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Schröder M, Muller SH, Vradi E, Mielke J, Lim YM, Couvelard F, Mostert M, Koudstaal S, Eijkemans MJ, Gerlinger C. Sharing Medical Big Data While Preserving Patient Confidentiality in Innovative Medicines Initiative: A Summary and Case Report from BigData@Heart. BIG DATA 2023; 11:399-407. [PMID: 37889577 PMCID: PMC10733752 DOI: 10.1089/big.2022.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
Sharing individual patient data (IPD) is a simple concept but complex to achieve due to data privacy and data security concerns, underdeveloped guidelines, and legal barriers. Sharing IPD is additionally difficult in big data-driven collaborations such as Bigdata@Heart in the Innovative Medicines Initiative, due to competing interests between diverse consortium members. One project within BigData@Heart, case study 1, needed to pool data from seven heterogeneous data sets: five randomized controlled trials from three different industry partners, and two disease registries. Sharing IPD was not considered feasible due to legal requirements and the sensitive medical nature of these data. In addition, harmonizing the data sets for a federated data analysis was difficult due to capacity constraints and the heterogeneity of the data sets. An alternative option was to share summary statistics through contingency tables. Here it is demonstrated that this method along with anonymization methods to ensure patient anonymity had minimal loss of information. Although sharing IPD should continue to be encouraged and strived for, our approach achieved a good balance between data transparency while protecting patient privacy. It also allowed a successful collaboration between industry and academia.
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Affiliation(s)
- Megan Schröder
- The Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-Universität München, Münich, Germany
| | - Sam H.A. Muller
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Eleni Vradi
- Biomedical Data Science II, Bayer AG, Berlin, Germany
| | - Johanna Mielke
- Research and Early Development, Bayer AG, Wuppertal, Germany
| | - Yvonne M.F. Lim
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Institute for Clinical Research, National Institutes of Health, Selangor, Malaysia
| | - Fabrice Couvelard
- Institut de Recherches Internationales SERVIER (I.R.I.S.), Suresnes, France
| | - Menno Mostert
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Stefan Koudstaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Cardiology, Groene Hart Ziekenhuis, Gouda, The Netherlands
| | - Marinus J.C. Eijkemans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Christoph Gerlinger
- Clinical Statistics and Data Insights, Bayer AG, Berlin, Germany
- Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg/Saar, Germany
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Mosquera Orgueira A, Díaz Arías JÁ, Serrano Martín R, Portela Piñeiro V, Cid López M, Peleteiro Raíndo A, Bao Pérez L, González Pérez MS, Pérez Encinas MM, Fraga Rodríguez MF, Vallejo Llamas JC, Bello López JL. A prognostic model based on gene expression parameters predicts a better response to bortezomib-containing immunochemotherapy in diffuse large B-cell lymphoma. Front Oncol 2023; 13:1157646. [PMID: 37188190 PMCID: PMC10175759 DOI: 10.3389/fonc.2023.1157646] [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: 02/02/2023] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
Diffuse Large B-cell Lymphoma (DLBCL) is the most common type of aggressive lymphoma. Approximately 60% of fit patients achieve curation with immunochemotherapy, but the remaining patients relapse or have refractory disease, which predicts a short survival. Traditionally, risk stratification in DLBCL has been based on scores that combine clinical variables. Other methodologies have been developed based on the identification of novel molecular features, such as mutational profiles and gene expression signatures. Recently, we developed the LymForest-25 profile, which provides a personalized survival risk prediction based on the integration of transcriptomic and clinical features using an artificial intelligence system. In the present report, we studied the relationship between the molecular variables included in LymForest-25 in the context of the data released by the REMoDL-B trial, which evaluated the addition of bortezomib to the standard treatment (R-CHOP) in the upfront setting of DLBCL. For this, we retrained the machine learning model of survival on the group of patients treated with R-CHOP (N=469) and then made survival predictions for those patients treated with bortezomib plus R-CHOP (N=459). According to these results, the RB-CHOP scheme achieved a 30% reduction in the risk of progression or death for the 50% of DLBCL patients at higher molecular risk (p-value 0.03), potentially expanding the effectiveness of this treatment to a wider patient population as compared with other previously defined risk groups.
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Affiliation(s)
- Adrián Mosquera Orgueira
- University Hospital of Santiago de Compostela, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
- *Correspondence: Adrián Mosquera Orgueira,
| | - Jose Ángel Díaz Arías
- University Hospital of Santiago de Compostela, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Rocio Serrano Martín
- University Hospital of Santiago de Compostela, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Victor Portela Piñeiro
- University Hospital of Santiago de Compostela, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Miguel Cid López
- University Hospital of Santiago de Compostela, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Andrés Peleteiro Raíndo
- University Hospital of Santiago de Compostela, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Laura Bao Pérez
- University Hospital of Santiago de Compostela, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Marta Sonia González Pérez
- University Hospital of Santiago de Compostela, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Manuel Mateo Pérez Encinas
- University Hospital of Santiago de Compostela, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Máximo Francisco Fraga Rodríguez
- University Hospital of Santiago de Compostela, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Juan Carlos Vallejo Llamas
- University Hospital of Santiago de Compostela, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Luis Bello López
- University Hospital of Santiago de Compostela, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Spain
- Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
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Adipokines in Non-Alcoholic Fatty Liver Disease: Are We on the Road toward New Biomarkers and Therapeutic Targets? BIOLOGY 2022; 11:biology11081237. [PMID: 36009862 PMCID: PMC9405285 DOI: 10.3390/biology11081237] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 12/04/2022]
Abstract
Simple Summary Non-alcoholic fatty liver disease (NAFLD) is an unmet medical need due to its increasingly high incidence, severe clinical consequences, and the absence of feasible diagnostic tools and effective drugs. This review summarizes the preclinical and clinical data on adipokines, cytokine-like hormones secreted by adipose tissue, and NAFLD. The aim is to establish the potential of adipokines as diagnostic and prognostic biomarkers, as well as their potential as therapeutic targets for NAFLD. The limitations of current research are also discussed, and future perspectives are outlined. Abstract Non-alcoholic fatty liver disease (NAFLD) has become the major cause of chronic hepatic illness and the leading indication for liver transplantation in the future decades. NAFLD is also commonly associated with other high-incident non-communicable diseases, such as cardiovascular complications, type 2 diabetes, and chronic kidney disease. Aggravating the socio-economic impact of this complex pathology, routinely feasible diagnostic methodologies and effective drugs for NAFLD management are unavailable. The pathophysiology of NAFLD, recently defined as metabolic associated fatty liver disease (MAFLD), is correlated with abnormal adipose tissue–liver axis communication because obesity-associated white adipose tissue (WAT) inflammation and metabolic dysfunction prompt hepatic insulin resistance (IR), lipid accumulation (steatosis), non-alcoholic steatohepatitis (NASH), and fibrosis. Accumulating evidence links adipokines, cytokine-like hormones secreted by adipose tissue that have immunometabolic activity, with NAFLD pathogenesis and progression; however, much uncertainty still exists. Here, the current knowledge on the roles of leptin, adiponectin, ghrelin, resistin, retinol-binding protein 4 (RBP4), visfatin, chemerin, and adipocyte fatty-acid-binding protein (AFABP) in NAFLD, taken from preclinical to clinical studies, is overviewed. The effect of therapeutic interventions on adipokines’ circulating levels are also covered. Finally, future directions to address the potential of adipokines as therapeutic targets and disease biomarkers for NAFLD are discussed.
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Rodriguez A, Tuck C, Dozier MF, Lewis SC, Eldridge S, Jackson T, Murray A, Weir CJ. Current recommendations/practices for anonymising data from clinical trials in order to make it available for sharing: A scoping review. Clin Trials 2022; 19:452-463. [PMID: 35730910 PMCID: PMC9373195 DOI: 10.1177/17407745221087469] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background/Aims There are increasing pressures for anonymised datasets from clinical trials
to be shared across the scientific community, and differing recommendations
exist on how to perform anonymisation prior to sharing. We aimed to
systematically identify, describe and synthesise existing recommendations
for anonymising clinical trial datasets to prepare for data sharing. Methods We systematically searched MEDLINE®, EMBASE and Web of Science
from inception to 8 February 2021. We also searched other resources to
ensure the comprehensiveness of our search. Any publication reporting
recommendations on anonymisation to enable data sharing from clinical trials
was included. Two reviewers independently screened titles, abstracts and
full text for eligibility. One reviewer extracted data from included papers
using thematic synthesis, which then was sense-checked by a second reviewer.
Results were summarised by narrative analysis. Results Fifty-nine articles (from 43 studies) were eligible for inclusion. Three
distinct themes are emerging: anonymisation, de-identification and
pseudonymisation. The most commonly used anonymisation techniques are:
removal of direct patient identifiers; and careful evaluation and
modification of indirect identifiers to minimise the risk of identification.
Anonymised datasets joined with controlled access was the preferred method
for data sharing. Conclusions There is no single standardised set of recommendations on how to anonymise
clinical trial datasets for sharing. However, this systematic review shows a
developing consensus on techniques used to achieve anonymisation.
Researchers in clinical trials still consider that anonymisation techniques
by themselves are insufficient to protect patient privacy, and they need to
be paired with controlled access.
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Affiliation(s)
- Aryelly Rodriguez
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Christopher Tuck
- Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
| | - Marshall F Dozier
- Library & University Collections, Information Services, The University of Edinburgh, Edinburgh, UK
| | - Stephanie C Lewis
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Sandra Eldridge
- Pragmatic Clinical Trials Unit, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Tracy Jackson
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | | | - Christopher J Weir
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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Carmona-Bayonas A, Jiménez-Fonseca P, Gallego J, Msaouel P. Causal Considerations Can Inform the Interpretation of Surprising Associations in Medical Registries. Cancer Invest 2021; 40:1-13. [PMID: 34709109 DOI: 10.1080/07357907.2021.1999971] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
An exploratory analysis of registry data from 2437 patients with advanced gastric cancer revealed a surprising association between astrological birth signs and overall survival (OS) with p = 0.01. After dichotomizing or changing the reference sign, p-values <0.05 were observed for several birth signs following adjustments for multiple comparisons. Bayesian models with moderately skeptical priors still pointed to these associations. A more plausible causal model, justified by contextual knowledge, revealed that these associations arose from the astrological sign association with seasonality. This case study illustrates how causal considerations can guide analyses through what would otherwise be a hopeless maze of statistical possibilities.
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Affiliation(s)
- Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain
| | - Paula Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Javier Gallego
- Medical Oncology Department, Hospital General de Elche, Elche, Spain
| | - Pavlos Msaouel
- Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Liu M, Chen J, Wu Q, Zhu W, Zhou X. Adherence to the CONSORT statement and extension for nonpharmacological treatments in randomized controlled trials of bariatric surgery: A systematic survey. Obes Rev 2021; 22:e13252. [PMID: 33817962 DOI: 10.1111/obr.13252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 02/05/2023]
Abstract
Reporting is critical for establishing the value of randomized controlled trials (RCTs). This study evaluated the adherence of bariatric surgery RCT reporting to the CONsolidated Standards Of Reporting Trials (CONSORT) statement 2010 and its 2017 extension for non-pharmacologic treatments (NPT extension). We identified all RCTs comparing bariatric surgery with conservational therapy or alternative bariatric surgery up to June 30, 2020. Reporting quality was assessed using criteria developed from the CONSORT statement and the NPT extension and scored as a percentage. The factors associated with reporting quality were explored by univariate and multivariate analysis. In total, 102 RCTs of bariatric surgery were included. The median scores according to the CONSORT statement and NPT extension were 63.3 and 26.8 of a maximum possible 100, respectively. Two-thirds of NPT extension items were reported in less than 25% of the RCTs. The median score improved over time for the CONSORT statement but not the NPT extension. A higher CONSORT score was associated with publication in core clinical journals, protocol registration, and funding. No factors associated with the NPT extension score were identified. Substantial efforts are warranted from authors, journals, registration platforms, and funders to overcome the flaws in the reporting of bariatric surgery RCTs.
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Affiliation(s)
- Meilu Liu
- Evidence-based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China.,Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jianrong Chen
- Department of Endocrinology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qingni Wu
- Evidence-based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Weifeng Zhu
- Evidence-based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Xu Zhou
- Evidence-based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
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Wharton S, Yin P, Burrows M, Gould E, Blavignac J, Christensen RAG, Kamran E, Camacho F, Barakat M. Extended-release naltrexone/bupropion is safe and effective among subjects with type 2 diabetes already taking incretin agents: a post-hoc analysis of the LIGHT trial. Int J Obes (Lond) 2021; 45:1687-1695. [PMID: 34083744 PMCID: PMC8310797 DOI: 10.1038/s41366-021-00831-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 03/17/2021] [Accepted: 04/21/2021] [Indexed: 12/22/2022]
Abstract
Background Extended-release naltrexone/bupropion (NB) is indicated for chronic weight management. Incretin agents are recommended for patients with type 2 diabetes. This analysis looked at the add-on of NB to incretins to see if weight loss could occur in patients already stabilized on incretin agents. Methods This was a post-hoc analysis of NB vs. placebo (PL) among subjects with type 2 diabetes stable on an incretin agent prior to randomization in a double-blind, PL-controlled cardiovascular outcome trial (N = 1317). Results Over 1 year, mean weight loss was significantly greater among NB patients vs. PL among those taking DPP-4i (mean absolute difference 4.6% [p < 0.0001]) and those taking GLP-1RAs (mean absolute difference 5.2%, p < 0.0001). Proportions of subjects achieving 5% weight loss were significantly greater for NB vs. PL at weeks 26 and 52 among those taking DPP-4is or GLP-1RAs. There were no significant differences in effectiveness observed between NB + DPP-4i and NB + GLP-1RA or between PL + DPP-4i and PL + GLP-1RA in any of the analyses. Serious adverse events were reported by 9.1% and 11.1% for PL + DPP-4i and PL + GLP-1RA, respectively, and 13.3% and 12.4% of NB + DPP-4i and NB + GLP-1RA, respectively. Conclusion NB appears to be effective in reducing weight in patients with T2DM and obesity/overweight who are taking DPP-4ihibitors or GLP-1RA. The SAE rates in all arms of this analysis were lower than have been reported in other cardiovascular outcome trials in type 2 diabetes.
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Affiliation(s)
- Sean Wharton
- The Wharton Medical Clinic, Toronto, ON, Canada.
| | | | | | - Errol Gould
- Currax Pharmaceuticals LLC, Morristown, NJ, USA
| | | | | | | | - Fernando Camacho
- Department of Statistics and Actuarial Sciences, University of Waterloo, Waterloo, ON, Canada
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Lavery JA, Callahan MK, Panageas KS. Apples and Oranges? Considerations for EHR-Based Analyses Aggregating Data From Interventional Clinical Trials and Point-of-Care Encounters in Oncology. JCO Clin Cancer Inform 2021; 5:21-23. [PMID: 33411618 DOI: 10.1200/cci.20.00096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jessica A Lavery
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Margaret K Callahan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Katherine S Panageas
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
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Riordan DO, Kinane M, Walsh KA, Shiely F, Eustace J, Bermingham M. Stakeholders' knowledge, attitudes and practices to pharmacovigilance and adverse drug reaction reporting in clinical trials: a mixed methods study. Eur J Clin Pharmacol 2020; 76:1363-1372. [PMID: 32507924 DOI: 10.1007/s00228-020-02921-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/27/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to explore the knowledge, attitudes and practices of health professionals working in clinical trials, to pharmacovigilance and adverse drug reaction (ADR) reporting. METHODS A mixed methods study comprising an online questionnaire disseminated from September to November 2018, three semi-structured interviews and four focus groups. The qualitative components were conducted with a random sample of questionnaire participants who had provided their contact details (n = 24). The qualitative interviews were conducted at a location convenient to the participant's place of work between October and December 2018. RESULTS One hundred forty-eight participants completed the questionnaire. Study coordinators/project managers represented the largest group of participants ( 28.6%, n = 38). Poor knowledge or understanding of ADR reporting was the most frequently cited barrier to ADR reporting (75%, n = 93). The most common enabler to reporting was having a clear understanding of an ADR definition (85.7%, n = 108). Focus group and interview participants described having limited staff as a barrier to reporting an ADR. They welcomed the prospect of pharmacovigilance training and indicated that face-to-face training would be preferred to provision of online training. CONCLUSION This study highlights key factors that influence the reporting of ADRs in clinical trials. Although the findings are specifically related to the clinical trial environment in Ireland, they may provide a useful platform for optimising the future conduct of trials. This research suggests that ADR reporting may be improved through provision of enhanced pharmacovigilance training to clinical trial staff.
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Affiliation(s)
- David O Riordan
- Health Research Board (HRB) Clinical Research Facility, University College Cork (UCC), 2nd Floor, Mercy University Hospital, Grenville Place, Cork, Republic of Ireland.
| | - Mary Kinane
- Pharmaceutical Care Research Group, School of Pharmacy, UCC, Cork, Ireland
| | - Kieran A Walsh
- Pharmaceutical Care Research Group, School of Pharmacy, UCC, Cork, Ireland
| | - Frances Shiely
- HRB Clinical Research Facility and School of Public Health, UCC, Cork, Ireland
| | - Joe Eustace
- Health Research Board (HRB) Clinical Research Facility, University College Cork (UCC), 2nd Floor, Mercy University Hospital, Grenville Place, Cork, Republic of Ireland
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Ventresca M, Schünemann HJ, Macbeth F, Clarke M, Thabane L, Griffiths G, Noble S, Garcia D, Marcucci M, Iorio A, Zhou Q, Crowther M, Akl EA, Lyman GH, Gloy V, DiNisio M, Briel M. Obtaining and managing data sets for individual participant data meta-analysis: scoping review and practical guide. BMC Med Res Methodol 2020; 20:113. [PMID: 32398016 PMCID: PMC7218569 DOI: 10.1186/s12874-020-00964-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/30/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Shifts in data sharing policy have increased researchers' access to individual participant data (IPD) from clinical studies. Simultaneously the number of IPD meta-analyses (IPDMAs) is increasing. However, rates of data retrieval have not improved. Our goal was to describe the challenges of retrieving IPD for an IPDMA and provide practical guidance on obtaining and managing datasets based on a review of the literature and practical examples and observations. METHODS We systematically searched MEDLINE, Embase, and the Cochrane Library, until January 2019, to identify publications focused on strategies to obtain IPD. In addition, we searched pharmaceutical websites and contacted industry organizations for supplemental information pertaining to recent advances in industry policy and practice. Finally, we documented setbacks and solutions encountered while completing a comprehensive IPDMA and drew on previous experiences related to seeking and using IPD. RESULTS Our scoping review identified 16 articles directly relevant for the conduct of IPDMAs. We present short descriptions of these articles alongside overviews of IPD sharing policies and procedures of pharmaceutical companies which display certification of Principles for Responsible Clinical Trial Data Sharing via Pharmaceutical Research and Manufacturers of America or European Federation of Pharmaceutical Industries and Associations websites. Advances in data sharing policy and practice affected the way in which data is requested, obtained, stored and analyzed. For our IPDMA it took 6.5 years to collect and analyze relevant IPD and navigate additional administrative barriers. Delays in obtaining data were largely due to challenges in communication with study sponsors, frequent changes in data sharing policies of study sponsors, and the requirement for a diverse skillset related to research, administrative, statistical and legal issues. CONCLUSIONS Knowledge of current data sharing practices and platforms as well as anticipation of necessary tasks and potential obstacles may reduce time and resources required for obtaining and managing data for an IPDMA. Sufficient project funding and timeline flexibility are pre-requisites for successful collection and analysis of IPD. IPDMA researchers must acknowledge the additional and unexpected responsibility they are placing on corresponding study authors or data sharing administrators and should offer assistance in readying data for sharing.
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Affiliation(s)
- Matthew Ventresca
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Fergus Macbeth
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - Mike Clarke
- Northern Ireland Hub for Trials Methodology Research and Cochrane Individual Participant Data Meta-analysis Methods Group, Queen’s University Belfast, Belfast, UK
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Gareth Griffiths
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Wales, UK; Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, Wales, UK
| | - David Garcia
- Department of Medicine, University of Washington School of Medicine, Seattle, WA USA
| | - Maura Marcucci
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
- Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
- Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Qi Zhou
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Elie A. Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Gary H. Lyman
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington USA
| | - Viktoria Gloy
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Marcello DiNisio
- Department of Medicine and Ageing Sciences, University G. D’Annunzio, Chieti-Pescara, Italy
| | - Matthias Briel
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
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Schwedt T, Reuter U, Tepper S, Ashina M, Kudrow D, Broessner G, Boudreau GP, McAllister P, Vu T, Zhang F, Cheng S, Picard H, Wen S, Kahn J, Klatt J, Mikol D. Early onset of efficacy with erenumab in patients with episodic and chronic migraine. J Headache Pain 2018; 19:92. [PMID: 30276500 PMCID: PMC6755616 DOI: 10.1186/s10194-018-0923-6] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 09/24/2018] [Indexed: 11/12/2022] Open
Abstract
Background Subcutaneous erenumab reduced monthly migraine days and increased the likelihood of achieving a ≥ 50% reduction at all monthly assessment points tested in 2 pivotal trials in episodic migraine (EM) and chronic migraine (CM). Early efficacy of migraine preventive medications is an important treatment characteristic to patients. Delays in achievement of efficacy can result in failed adherence. The objective of these post-hoc analyses were to evaluate efficacy in the first 4 weeks after initial subcutaneous administration of erenumab 70 mg, erenumab 140 mg, or placebo. Methods There is no generally accepted methodology to measure onset of action for migraine preventive medications. We used a comprehensive approach with data from both studies to evaluate change from baseline in weekly migraine days (WMD), achievement of ≥ 50% reduction in WMD, and proportion of patients experiencing migraine measured on a daily basis. The 7-day moving averages were overlaid with observed data. Results In both studies (EM: N = 955; CM: N = 667), there was evidence of onset of efficacy of erenumab vs. placebo during the first week of treatment, which in some cases reached nominal significance. For EM the changes in WMD were (least squares mean [LSM] [95% CI]): placebo, − 0.1 (− 0.3, 0.0); erenumab 70 mg, − 0.3 (− 0.5, − 0.2) p = 0.130; erenumab 140 mg, − 0.6 (− 0.7, − 0.4) p < 0.001. For CM the changes were: placebo, − 0.5 (− 0.8, − 0.3); erenumab 70 mg, − 0.9 (− 1.2, − 0.7) p = 0.047; erenumab 140 mg, − 0.8 (− 1.1, − 0.5) p = 0.18. Achievement of ≥ 50% reduction in WMD was observed as early as Week 1 (adjusted OR [95% CI] erenumab vs placebo) in EM: erenumab 70 mg, 1.3 (1.0, 1.9) p = 0.097; erenumab 140 mg, 2.0 (1.4, 2.7) p < 0.001. A similar outcome was observed for CM: erenumab 70 mg, 1.8 (1.1, 2.8) p = 0.011; erenumab 140 mg, 1.9 (1.2, 2.9) p = 0.009. Seven-day moving averages of observed data showed each treatment arm differed from placebo by Week 1 (OR [95% CI]): in EM Day 3 for erenumab 140 mg, 0.7 (0.5, 1.0) p = 0.031 and at Day 7 for 70 mg, 0.6 (0.4, 0.8) p = 0.002; in CM: Day 6 for erenumab 70 mg, 0.6 (0.4, 0.9) p = 0.022 and at Day 7 for 140 mg, 0.7 (0.4, 1.0); p = 0.038. Conclusion Erenumab showed early onset of efficacy with separation from placebo within the first week of treatment in both chronic and episodic migraine patients.
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Affiliation(s)
- Todd Schwedt
- Department of Neurology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA.
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Stewart Tepper
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Messoud Ashina
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - David Kudrow
- California Medical Clinic for Headache, Santa Monica, CA, USA
| | - Gregor Broessner
- Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Innsbruck, Austria
| | - Guy P Boudreau
- Clinique de la Migraine et Céphalées, Département de Neurologie, Centre Hospitalier de L'Université de Montréal, Hôpital Notre-Dame, Montréal, QC, Canada
| | - Peter McAllister
- New England Institute for Neurology & Headache, Stamford, CT, USA
| | - Thuy Vu
- Amgen Inc., Thousand Oaks, CA, USA
| | | | | | | | - Shihua Wen
- Novartis Pharmaceuticals Corp., East Hanover, NJ, USA
| | - Joseph Kahn
- Novartis Pharmaceuticals Corp., East Hanover, NJ, USA
| | - Jan Klatt
- Novartis Pharma AG, Basel, Switzerland
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Data sharing from pharmaceutical industry sponsored clinical studies: audit of data availability. BMC Med 2018; 16:165. [PMID: 30261889 PMCID: PMC6161442 DOI: 10.1186/s12916-018-1154-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 08/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical trial transparency is important to participants, trialists, publishers, and regulators, and there have been recent major policy changes by the pharmaceutical industry regarding clinical study data sharing. However, it is unknown if these changes are enabling independent researchers to access participant-level data from prominent contemporary clinical trials sponsored by the pharmaceutical industry 2 years after publication of the primary results. MAIN TEXT PubMed and ClinicalTrials.gov were searched to identify clinical trials of medicines sponsored by the pharmaceutical industry and first published between 1 July 2015 and 31 December 2015 in the top 10 general and internal medical journals by impact factor. For each clinical trial, the eligibility of independent researchers to request participant-level data was identified via the sponsor having a data sharing policy/process and a positive response to an enquiry. Fifty-six publications reporting on 61 industry-sponsored clinical trials were identified, of which 32 (52%) had a public data sharing policy/process and 9 (15%) were confirmed eligible for data sharing. Industry sponsors within the top 25 by global sales were more likely to have a data sharing policy (93% vs 10%), and there was a trend towards increased data sharing eligibility (23% vs 4%). Twenty-six studies were explicitly confirmed as ineligible for data sharing. The two most common data sharing policy conditions that prevented sharing of data for published results were the exclusion of studies that had ongoing follow-up of the published results and the exclusion of studies of medicines that have not yet achieved regulatory approval in the USA and the European Union. CONCLUSIONS Fifteen percent of the sampled clinical trials were available for data sharing 2 years after publication of primary results of the trial. Key issues limiting data sharing include a large proportion of industry sponsors who do not have a data sharing policy/process, and data sharing policy conditions that exclude access on the basis of ongoing follow-up and regulatory activity.
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