1
|
Salovaara PK, Li C, Nicholson A, Lipsitz SR, Natarajan S. Navigating COVID-19 and related challenges to completing clinical trials: Lessons from the PATRIOT and STEP-UP randomized prevention trials. Clin Trials 2023; 20:153-165. [PMID: 36562090 PMCID: PMC9790858 DOI: 10.1177/17407745221140041] [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] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIMS High follow-up is critical in randomized clinical trials. We developed novel approaches to modify in-person visits and complete follow-up during COVID-19. Since these strategies are broadly applicable to circumstances wherein follow-up is difficult, they may help in contingency planning. The objective of this article is to develop and evaluate new approaches to replace detailed, in-person study visits for two trials focused on preventing diabetic foot complications. METHODS A quasi-experimental pre-post design compared approaches for follow-up during COVID-19 to approaches pre-COVID-19. Study subjects were outpatients at two Veterans Affairs Medical Centers. Following a research "hold," research resumed in February 2021 for Self-monitoring, Thermometry and Educating Patients for Ulcer Prevention (STEP UP) (n = 241), which focused on preventing recurrent foot ulcers, and in April 2021 for Preventing Amputation by Tailored Risk-based Intervention to Optimize Therapy (PATRIOT) (n = 406), which focused on preventing pre-ulcerative and ulcerative lesions. To complete data collection, we shortened visits, focused on primary and secondary outcomes, and conducted virtual visits when appropriate. For STEP UP, we created a 20-min assessment process that could be administered by phone. Since PATRIOT required plantar photographs to assess foot lesions, we conducted short face-to-face visits. We explored differences and assessed proportion completing visit, visit completion/100 person-months and compared COVID-19 to pre- COVID-19 using unadjusted risk ratios, incidence rate ratios, all with associated 95% confidence intervals (CIs). Finally, we report time-to-visit curves. RESULTS In both studies, participants whose follow-up concluded pre- COVID-19 seemed older than those whose follow-up concluded during COVID-19 (PATRIOT: 68.0 (67.2, 68.9) versus 65.2 years (61.9, 68.5); STEP UP: 67.5 (66.2, 68.9) versus 65.3 (63.3, 67.3)). For STEP UP, we completed 91 visits pre- COVID-19 (37.8% (31.6%, 44.2%)) and 63 visits during COVID-19 (78.8% (68.2%, 87.1%)). This was over 1309 person-months pre-COVID-19, and over 208.8 person-months during COVID-19; the visit completion rate/100 person-months were: pre-COVID-19 7.0 (5.6, 8.5), COVID-19 30.2 (23.2, 38.6); risk ratio: 2.1 (1.7, 2.5); and incidence rate ratio 4.3 (3.1, 5.9). Similarly, for PATRIOT, we completed 316 visits pre-COVID-19 (77.8% (73.5%, 81.8%)) and 27 assessments during COVID-19 (84.4% (67.2%, 94.7%)). This was over 1192.7 person-months pre-COVID-19 and 39.3 person-months during COVID-19. The visit completion rate/100 person-months in PATRIOT were: pre-COVID-19 2.7 (2.4, 3.0), COVID-19 6.9 (4.5, 10); risk ratio 1.1 (0.9, 1.3); incidence rate ratio 2.6 (1.8, 3.8). For both studies, the follow-up curves began separating at < 2 months. CONCLUSIONS We achieved higher completion rates during COVID-19 compared to pre-COVID-19 by modifying visits and focusing on primary and secondary outcomes. These strategies prevent excessive missing data, support more valid conclusions, and improve efficiency. They may provide important alternative strategies to achieving higher follow-up in randomized clinical trials.
Collapse
Affiliation(s)
- Priscilla K Salovaara
- Columbia University, New York, NY, USA.,VA New York Harbor Healthcare System, New York, NY, USA
| | - Christine Li
- VA New York Harbor Healthcare System, New York, NY, USA.,New York University, New York, NY, USA
| | - Andrew Nicholson
- VA New York Harbor Healthcare System, New York, NY, USA.,New York University Grossman School of Medicine, New York, NY, USA
| | - Stuart R Lipsitz
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Sundar Natarajan
- VA New York Harbor Healthcare System, New York, NY, USA.,New York University Grossman School of Medicine, New York, NY, USA
| |
Collapse
|
2
|
Grenier C, Loniewski M, Plazy M, Onaisi R, Doucet MH, Joseph JP, Duvignaud A, Malvy D, Anglaret X, Orne-Gliemann J. Implementing an outpatient clinical trial on COVID-19 treatment in an emergency epidemic context: a mixed methods study among operational and research stakeholders within the Coverage trial, Bordeaux (France). Arch Public Health 2022; 80:245. [PMID: 36463300 PMCID: PMC9719237 DOI: 10.1186/s13690-022-00999-9] [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: 03/24/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The emergency set-up and implementation of outpatient clinical trials on epidemic emerging infectious diseases such as COVID-19 raise many issues in terms of research structuration, regulations, and health systems organization. We aimed to describe the experience and points of view of different stakeholders involved in a French home-based outpatient trial on COVID-19 and to identify the early barriers and facilitators to the trial implementation. METHODS We conducted a mixed-methods study in July 2020. A self-administered questionnaire was emailed to 213 clinical, operational and research stakeholders involved in the Coverage trial; individual semi-directed interviews were conducted among 14 stakeholders. Questionnaire data and written interview notes are presented together by key theme. RESULTS One hundred fifty six stakeholders responded to the questionnaire. 53.4% did not have prior experience in clinical research. The motivation of most stakeholders to participate in the Coverage trial was to feel useful during the pandemic. 87.9% agreed that the trial had an unusual set-up timeframe, and many regretted a certain lack of regulatory flexibility. Mobile medical teams and specific professional skills were perceived as instrumental for outpatient research. CONCLUSIONS The implementation of a home-based outpatient clinical trial on COVID-19 was perceived as relevant and innovative although requiring important adaptations of usual professional responsibilities and standard research procedures. Lessons learned from the Coverage trial underline the need for improved networks between hospital and community medicine, and call for a dedicated and reactive outpatient research platform on emerging or threatening infectious diseases.
Collapse
Affiliation(s)
- Carine Grenier
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France
| | - Macha Loniewski
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France
| | - Mélanie Plazy
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France
| | - Racha Onaisi
- grid.412041.20000 0001 2106 639XDepartment of General Practice, University of Bordeaux, Bordeaux, France
| | - Marie-Hélène Doucet
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France
| | - Jean-Philippe Joseph
- grid.412041.20000 0001 2106 639XDepartment of General Practice, University of Bordeaux, Bordeaux, France
| | - Alexandre Duvignaud
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France ,grid.42399.350000 0004 0593 7118Department of Infectious Diseases and Tropical Medicine, Division of Tropical Medicine and Clinical International Health, CHU Bordeaux, Bordeaux, France
| | - Denis Malvy
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France ,grid.42399.350000 0004 0593 7118Department of Infectious Diseases and Tropical Medicine, Division of Tropical Medicine and Clinical International Health, CHU Bordeaux, Bordeaux, France
| | - Xavier Anglaret
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France
| | - Joanna Orne-Gliemann
- grid.412041.20000 0001 2106 639XUniversity of Bordeaux, Bordeaux, France ,grid.508062.90000 0004 8511 8605National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Research Centre, Bordeaux, France ,Research Institute for Sustainable Development (IRD) EMR 271, GHiGS, Bordeaux, France
| | | |
Collapse
|
3
|
Zhu Y, Sun Y, Jin Y, Tao T, Yi L, Li X. Impact of the COVID-19 pandemic on clinical trials: a cross-sectional questionnaire study in China. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1154. [PMID: 36467359 PMCID: PMC9708462 DOI: 10.21037/atm-22-777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022]
Abstract
Background The number of Chinese clinical trials has continued to grow throughout the coronavirus disease 2019 (COVID-19) pandemic, but we know little about clinical trial team members' perceptions and attitudes toward the impacts of the pandemic. This study aimed to assess the impact of the COVID-19 pandemic on clinical trials in China from the perspective of research staff to provide a deeper understanding and some recommendations for the ongoing and upcoming clinical trials during the pandemic. Methods A nationwide cross-sectional questionnaire was distributed to respondents throughout mainland China between September 2021 and October 2021. The participants assessed the impact of the COVID-19 pandemic on clinical trials based on a 5-point Likert-type scale, and exploratory factor analysis (EFA) was used to confirm the factor structure. Descriptive statistical analysis and the Mann-Whitney test were used to discover the differences between different groups. Results A total of 2,393 questionnaires from 272 hospitals were collected in mainland China. Factor analysis resulted in 4 factors, with a cumulative explained variance of 64.93%, as follows: subject enrollment, patient care, study supplies and data management, and research milestones and quality management. The research team members, predominantly represented by clinical research coordinators (CRCs), basically agreed with all but 3 preset scenarios of the impact of COVID-19 on clinical trials. Most respondents did not agree that the pandemic was associated with more serious adverse events (SAEs), missed reports of safety events, or any increase of unscheduled unblinding. In addition, significant differences were revealed in different age, gender, and role groups of respondents based on their views on the impact of the pandemic. Conclusions The current pandemic situation has had a negative impact on clinical trials, especially in terms of subject recruitment and protocol compliance, yet research team members feel confident that some of the effective measures proposed in the study can moderate the negative impact.
Collapse
Affiliation(s)
- Yanhong Zhu
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Yanjun Sun
- School of Marxism, Nanjing Medical University, Nanjing, China
| | - Yan Jin
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Tiantian Tao
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Ling Yi
- Department of Drug Clinical Trials Institution, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xin Li
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China.,Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
| |
Collapse
|
4
|
Participant and Research Team Perspectives on the Conduct of a Remote Therapeutic COVID-19 Clinical Trial: A Mixed Methods Approach. J Clin Transl Sci 2022; 6:e69. [PMID: 35836793 PMCID: PMC9257771 DOI: 10.1017/cts.2022.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/16/2022] [Accepted: 04/27/2022] [Indexed: 11/08/2022] Open
Abstract
Background: Responding to the need to investigate potential treatments of COVID-19, a research team employed a telehealth platform to determine whether niclosamide, an oral anthelmintic drug that had shown antiviral activity, reduced SARS-CoV-2 shedding and duration of symptoms in patients with mild-to-moderate symptoms of COVID-19. To encourage compliance with patient self-quarantine, this randomized placebo-controlled clinical trial was conducted utilizing a remote telehealth design to complete all study visits, monitor symptoms, and coordinate participant self-collected specimens. Methods: A mixed methods approach employing surveys and interviews of trial participants and interviews of research team members was used to collect their experiences with and perspectives on the acceptability of the remote clinical trial design and delivery. Results: Of the 67 eligible trial participants invited to take part in a study to evaluate the telehealth platform, 46% (n = 31) completed a post-participation survey. While 97% (n = 30) of respondents had not previously participated in a clinical trial, 77% (n = 24) reported they would consider taking part in a future remote research study. The majority of respondents were moderately or very comfortable (93%) with using the technology. Conclusions: The COVID-19 crisis was a call to action to expand understanding of the conduct of remote clinical trials, including the experiences of research participants. Our findings showed that this approach can be both effective for the conduct of research and positive for participants. Further research on the use of telehealth research platforms seems warranted in rural, underserved populations, and remote trials of prevention, screening, and treatment.
Collapse
|