials.gov testing interventions relevant to COVID-19. DATA SOURCES ClinicalTrials.gov was searched for COVID-19 and related terms to identify trials registered between 1 December 2019 and 1 May 2020 that test interventions related to the COVID-19 pandemic. MAIN OUTCOME MEASURES We classified trials according to intervention type, and report key trial characteristics including recruitment status, location, funder type, target enrolment number, intervention model (single group, randomised or sequential assignment) and projected completion date. RESULTS Of the 630 identified clinical trials related to COVID-19, 509 (81%) involved the study of drugs or biological agents. Of these trials of drugs and biologics, 305 (60%) use an open-label design, 43 (8%) are single blinded (participant only) and 161 (32%) are double blinded (participant and investigator). 94 (18%) of the drug/biological trials are non-randomised. Either hydroxychloroquine or chloroquine is administered as part of the study protocol in 152 (30%) of the drug/biological trials. The total planned enrolment for these hydroxychloroquine/chloroquine trials is over 200 000 participants, which represents 65% of the total planned enrolment for all registered trials of drugs or biologics. There are also at least 25 registered trials of azithromycin (n=53), convalescent plasma (n=38), lopinavir/ritonavir (n=30), stem cell treatments (n=29) and tocilizumab (n=25). 142 trials were registered in the first 3 months of 2020, and 488 trials were registered between 1 April and 1 May 2020. CONCLUSIONS These findings demonstrate a robust research response to the COVID-19 pandemic, though many of the currently planned and ongoing trials focus on a small number of potential therapies, and many also lack essential design features and power necessary to provide accurate treatment effect estimates.
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Affiliation(s)
- Christopher W Jones
- Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Ashley L Woodford
- Emergency Medicine, Cooper Medical School of Rowan University, Camden, New Jersey, USA
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20
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Gresham G, Meinert JL, Gresham AG, Meinert CL. Assessment of Trends in the Design, Accrual, and Completion of Trials Registered in ClinicalTrials.gov by Sponsor Type, 2000-2019. JAMA Netw Open 2020; 3:e2014682. [PMID: 32845329 PMCID: PMC7450351 DOI: 10.1001/jamanetworkopen.2020.14682] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
IMPORTANCE ClinicalTrials.gov is a valuable resource that can be used to trace the state and nature of trials. Since its launch in 2000, more than 345 000 trials have been registered. Little is known about the characteristics and trends in clinical trials over time and how they differ by sponsor type. OBJECTIVE To assess trends in clinical trials registered in ClinicalTrials.gov over time and by sponsor type. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included clinical trials (interventional studies) registered in ClinicalTrials.gov from January 1, 2000, through December 31, 2019. The trials were grouped by lead sponsor: National Institutes of Health (NIH) and other US government agencies, industry, and other sources (foundations, universities, hospitals, clinics, and others). A static version of the Clinical Trials Transformation Initiative Aggregate Analysis of ClinicalTrials.gov database was downloaded on January 1, 2020, for analysis. MAIN OUTCOMES AND MEASURES ClinicalTrials.gov registration fields, including overall status, phase, intervention, number of sites, use of masking and randomization, sample size, and time to study completion by start year and lead sponsor (organization that provided funding or support for a clinical study). RESULTS A total of 245 999 clinical trials (interventional studies) were started between 2000 and 2019, of which 135 144 (54.9%) were completed. Among completed trials, 5113 (3.8%) were sponsored by the NIH or a US government agency, 48 668 (36.0%) by industry, and 81 363 (60.2%) by other sources. Most trials were single center (61.3%), randomized (65.6%), and phase 1 to 2 (35.5%) or did not have a US Food and Drug Administration-defined phase (38.4%), with fewer drug trials being conducted over time. Sample sizes were small (median, 60; interquartile range [IQR], 30-160) and diminished over time. Trial median completion times varied by lead sponsor: 3.4 years (IQR, 1.9-5.0 years) for NIH- and US government-sponsored trials, 1.2 years (IQR, 0.5-2.4 years) for industry trials, and 2.1 years (IQR, 1.1-3.7) for trials sponsored by other sources. CONCLUSIONS AND RELEVANCE The findings suggest that the composition and design of trials changed from 2000 to 2019 and differed substantially by sponsor type. Increased funding toward larger randomized clinical trials may be warranted to inform clinical decision-making and guide future research.
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Affiliation(s)
- Gillian Gresham
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
- Center for Clinical Trials and Evidence Synthesis, Johns Hopkins University, Baltimore, Maryland
| | - Jill L Meinert
- Center for Clinical Trials and Evidence Synthesis, Johns Hopkins University, Baltimore, Maryland
| | - Arthur G Gresham
- Center for Clinical Trials and Evidence Synthesis, Johns Hopkins University, Baltimore, Maryland
| | - Curtis L Meinert
- Center for Clinical Trials and Evidence Synthesis, Johns Hopkins University, Baltimore, Maryland
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Strzebonska K, Wasylewski MT, Zaborowska L, Riedel N, Wieschowski S, Strech D, Waligora M. Results dissemination of registered clinical trials across Polish academic institutions: a cross-sectional analysis. BMJ Open 2020; 10:e034666. [PMID: 31974090 PMCID: PMC7044990 DOI: 10.1136/bmjopen-2019-034666] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To establish the rates of publication and reporting of results for interventional clinical trials across Polish academic medical centres (AMCs) completed between 2009 and 2013. We aim also to compare the publication and reporting success between adult and paediatric trials. DESIGN Cross-sectional study. SETTING AMCs in Poland. PARTICIPANTS AMCs with interventional trials registered on ClinicalTrials.gov. MAIN OUTCOME MEASURE Results reporting on ClinicalTrials.gov and publishing via journal publication. RESULTS We identified 305 interventional clinical trials registered on ClinicalTrials.gov, completed between 2009 and 2013 and affiliated with at least one AMC. Overall, 243 of the 305 trials (79.7%) had been published as articles or posted their summary results on ClinicalTrials.gov. Results were posted within a year of study completion and/or published within 2 years of study completion for 131 trials (43.0%). Dissemination by both posting and publishing results in a timely manner was achieved by four trials (1.3%). CONCLUSIONS Our cross-sectional analysis revealed that Polish AMCs fail to meet the expectation for timely disseminating the findings of all interventional clinical trials. Delayed dissemination and non-dissemination of trial results negatively affects decisions in healthcare.
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Affiliation(s)
- Karolina Strzebonska
- REMEDY, Research Ethics in Medicine Study Group, Department of Philosophy and Bioethics, Jagiellonian University Medical College, Krakow, Poland
| | - Mateusz T Wasylewski
- REMEDY, Research Ethics in Medicine Study Group, Department of Philosophy and Bioethics, Jagiellonian University Medical College, Krakow, Poland
| | - Lucja Zaborowska
- REMEDY, Research Ethics in Medicine Study Group, Department of Philosophy and Bioethics, Jagiellonian University Medical College, Krakow, Poland
| | - Nico Riedel
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Germany
| | - Susanne Wieschowski
- Institute for Ethics, History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
| | - Daniel Strech
- QUEST Center for Transforming Biomedical Research, Berlin Institute of Health, Berlin, Germany
- Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Marcin Waligora
- REMEDY, Research Ethics in Medicine Study Group, Department of Philosophy and Bioethics, Jagiellonian University Medical College, Krakow, Poland
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More systematic reviews were registered in PROSPERO each year, but few records' status was up-to-date. J Clin Epidemiol 2020; 117:60-67. [DOI: 10.1016/j.jclinepi.2019.09.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 12/19/2022]
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Pillamarapu M, Mohan A, Saberwal G. An analysis of deficiencies in the data of interventional drug trials registered with Clinical Trials Registry - India. Trials 2019; 20:535. [PMID: 31455366 PMCID: PMC6712861 DOI: 10.1186/s13063-019-3592-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 07/16/2019] [Indexed: 11/21/2022] Open
Abstract
Background Clinical Trials Registry - India (CTRI) was established in July 2007 and today hosts thousands of trials, a significant fraction of them registered in the last couple of years. We wished to undertake an up-to-date analysis of specific fields of the registered trials. In doing so we discovered problems with the quality of the data, which we describe in this paper. Methods We downloaded CTRI records and reformatted the data into an SQLite database, which we then queried. We also accessed ClinicalTrials.gov records as needed. Results We discovered various categories of problems with the data in the CTRI database, including (1) a lack of clarity in the classification of Types of Study, (2) internal inconsistencies, (3) incomplete or non-standard information, (4) missing data, (5) variations in names or classification, and (6) incomplete or incorrect details of ethics committees. For most of these problems, error rates have been calculated, over time. Most were found to be in single digits, although others were significantly higher. We suggest how data quality in future editions of CTRI could be improved, including (1) a more elaborate and structured way of classifying the Type of Study, (2) the use of logic rules to prevent internal inconsistencies, (3) less use of free text fields and greater use of drop-down menus, (4) more fields to be made compulsory, (5) the pre-registration of individuals’ and organizations’ names and their subsequent selection from drop-down menus while registering a trial, and (6) more information about each ethics committee, including (a) its address and (b) linking the name of the trial site to the relevant ethics committee. As we discuss problems with the data of specific fields, we also examine — where possible — the quality of the data in the corresponding fields in ClinicalTrials.gov, the largest clinical trial registry in the world. Conclusions It is a scientific and ethical obligation to correctly record all information pertaining to each trial run in India. CTRI is a valuable database that has proved its worth in terms of improving the record of trials in the country. The suggestions made herein would improve it further. Electronic supplementary material The online version of this article (10.1186/s13063-019-3592-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mounika Pillamarapu
- Institute of Bioinformatics and Applied Biotechnology, Biotech Park, Electronics City Phase 1, Bengaluru, Karnataka, 560100, India
| | - Abhilash Mohan
- Institute of Bioinformatics and Applied Biotechnology, Biotech Park, Electronics City Phase 1, Bengaluru, Karnataka, 560100, India
| | - Gayatri Saberwal
- Institute of Bioinformatics and Applied Biotechnology, Biotech Park, Electronics City Phase 1, Bengaluru, Karnataka, 560100, India.
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Jain NM, Culley A, Knoop T, Micheel C, Osterman T, Levy M. Conceptual Framework to Support Clinical Trial Optimization and End-to-End Enrollment Workflow. JCO Clin Cancer Inform 2019; 3:1-10. [PMID: 31225983 PMCID: PMC6873934 DOI: 10.1200/cci.19.00033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2019] [Indexed: 12/19/2022] Open
Abstract
In this work, we present a conceptual framework to support clinical trial optimization and enrollment workflows and review the current state, limitations, and future trends in this space. This framework includes knowledge representation of clinical trials, clinical trial optimization, clinical trial design, enrollment workflows for prospective clinical trial matching, waitlist management, and, finally, evaluation strategies for assessing improvement.
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Affiliation(s)
- Neha M. Jain
- Vanderbilt University Medical Center, Nashville, TN
| | | | - Teresa Knoop
- Vanderbilt University Medical Center, Nashville, TN
| | | | | | - Mia Levy
- Vanderbilt University Medical Center, Nashville, TN
- Rush University Medical Center, Chicago, IL
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Frochot C, Mordon S. Update of the situation of clinical photodynamic therapy in Europe in the 2003–2018 period. J PORPHYR PHTHALOCYA 2019. [DOI: 10.1142/s1088424619300027] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Photodynamic therapy has become of interest in many European countries. Since, most of national authorities and all medical journals require the registration of the clinical study on the database ClinicalTrials. gov in order to be published, information regarding clinical studies are now available. This article aims to synthetize data gathered thanks to this database. The keywords used for this analysis was: (i) status: “All studies “(recruiting, completed, terminated, we did not take into account unknown status), (ii) condition or disease: “Photodynamic Therapy”, (iii) country: name of each European country. Since 2003, 76 clinical trials were registered in Europe. Most clinical studies are performed in Germany (22), France (20) and UK (19). These 3 countries represent 80% of all studies performed in Europe. However 21 European countries have one or more studies on PDT. Clinical studies were mainly performed on skin. Actinic Keratosis treatment (20 studies) represents more than 45% of all studies. 21% were focused on eye, mainly on Age Macular Degeneration (AMD) (8 studies). In 2018, ten (10) clinical trials are in the recruitment phase. On November, 10, 2017, Padeliporfin (STEBA Biotech S.A, Luxembourg) obtained the marketing authorization throughout the European Union. Despite the critical importance of trial registration, compliance with requirements from governmental regulators which mandate the prospective registration of clinical trials has been imperfect. Besides, a large proportion of registry entries are never updated to reflect study completion. However, this review clearly demonstrated that PDT is progressively used in most European countries.
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Affiliation(s)
- Céline Frochot
- Laboratoire Réactions et Génie des Procédés, UMR 7274 CNRS-Lorraine University, 1 Rue Grandville, 54000 Nancy, France
| | - Serge Mordon
- Université de Lille, INSERM, CHU Lille, U1189 ONCO-THAI, Image Assisted Laser Therapy for Oncology, F-59000 Lille, France
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Pandolfini C, Bonati M. 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. Trials 2018; 19:509. [PMID: 30236146 PMCID: PMC6149175 DOI: 10.1186/s13063-018-2910-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 09/08/2018] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Chiara Pandolfini
- Department of Public Health, Laboratory for Mother and Child Health, IRCCS - Istituto di Ricerche Farmacologiche “Mario Negri”, via Giuseppe La Masa 19, 20156 Milan, Italy
| | - Maurizio Bonati
- Department of Public Health, Laboratory for Mother and Child Health, IRCCS - Istituto di Ricerche Farmacologiche “Mario Negri”, via Giuseppe La Masa 19, 20156 Milan, Italy
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Fleminger J, Goldacre B. Prevalence of clinical trial status discrepancies: A cross-sectional study of 10,492 trials registered on both ClinicalTrials.gov and the European Union Clinical Trials Register. PLoS One 2018. [PMID: 29513684 PMCID: PMC5841737 DOI: 10.1371/journal.pone.0193088] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Trial registries are a key source of information for clinicians and researchers. While building OpenTrials, an open database of public trial information, we identified errors and omissions in registries, including discrepancies between descriptions of the same trial in different registries. We set out to ascertain the prevalence of discrepancies in trial completion status using a cohort of trials registered on both the European Union Clinical Trials Register (EUCTR) and ClinicalTrials.gov. STUDY DESIGN AND SETTING We used matching titles and registry IDs provided by both registries to build a cohort of dual-registered trials. Completion statuses were compared; we calculated descriptive statistics on the prevalence of discrepancies. RESULTS 11,988 dual-registered trials were identified. 1,496 did not provide a comparable completion status, leaving 10,492 trials. 16.2% were discrepant on completion status. The majority of discrepancies (90.5%) were a 'completed' trial on ClinicalTrials.gov inaccurately marked as 'ongoing' on EUCTR. Overall, 33.9% of dual-registered trials described as 'ongoing' on EUCTR were listed as 'completed' on ClinicalTrials.gov. CONCLUSION Completion status on registries is commonly inaccurate. Previous work on publication bias may underestimate non-reporting. We describe simple steps registry owners and trialists could take to improve accuracy.
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Affiliation(s)
- Jessica Fleminger
- Centre for Evidence Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Ben Goldacre
- Centre for Evidence Based Medicine, Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- * E-mail:
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Shepshelovich D, Yelin D, Gafter-Gvili A, Goldman S, Avni T, Yahav D. Comparison of reporting phase III randomized controlled trials of antibiotic treatment for common bacterial infections in ClinicalTrials.gov and matched publications. Clin Microbiol Infect 2018; 24:1211.e9-1211.e14. [PMID: 29454846 DOI: 10.1016/j.cmi.2018.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 02/06/2018] [Accepted: 02/10/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Discrepancies between ClinicalTrials.gov entries and matching publications were previously described in general medicine. We aimed to evaluate the consistency of reporting in trials addressing systemic antibiotic therapy. METHODS We searched ClinicalTrials.gov for completed phase III trials comparing antibiotic regimens until May 2017. Matched publications were identified in PubMed. Two independent reviewers extracted data and identified inconsistencies. Reporting was assessed among studies started before and after 1 July 2005, when the International Committee of Medical Journal Editors (ICMJE) required mandatory registration as a prerequisite for considering a trial for publication. RESULTS Matching publications were identified for 75 (70%) of 107 ClinicalTrials.gov entries. Median time from study completion to publication was 26 months (interquartile range 19-42). Primary outcome definition was inconsistent between ClinicalTrials.gov and publications in seven trials (7/72, 10%) and reporting of the primary outcome timeframe was inconsistent in 14 (14/71, 20%). Secondary outcomes definitions were inconsistent in 36 trials (36/66, 55%). Reporting of inclusion criteria and study timeline were inconsistent in 17% (13/65) and 3% (2/65), respectively. Trials started after July 2005 were significantly less likely to have reporting inconsistencies and were published in higher impact factor journals. CONCLUSIONS We found a lower inconsistency rate of outcome reporting compared with other medical disciplines. Reporting completeness and consistency were significantly better after July 2005. The ICMJE requirement for mandatory registration was associated with significant improvement in reporting quality in infectious diseases trials. Prolonged time lag to publication and missing data from unpublished trials should raise a discussion on current reporting and publishing procedures.
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Affiliation(s)
- D Shepshelovich
- Medicine A, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - D Yelin
- Medicine A, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel
| | - A Gafter-Gvili
- Medicine A, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel; Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - S Goldman
- Department of Nephrology and Hypertension, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel
| | - T Avni
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel; Infectious Diseases Unit, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel
| | - D Yahav
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel; Infectious Diseases Unit, Rabin Medical Centre, Beilinson Hospital, Petah Tikva, Israel.
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