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Neumann S, Taylor J, Bamford A, Metcalfe C, Gaunt DM, Whone A, Steeds D, Emmett SR, Hollingworth W, Ben-Shlomo Y, Henderson EJ. Cholinesterase inhibitor to prevent falls in Parkinson's disease (CHIEF-PD) trial: a phase 3 randomised, double-blind placebo-controlled trial of rivastigmine to prevent falls in Parkinson's disease. BMC Neurol 2021; 21:422. [PMID: 34715821 PMCID: PMC8556953 DOI: 10.1186/s12883-021-02430-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Falls are a common complication of Parkinson's disease. There is a need for new therapeutic options to target this debilitating aspect of the disease. Cholinergic deficit has been shown to contribute to both gait and cognitive dysfunction seen in the condition. Potential benefits of using cholinesterase inhibitors were shown during a single centre phase 2 trial. The aim of this trial is to evaluate the effectiveness of a cholinesterase inhibitor on fall rate in people with idiopathic Parkinson's disease. METHODS This is a multi-centre, double-blind, randomised placebo-controlled trial in 600 people with idiopathic Parkinson's disease (Hoehn and Yahr stages 1 to 4) with a history of a fall in the past year. Participants will be randomised to two groups, receiving either transdermal rivastigmine or identical placebo for 12 months. The primary outcome is the fall rate over 12 months follow-up. Secondary outcome measures, collected at baseline and 12 months either face-to-face or via remote video/telephone assessments, include gait and balance measures, neuropsychiatric indices, Parkinson's motor and non-motor symptoms, quality of life and cost-effectiveness. DISCUSSION This trial will establish whether cholinesterase inhibitor therapy is effective in preventing falls in Parkinson's disease. If cost-effective, it will alter current management guidelines by offering a new therapeutic option in this high-risk population. TRIAL REGISTRATION REC reference: 19/SW/0043. EudraCT: 2018-003219-23. ISCRTN 41639809 (registered 16/04/2019). ClinicalTrials.gov Identifier: NCT04226248 PROTOCOL AT TIME OF PUBLICATION: Version 7.0, 20th January 2021.
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Affiliation(s)
- S Neumann
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - J Taylor
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - A Bamford
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - C Metcalfe
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - D M Gaunt
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - A Whone
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - D Steeds
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - S R Emmett
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - W Hollingworth
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - Y Ben-Shlomo
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK
| | - E J Henderson
- University of Bristol, Population Health Sciences, Bristol Medical School, Faculty of Health Sciences, Bristol, UK.
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
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Howells L, Gran S, Chalmers JR, Stuart B, Santer M, Bradshaw L, Gaunt DM, Ridd MJ, Gerbens LAA, Spuls PI, Huang C, Francis NA, Thomas KS. Do patient characteristics matter when calculating sample size for eczema clinical trials? Skin Health and Disease 2021; 1:e42. [PMID: 35663143 PMCID: PMC9060078 DOI: 10.1002/ski2.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/21/2021] [Accepted: 04/22/2021] [Indexed: 11/11/2022]
Abstract
Background The Patient‐Oriented Eczema Measure (POEM) is the core outcome instrument recommended for measuring patient‐reported atopic eczema symptoms in clinical trials. To ensure that the statistical significance of clinical trial results is meaningful, trials are often designed by specifying the target difference in the primary outcome as part of the sample size calculation. One method used to specify the target difference is a score that corresponds to a standardized effect size. Objectives to assess how the standardized effect size of POEM scores vary across age, gender, ethnicity and disease severity. Methods This study combined data from five UK‐based randomized clinical trials of eczema treatments in order to assess differences in self‐reported eczema symptoms (POEM) corresponding to a standardized effect size (0.5 SD of baseline POEM scores) across age, gender, ethnicity and disease severity. Results POEM scores corresponding to 0.5 SD(baseline) were remarkably consistent across participants of varying ages, gender, ethnicity and disease severity from datasets of five UK trials in children (range 2.99–3.45). Conclusions This study provides information that can support those designing clinical trials to determine their sample size and can aid individuals interpreting trial results. Further exploration of differences in populations beyond the United Kingdom is needed.
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Affiliation(s)
- L. Howells
- Centre of Evidence Based Dermatology School of Medicine University of Nottingham King's Meadow Campus Nottingham UK
| | - S. Gran
- Centre of Evidence Based Dermatology School of Medicine University of Nottingham King's Meadow Campus Nottingham UK
| | - J. R. Chalmers
- Centre of Evidence Based Dermatology School of Medicine University of Nottingham King's Meadow Campus Nottingham UK
| | - B. Stuart
- Primary Care Research Centre School of Primary Care Population Sciences and Medical Education University of Southampton Southampton UK
| | - M. Santer
- Primary Care Research Centre School of Primary Care Population Sciences and Medical Education University of Southampton Southampton UK
| | - L. Bradshaw
- Nottingham Clinical Trials Unit University of Nottingham Nottingham UK
| | - D. M. Gaunt
- Bristol Medical School: Population Health Sciences University of Bristol Bristol UK
| | - M. J. Ridd
- Bristol Medical School: Population Health Sciences University of Bristol Bristol UK
| | - L. A. A. Gerbens
- Department of Dermatology Amsterdam Public Health Infection and Immunity Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
| | - P. I. Spuls
- Department of Dermatology Amsterdam Public Health Infection and Immunity Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
| | - C. Huang
- Hull York Medical School University of Hull Hull UK
| | - N. A. Francis
- Primary Care Research Centre School of Primary Care Population Sciences and Medical Education University of Southampton Southampton UK
- Division of Population Medicine Cardiff University School of Medicine Cardiff UK
| | - K. S. Thomas
- Centre of Evidence Based Dermatology School of Medicine University of Nottingham King's Meadow Campus Nottingham UK
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Ridd MJ, Gaunt DM, Guy RH, Redmond NM, Garfield K, Hollinghurst S, Ball N, Shaw L, Purdy S, Metcalfe C. Comparison of patient (POEM), observer (EASI, SASSAD, TIS) and corneometry measures of emollient effectiveness in children with eczema: findings from the COMET feasibility trial. Br J Dermatol 2018; 179:362-370. [PMID: 29476542 DOI: 10.1111/bjd.16475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Eczema affects around 20% of children, but multiple different outcome measures have hampered research into the effectiveness of different treatments. OBJECTIVES To compare the change in scores and correlations within and between five measures of eczema severity: Patient-Orientated Eczema Measure (POEM), Eczema Area and Severity Index (EASI), Six Area, Six Sign Atopic Dermatitis (SASSAD), Three Item Severity (TIS) and skin hydration (corneometry). METHODS Data from a feasibility trial that randomized young children with eczema to one of four emollients were used. Participants were followed for 3 months (84 days). Descriptive statistics (by emollient over time) and Spearman's correlation coefficients comparing scores at each time point and absolute change (between adjacent time points) for each outcome measure were calculated. RESULTS In total, 197 children, mean ± SD age 21·7 ± 12·8 months, were randomized. POEM and TIS appeared to capture a range of eczema severity at baseline, but only POEM had close approximation to normal distribution. Mean POEM, EASI, SASSAD and TIS scores improved month by month, with POEM showing the greatest sensitivity (effect size 0·42). Correlations within POEM, EASI, SASSAD and TIS were moderate to good, decreasing over time. Correlations between measures were strongest for EASI, SASSAD and TIS. By contrast, corneometry scores were more variable, correlated less well over time and were poorly correlated with the other measures. CONCLUSIONS Except for corneometry, all measures appear to change in relation to emollient use over time and correlate well with themselves. POEM demonstrated the greatest range of scores at baseline and change in eczema severity over the first 28 days.
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Affiliation(s)
- M J Ridd
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, U.K
| | - D M Gaunt
- Bristol Randomised Trials Collaboration, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, U.K
| | - R H Guy
- Department of Pharmacy & Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, U.K
| | - N M Redmond
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, U.K.,NIHR CLAHRC West, University Hospitals Bristol NHS Foundation Trust, 9th Floor, Whitefriars, Lewins Mead, Bristol, BS1 2NT, U.K
| | - K Garfield
- Bristol Randomised Trials Collaboration, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, U.K
| | - S Hollinghurst
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, U.K
| | - N Ball
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, U.K
| | - L Shaw
- Department of Dermatology, University Hospitals Bristol NHS Foundation Trust, Marlborough Street, Bristol, BS1 3NU, U.K
| | - S Purdy
- Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, U.K
| | - C Metcalfe
- Bristol Randomised Trials Collaboration, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, U.K
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Henderson EJ, Smith N, Gaunt DM, Lawrence AD, Brodie MA, Close JCT, Lord SR, Ben-Shlomo Y, Whone AL. 158Does The Anticholinergic Burden Of Drugs Predict Outcomes In People With Parkinson's Disease With A History Of A Fall? Age Ageing 2017. [DOI: 10.1093/ageing/afx062.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Gaunt DM, Metcalfe C, Ridd M. The Patient-Oriented Eczema Measure in young children: responsiveness and minimal clinically important difference. Allergy 2016; 71:1620-1625. [PMID: 27232584 PMCID: PMC5113674 DOI: 10.1111/all.12942] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2016] [Indexed: 11/27/2022]
Abstract
Background The Patient‐Oriented Eczema Measure (POEM) has been recommended as the core patient‐reported outcome measure for trials of eczema treatments. Using data from the Choice of Moisturiser for Eczema Treatment randomized feasibility study, we assess the responsiveness to change and determine the minimal clinically important difference (MCID) of the POEM in young children with eczema. Methods Responsiveness to change by repeated administrations of the POEM was investigated in relation to change recalled using the Parent Global Assessment (PGA) measure. Five methods of determining the MCID of the POEM were employed; three anchor‐based methods using PGA as the anchor: the within‐patient score change, between‐patient score change and sensitivity and specificity method, and two distribution‐based methods: effect size estimate and the one half standard deviation of the baseline distribution of POEM scores. Results Successive POEM scores were found to be responsive to change in eczema severity. The MCID of the POEM change score, in relation to a slight improvement in eczema severity as recalled by parents on the PGA, estimated by the within‐patient score change (4.27), the between‐patient score change (2.89) and the sensitivity and specificity method (3.00) was similar to the one half standard deviation of the POEM baseline scores (2.94) and the effect size estimate (2.50). Conclusions The Patient‐Oriented Eczema Measure as applied to young children is responsive to change, and the MCID is around 3. This study will encourage the use of POEM and aid in determining sample size for future randomized controlled trials of treatments for eczema in young children.
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Affiliation(s)
- D. M. Gaunt
- Bristol Randomised Trials Collaboration School of Social and Community Medicine University of BristolBristolUK
| | - C. Metcalfe
- Bristol Randomised Trials Collaboration School of Social and Community Medicine University of BristolBristolUK
| | - M. Ridd
- Centre for Academic Primary Care School of Social and Community Medicine University of Bristol Bristol UK
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