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Zemsi A, Nekame LJG, Mohammed N, Batchilly ES, Dabira E, Sillah SO, Sey G, Williams DH, Dondeh BL, Cerami C, Clarke E, D'Alessandro U. Practical Guidelines for Standardised Resolution of Important Protocol Deviations in Clinical Trials Conducted in Sub-Saharan Africa. Ther Innov Regul Sci 2024; 58:395-403. [PMID: 38285370 PMCID: PMC11043146 DOI: 10.1007/s43441-023-00604-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/01/2023] [Indexed: 01/30/2024]
Abstract
A clinical trial is any research on human subjects that involves an investigational medicinal product or device. Investigational medicinal products include unlicensed drugs or drugs used outside the product license (e.g. for a new indication) (ICH-GCP). As per the internationally accepted ICH-GCP guidelines, clinical trials should be conducted strictly per the approved protocol. However, during the lifecycle of a trial, protocol deviations may occur. Under ICH efficacy guidelines, protocol deviations are divided into non-important (minor) or important (major), and the latter can jeopardise the participant's rights, safety or the quality of data generated by the study. Existing guidelines on protocol deviation management do not detail or standardise actions to be taken for participants, investigational products, data or samples as part of a holistic management of important protocol deviations. Herein, we propose guidelines to address the current literature gap and promote the standardisation of actions to address important protocol deviations in clinical trials. The advised actions should complement the existing local institutional review board and national regulatory authority requirements.
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Affiliation(s)
- Armel Zemsi
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia.
| | | | - Nuredin Mohammed
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | | | - Edgard Dabira
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Sheikh Omar Sillah
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Gibbi Sey
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Daisy H Williams
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Bai-Lamin Dondeh
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Carla Cerami
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
| | - Ed Clarke
- MRCG at LSHTM, Atlantic Boulevard, Fajara, P.O. Box 273, Banjul, The Gambia
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Lee TH, Streed CG. Gender Eligibility Descriptions for Clinical Trials. JAMA 2024; 331:1415-1416. [PMID: 38526485 DOI: 10.1001/jama.2024.0689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Affiliation(s)
- Tzu-Hao Lee
- Section of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, Texas
| | - Carl G Streed
- GenderCare Center, Boston Medical Center, Boston, Massachusetts
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Mohan S, Tse T. Gender Eligibility Descriptions for Clinical Trials-Reply. JAMA 2024; 331:1416-1417. [PMID: 38526481 DOI: 10.1001/jama.2024.0692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Affiliation(s)
- Swapna Mohan
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland
| | - Tony Tse
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland
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Gidh-Jain M, Parke T, König F, Spiertz C, Mesenbrink P. Developing generic templates to shape the future for conducting integrated research platform trials. Trials 2024; 25:204. [PMID: 38515103 PMCID: PMC10956223 DOI: 10.1186/s13063-024-08034-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 03/04/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Interventional clinical studies conducted in the regulated drug research environment are designed using International Council for Harmonisation (ICH) regulatory guidance documents: ICH E6 (R2) Good Clinical Practice-scientific guideline, first published in 2002 and last updated in 2016. This document provides an international ethical and scientific quality standard for designing and conducting trials that involve the participation of human subjects. Recently, there has been heightened awareness of the importance of integrated research platform trials (IRPs) designed to evaluate multiple therapies simultaneously. The use of a single master protocol as a key source document to fulfill trial conduct obligations has resulted in a re-examination of the templates used to fulfill the dynamic regulatory and modern drug development environment challenges. METHODS Regulatory medical writing, biostatistical, and other members of EU Patient-cEntric clinicAl tRial pLatforms (EU-PEARL) developed the suite of templates for IRPs over a 3.5-year period. Stakeholders contributing expertise included academic hospitals, pharmaceutical companies, non-governmental organizations, patient representative groups, and small and medium-sized enterprises (SMEs). RESULTS The suite of templates for IRPs based on TransCelerate's Common Protocol Template (CPT) and statistical analysis plan (SAP) should help authors navigate relevant guidelines as they create study design content relevant for today's IRP studies. It offers practical suggestions for adaptive platform designs which offer flexible features such as dropping treatments for futility or adding new treatments to be tested during a trial. The EU-PEARL suite of templates for IRPs comprises a preface, followed by the actual resource. The preface clarifies the intended use and underlying principles that inform resource utility. The preface lists references contributing to the development of the resource. The resource includes TransCelerate CPT guidance text, and EU-PEARL-derived guidance text, distinguished from one another using shading. Rationale comments are used throughout for clarification purposes. In addition, a user-friendly, functional, and informative Platform Trials Best Practices tool to support the setup, design, planning, implementation, and conduct of complex and innovative trials to support multi-sourced/multi-company platform trials is also provided. Together, the EU-PEARL suite of templates and the Platform Trials Best Practices tool constitute the reference user manual. CONCLUSIONS This publication is intended to enhance the use, understanding, and dissemination of the EU-PEARL suite of templates for designing IRPs. The reference user manual and the associated website ( http://www.eu-pearl ) should facilitate the designing of IRP trials.
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Affiliation(s)
| | - Tom Parke
- Berry Consultants, Suite3, 5 East Saint Helen Street, Abingdon, OX14 5EG, UK
| | - Franz König
- Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | | | - Peter Mesenbrink
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936, USA.
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Florez M, Smith Z, Olah Z, Martin M, Getz K. Quantifying Site Burden to Optimize Protocol Performance. Ther Innov Regul Sci 2024; 58:347-356. [PMID: 38191957 DOI: 10.1007/s43441-023-00602-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/14/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND The increase in protocol complexity and the resulting rise in the effort required by investigative sites to implement protocols have been well documented, but existing measures of site burden only offer an incomplete view of the burden experienced by site personnel. The introduction of Decentralized Clinical Trials-trials supported by remote and virtual technologies and services-is expected to impact the burden imposed on sites, but this impact has not yet been systematically measured. METHODS The Tufts Center for the Study of Drug Development conducted an online survey among clinical research sites worldwide and gathered 355 responses assessing the burden associated with distinct activities and procedures related to the implementation of clinical trial protocols using traditional and decentralized approaches. RESULTS A high percentage of investigative sites (50.5%) have had no experience with DCT solutions and only a small percentage (6.6%) have participated in fully decentralized clinical trials. Overall, half of respondents view DCT solutions as more burdensome than traditional clinical trials. In general, activities related to operational and managerial aspects of trial implementation were viewed as less burdensome when done remotely, while clinical procedures or elements that require study team-patient interactions were viewed as more burdensome when using DCT approaches versus in-person or traditional methods.
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Affiliation(s)
- Maria Florez
- Tufts Center for the Study of Drug Development, Tufts School of Medicine, Boston, USA.
| | - Zachary Smith
- Tufts Center for the Study of Drug Development, Tufts School of Medicine, Boston, USA
| | | | | | - Kenneth Getz
- Tufts Center for the Study of Drug Development, Tufts School of Medicine, Boston, USA
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Lenharo M. Move over, CRISPR: RNA-editing therapies pick up steam. Nature 2024; 626:933-934. [PMID: 38366220 DOI: 10.1038/d41586-024-00275-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
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Jull G, Moore AP. Extra criteria for quality assessment of clinical trials in physiotherapy. Musculoskelet Sci Pract 2024; 69:102910. [PMID: 38246812 DOI: 10.1016/j.msksp.2024.102910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
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Prioul A, Fournier D, Lefeuvre C, Duranton S, Olivier P, Blanc E, Peyro-Saint-Paul L, Ruault S, Jamet A, Mouchel C. Overview of literature monitoring practice of clinical trials vigilance units in French institutional sponsors - A study from the REVISE working group. Therapie 2023; 78:659-666. [PMID: 36906491 DOI: 10.1016/j.therap.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Abstract
INTRODUCTION The evaluation of clinical trial (CT) safety is the main task of CT vigilance units. In addition to the management of adverse events, the units must review the literature to identify information that may impact the benefit-risk assessment of studies. In this survey, we investigated the literature monitoring (LM) activity of French Institutional Vigilance Units (IVU) from the working group "REflexion sur la VIgilance et la SEcurite des essais cliniques" (REVISE). MATERIAL AND METHODS We sent a questionnaire of 26 questions, divided into four themes, to the 60 IVU: (1) Presentation of the IVU and the LM activity; (2) Used sources, queries and criteria for selecting articles; (3) Valuation of the LM and (4) Practical organisation. RESULTS Of the 27 IVU that responded to the questionnaire, 85% of them carried out LM. This was mainly provided by medical staff to improve general knowledge (83%), to detect Adverse Reactions (AR) not listed in the reference documents (70%) and to detect new safety information (61%). Due to lack of time, staff, available recommendations and sources, only 21% of IVU conducted LM for all CT. On average, units reported four sources: ANSM information (96%), PubMed database (83%), EMA alerts (57%) and the subscription to APM international (48%). The LM had an impact on the CT of 57% of the IVU such as changing the conditions of a study (39%) or suspending a study (22%). DISCUSSION/CONCLUSION LM is an important but time-consuming activity with heterogeneous practices. According to the results of this survey, we proposed seven ways to improve this practice: (1) Target the highest risk CT; (2) Refine the PubMed queries; (3) Use other tools; (4) Create a decision flowchart for the selection of PubMed articles; (5) Improve training; (6) Value the activity and (7) Outsource the activity.
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Affiliation(s)
- Astrid Prioul
- Service de pharmacologie clinique, unité de vigilance des essais cliniques, CIC Inserm 1414, CHU de Rennes, 35033 Rennes, France.
| | - Dorine Fournier
- Service de pharmacologie clinique, unité de vigilance des essais cliniques, CIC Inserm 1414, CHU de Rennes, 35033 Rennes, France
| | - Cécile Lefeuvre
- Service de pharmacologie clinique, unité de vigilance des essais cliniques, CIC Inserm 1414, CHU de Rennes, 35033 Rennes, France
| | - Sophie Duranton
- Direction de la recherche, unité de vigilance des essais cliniques, CHU de Poitiers, 86021 Poitiers cedex, France
| | - Pascale Olivier
- Service de pharmacologie médicale et clinique, centre de pharmacovigilance, de pharmacoépidémiologie et d'informations sur le médicament INSERM UMR 1027, CIC 1436, CHU de Toulouse, 31059 Toulouse, France
| | - Emeline Blanc
- Direction de la recherche en santé, unité de vigilance des essais cliniques, Hospices civils de Lyon, 69229 Lyon, France
| | | | - Sophie Ruault
- Maison de la recherche clinique, CHU de Rouen, 76031 Rouen, France
| | - Aurélie Jamet
- Vigilance des essais cliniques, CHU d'Angers, 49933 Angers, France
| | - Catherine Mouchel
- Service de pharmacologie clinique, unité de vigilance des essais cliniques, CIC Inserm 1414, CHU de Rennes, 35033 Rennes, France
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Noyes J. Why do authors persist in submitting trial reports that do not meet the journal eligibility criteria or AllTrials standards? J Clin Nurs 2023; 32:5425-5426. [PMID: 36912707 DOI: 10.1111/jocn.16667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 03/14/2023]
Affiliation(s)
- Jane Noyes
- Journals of Advanced Nursing, Clinical Nursing and Nursing Open
- Health and Social Services Research and Child Health, School of Medical and Health Sciences, Bangor University, Bangor, UK
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Webbe J, Baba A, Butcher NJ, Rodrigues C, Stallwood E, Goren K, Monsour A, Chang ASM, Trivedi A, Manley BJ, McCall E, Bogossian F, Namba F, Schmölzer GM, Popat H, Nguyen KA, Doyle LW, Jardine L, Rysavy MA, Konstantinidis M, Muhd Helmi MA, Lai NM, Hay S, Onland W, Choo YM, Gale C, Soll RF, Offringa M. Strengthening Reporting of Neonatal Trials. Pediatrics 2023; 152:e2022060765. [PMID: 37641894 DOI: 10.1542/peds.2022-060765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is variability in the selection and reporting of outcomes in neonatal trials with key information frequently omitted. This can impact applicability of trial findings to clinicians, families, and caregivers, and impair evidence synthesis. The Neonatal Core Outcomes Set describes outcomes agreed as clinically important that should be assessed in all neonatal trials, and Consolidated Standards of Reporting Trials (CONSORT)-Outcomes 2022 is a new, harmonized, evidence-based reporting guideline for trial outcomes. We reviewed published trials using CONSORT-Outcomes 2022 guidance to identify exemplars of neonatal core outcome reporting to strengthen description of outcomes in future trial publications. METHODS Neonatal trials including >100 participants per arm published between 2015 to 2020 with a primary outcome included in the Neonatal Core Outcome Set were identified. Primary outcome reporting was reviewed using CONSORT 2010 and CONSORT-Outcomes 2022 guidelines by assessors recruited from Cochrane Neonatal. Examples of clear and complete outcome reporting were identified with verbatim text extracted from trial reports. RESULTS Thirty-six trials were reviewed by 39 assessors. Examples of good reporting for CONSORT 2010 and CONSORT-Outcomes 2022 criteria were identified and subdivided into 3 outcome categories: "survival," "short-term neonatal complications," and "long-term developmental outcomes" depending on the core outcomes to which they relate. These examples are presented to strengthen future research reporting. CONCLUSIONS We have identified examples of good trial outcome reporting. These illustrate how important neonatal outcomes should be reported to meet the CONSORT 2010 and CONSORT-Outcomes 2022 guidelines. Emulating these examples will improve the transmission of information relating to outcomes and reduce associated research waste.
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Affiliation(s)
- James Webbe
- Neonatal Medicine, School of Public Health, Imperial College London, United Kingdom
| | - Ami Baba
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Craig Rodrigues
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Emma Stallwood
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Katherine Goren
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Andrea Monsour
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Alvin S M Chang
- Quality, Safety and Risk Management (QSRM) and Department of Neonatology, KK Women's and Children's Hospital, Singapore
- DUKE-NUS Medical School, Singapore
| | - Amit Trivedi
- The Children's Hospital at Westmead, New South Wales, Australia
| | | | - Emma McCall
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland
| | | | - Fumihiko Namba
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | | | - Himanshu Popat
- The Children's Hospital at Westmead, New South Wales, Australia
| | | | - Lex W Doyle
- Department of Obstetrics and Gynaecology, The Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Luke Jardine
- Department of Neonatology, Mater Mothers' Hospital, South Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Australia
| | - Matthew A Rysavy
- University of Texas Health Science Centre at Houston, Houston, Texas
| | - Menelaos Konstantinidis
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Muhd Alwi Muhd Helmi
- Department of Paediatrics, International Islamic University, Kuala Lumpur, Malaysia
| | - Nai Ming Lai
- School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Selangor, Malaysia
| | - Susanne Hay
- Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Wes Onland
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, Netherlands
| | - Yao Mun Choo
- Neonatal Medicine, School of Public Health, Imperial College London, United Kingdom
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Imperial College London, United Kingdom
| | - Roger F Soll
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Neonatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Reardon S. Alzheimer's drug trials plagued by lack of racial diversity. Nature 2023; 620:256-257. [PMID: 37532857 DOI: 10.1038/d41586-023-02464-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
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Llibre-Guerra JJ, Heavener A, Brucki SMD, Marante JPD, Pintado-Caipa M, Chen Y, Behrens MI, Hardi A, Admirall-Sanchez A, Akinyemi R, Alladi S, Dorsman KA, Rodriguez-Salgado AM, Solorzano J, Babulal GM. A call for clinical trial globalization in Alzheimer's disease and related dementia. Alzheimers Dement 2023; 19:3210-3221. [PMID: 36840622 PMCID: PMC10450094 DOI: 10.1002/alz.12995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/07/2023] [Accepted: 01/09/2023] [Indexed: 02/26/2023]
Abstract
BACKGROUND The burden of Alzheimer's disease and related dementia (ADRD) is projected to disproportionally impact low-middle-income countries (LMICs). However, there is a systematic under-representation of LMICs in ADRD clinical trial platforms. METHODS We aimed to determine the global distribution of ADRD clinical trials and identify existing barriers for conducting clinical trials in LMICs. Primary data sources to identify trial distribution in LMICs included ClinicalTrials.gov and the International Trials Registry Platform. An additional systematic review and expert consensus interviews were conducted to identify barriers for conducting clinical trials in LMICs. FINDINGS Among 1237 disease-modifying therapies tested in ADRD clinical trials, only 11.6% have been or are conducted in emerging economies (upper-middle income [9.6%] and low-middle income [2.0%]). We identified several limitations for trial implementation including a lack of financial resources, low industry presence, regulatory obstacles, and operational barriers INTERPRETATION: Although LMICs bear the greatest burden of ADRD globally, substantial development of clinical trial platforms to address this inequity and health disparity is lacking.
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Affiliation(s)
- Jorge J Llibre-Guerra
- Department of Neurology, Washington University, School of Medicine, St. Louis, Missouri, USA
- Dominantly Inherited Alzheimer's Network Trial Unit, St. Louis, Missouri, USA
- Institute of Public Health, Washington University, St. Louis, Missouri, USA
| | - Anika Heavener
- Department of Global Health and Social Medicine, Harvard Medical School, St. Louis, Missouri, USA
| | - Sonia Maria Dozzi Brucki
- Cognitive and Behavioral Neurology Unit, Department of Neurology, University of Sao Paulo, São Paulo, Brazil
| | | | | | - Yaohua Chen
- Department of Geriatrics, Lille Neurosciences & Cognition, University of Lille, Lille, France
| | - María Isabel Behrens
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Independencia, Santiago, Chile
| | - Angela Hardi
- Becker Medical Library, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Rufus Akinyemi
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Suvarna Alladi
- National Institute of Mental Health and Neuroscience, Bangalore, India
| | - Karen A Dorsman
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Joel Solorzano
- Department of Medicine, Hospital Antonio Luaces Iralola, Ciego de Avila, Cuba
| | - Ganesh M Babulal
- Department of Neurology, Washington University, School of Medicine, St. Louis, Missouri, USA
- Institute of Public Health, Washington University, St. Louis, Missouri, USA
- Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
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DeVito NJ. Increasing the Reporting Quality of Clinical Trials-No Easy Solutions? JAMA Netw Open 2023; 6:e2317665. [PMID: 37294573 DOI: 10.1001/jamanetworkopen.2023.17665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Affiliation(s)
- Nicholas J DeVito
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Nelson JT, Tse T, Puplampu-Dove Y, Golfinopoulos E, Zarin DA. Comparison of Availability of Trial Results in ClinicalTrials.gov and PubMed by Data Source and Funder Type. JAMA 2023; 329:1404-1406. [PMID: 36995689 PMCID: PMC10064282 DOI: 10.1001/jama.2023.2351] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/10/2023] [Indexed: 03/31/2023]
Abstract
This study examines the dissemination of trial results by data source (ie, ClinicalTrials.gov and PubMed) and funder type (ie, industry and nonindustry).
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Affiliation(s)
- Julianne T. Nelson
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland
| | - Tony Tse
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland
| | | | - Elisa Golfinopoulos
- National Library of Medicine, National Institutes of Health, Bethesda, Maryland
| | - Deborah A. Zarin
- Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and Harvard, Cambridge, Massachusetts
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Wise J. Clinical trials: Streamlined framework aims to boost UK research. BMJ 2023; 380:696. [PMID: 36958751 DOI: 10.1136/bmj.p696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
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Saville BR, Detry MA, Viele K. Conditional Power: How Likely Is Trial Success? JAMA 2023; 329:508-509. [PMID: 36689237 DOI: 10.1001/jama.2022.25080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This JAMA Guide to Statistics and Methods article examines conditional power, calculated while a trial is ongoing and based on both the currently observed data and an assumed treatment effect for future patients.
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Affiliation(s)
- Benjamin R Saville
- Berry Consultants LLC, Austin, Texas
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Kert Viele
- Berry Consultants LLC, Austin, Texas
- Department of Biostatistics, University of Kentucky, Lexington
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Butcher NJ, Monsour A, Mew EJ, Chan AW, Moher D, Mayo-Wilson E, Terwee CB, Chee-A-Tow A, Baba A, Gavin F, Grimshaw JM, Kelly LE, Saeed L, Thabane L, Askie L, Smith M, Farid-Kapadia M, Williamson PR, Szatmari P, Tugwell P, Golub RM, Monga S, Vohra S, Marlin S, Ungar WJ, Offringa M. Guidelines for Reporting Outcomes in Trial Protocols: The SPIRIT-Outcomes 2022 Extension. JAMA 2022; 328:2345-2356. [PMID: 36512367 DOI: 10.1001/jama.2022.21243] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Complete information in a trial protocol regarding study outcomes is crucial for obtaining regulatory approvals, ensuring standardized trial conduct, reducing research waste, and providing transparency of methods to facilitate trial replication, critical appraisal, accurate reporting and interpretation of trial results, and knowledge synthesis. However, recommendations on what outcome-specific information should be included are diverse and inconsistent. To improve reporting practices promoting transparent and reproducible outcome selection, assessment, and analysis, a need for specific and harmonized guidance as to what outcome-specific information should be addressed in clinical trial protocols exists. OBJECTIVE To develop harmonized, evidence- and consensus-based standards for describing outcomes in clinical trial protocols through integration with the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 statement. EVIDENCE REVIEW Using the Enhancing the Quality and Transparency of Health Research (EQUATOR) methodological framework, the SPIRIT-Outcomes 2022 extension of the SPIRIT 2013 statement was developed by (1) generation and evaluation of candidate outcome reporting items via consultation with experts and a scoping review of existing guidance for reporting trial outcomes (published within the 10 years prior to March 19, 2018) identified through expert solicitation, electronic database searches of MEDLINE and the Cochrane Methodology Register, gray literature searches, and reference list searches; (2) a 3-round international Delphi voting process (November 2018-February 2019) completed by 124 panelists from 22 countries to rate and identify additional items; and (3) an in-person consensus meeting (April 9-10, 2019) attended by 25 panelists to identify essential items for outcome-specific reporting to be addressed in clinical trial protocols. FINDINGS The scoping review and consultation with experts identified 108 recommendations relevant to outcome-specific reporting to be addressed in trial protocols, the majority (72%) of which were not included in the SPIRIT 2013 statement. All recommendations were consolidated into 56 items for Delphi voting; after the Delphi survey process, 19 items met criteria for further evaluation at the consensus meeting and possible inclusion in the SPIRIT-Outcomes 2022 extension. The discussions during and after the consensus meeting yielded 9 items that elaborate on the SPIRIT 2013 statement checklist items and are related to completely defining and justifying the choice of primary, secondary, and other outcomes (SPIRIT 2013 statement checklist item 12) prospectively in the trial protocol, defining and justifying the target difference between treatment groups for the primary outcome used in the sample size calculations (SPIRIT 2013 statement checklist item 14), describing the responsiveness of the study instruments used to assess the outcome and providing details on the outcome assessors (SPIRIT 2013 statement checklist item 18a), and describing any planned methods to account for multiplicity relating to the analyses or interpretation of the results (SPIRIT 2013 statement checklist item 20a). CONCLUSIONS AND RELEVANCE This SPIRIT-Outcomes 2022 extension of the SPIRIT 2013 statement provides 9 outcome-specific items that should be addressed in all trial protocols and may help increase trial utility, replicability, and transparency and may minimize the risk of selective nonreporting of trial results.
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Affiliation(s)
- Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Monsour
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Emma J Mew
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, Connecticut
| | - An-Wen Chan
- Department of Medicine, Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Evan Mayo-Wilson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Caroline B Terwee
- Amsterdam University Medical Centers, Vrije Universiteit, Department of Epidemiology and Data Science, Amsterdam, the Netherlands
- Department of Methodology, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Alyssandra Chee-A-Tow
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Ami Baba
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Frank Gavin
- public panel member, Toronto, Ontario, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lauren E Kelly
- Department of Pharmacology and Therapeutics, University of Manitoba, Winnipeg, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Leena Saeed
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Lehana Thabane
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Askie
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Mufiza Farid-Kapadia
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Paula R Williamson
- MRC-NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, England
| | - Peter Szatmari
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Tugwell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert M Golub
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Suneeta Monga
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sunita Vohra
- Departments of Pediatrics and Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Susan Marlin
- Clinical Trials Ontario, Toronto, Canada
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Butcher NJ, Monsour A, Mew EJ, Chan AW, Moher D, Mayo-Wilson E, Terwee CB, Chee-A-Tow A, Baba A, Gavin F, Grimshaw JM, Kelly LE, Saeed L, Thabane L, Askie L, Smith M, Farid-Kapadia M, Williamson PR, Szatmari P, Tugwell P, Golub RM, Monga S, Vohra S, Marlin S, Ungar WJ, Offringa M. Guidelines for Reporting Outcomes in Trial Reports: The CONSORT-Outcomes 2022 Extension. JAMA 2022; 328:2252-2264. [PMID: 36511921 DOI: 10.1001/jama.2022.21022] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Clinicians, patients, and policy makers rely on published results from clinical trials to help make evidence-informed decisions. To critically evaluate and use trial results, readers require complete and transparent information regarding what was planned, done, and found. Specific and harmonized guidance as to what outcome-specific information should be reported in publications of clinical trials is needed to reduce deficient reporting practices that obscure issues with outcome selection, assessment, and analysis. OBJECTIVE To develop harmonized, evidence- and consensus-based standards for reporting outcomes in clinical trial reports through integration with the Consolidated Standards of Reporting Trials (CONSORT) 2010 statement. EVIDENCE REVIEW Using the Enhancing the Quality and Transparency of Health Research (EQUATOR) methodological framework, the CONSORT-Outcomes 2022 extension of the CONSORT 2010 statement was developed by (1) generation and evaluation of candidate outcome reporting items via consultation with experts and a scoping review of existing guidance for reporting trial outcomes (published within the 10 years prior to March 19, 2018) identified through expert solicitation, electronic database searches of MEDLINE and the Cochrane Methodology Register, gray literature searches, and reference list searches; (2) a 3-round international Delphi voting process (November 2018-February 2019) completed by 124 panelists from 22 countries to rate and identify additional items; and (3) an in-person consensus meeting (April 9-10, 2019) attended by 25 panelists to identify essential items for the reporting of outcomes in clinical trial reports. FINDINGS The scoping review and consultation with experts identified 128 recommendations relevant to reporting outcomes in trial reports, the majority (83%) of which were not included in the CONSORT 2010 statement. All recommendations were consolidated into 64 items for Delphi voting; after the Delphi survey process, 30 items met criteria for further evaluation at the consensus meeting and possible inclusion in the CONSORT-Outcomes 2022 extension. The discussions during and after the consensus meeting yielded 17 items that elaborate on the CONSORT 2010 statement checklist items and are related to completely defining and justifying the trial outcomes, including how and when they were assessed (CONSORT 2010 statement checklist item 6a), defining and justifying the target difference between treatment groups during sample size calculations (CONSORT 2010 statement checklist item 7a), describing the statistical methods used to compare groups for the primary and secondary outcomes (CONSORT 2010 statement checklist item 12a), and describing the prespecified analyses and any outcome analyses not prespecified (CONSORT 2010 statement checklist item 18). CONCLUSIONS AND RELEVANCE This CONSORT-Outcomes 2022 extension of the CONSORT 2010 statement provides 17 outcome-specific items that should be addressed in all published clinical trial reports and may help increase trial utility, replicability, and transparency and may minimize the risk of selective nonreporting of trial results.
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Affiliation(s)
- Nancy J Butcher
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Monsour
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Emma J Mew
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, Connecticut
| | - An-Wen Chan
- Department of Medicine, Women's College Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Evan Mayo-Wilson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill
| | - Caroline B Terwee
- Amsterdam University Medical Centers, Vrije Universiteit, Department of Epidemiology and Data Science, Amsterdam, the Netherlands
- Department of Methodology, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Alyssandra Chee-A-Tow
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Ami Baba
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Frank Gavin
- public panel member, Toronto, Ontario, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lauren E Kelly
- Department of Pharmacology and Therapeutics, University of Manitoba, Winnipeg, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Leena Saeed
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Lehana Thabane
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Askie
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Mufiza Farid-Kapadia
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Paula R Williamson
- MRC-NIHR Trials Methodology Research Partnership, Department of Health Data Science, University of Liverpool, Liverpool, England
| | - Peter Szatmari
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Tugwell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert M Golub
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Suneeta Monga
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sunita Vohra
- Departments of Pediatrics and Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Susan Marlin
- Clinical Trials Ontario, Toronto, Canada
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada
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Affiliation(s)
- Thomas J Hwang
- From the Division of Urological Surgery, Brigham and Women's Hospital, and the Cancer Innovation and Regulation Initiative, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute - both in Boston (T.J.H.); and the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health - both in Baltimore (O.W.B.)
| | - Otis W Brawley
- From the Division of Urological Surgery, Brigham and Women's Hospital, and the Cancer Innovation and Regulation Initiative, Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute - both in Boston (T.J.H.); and the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, and the Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health - both in Baltimore (O.W.B.)
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Abstract
BACKGROUND The fragility index has been gaining ground in the evaluation of comparative clinical studies. Many scientists evaluated trials in their fields and deemed them to be fragile, although there is no consensus on the definition of fragility. We aimed to calculate the fragility index and its permutations for paediatric surgical trials. METHODS We searched pubmed for prospectively conducted paediatric surgical trials with intervention and control group without limitations and calculated their (reverse) fragility indices and respective quotients along with posthoc-power. Relationships between variables were evaluated using Spearman's ρ. We also calculated S values by negative log transformation base-2 of P values. RESULTS Of 516 retrieved records, we included 87. The median fragility index was 1.5 (interquartile range: 0-4) and the median reverse fragility index was 3 (interquartile range: 2-4), although they were statistically not different (Mood's test: χ2 = 0.557, df = 1, P = 0.4556). P values and fragility indices were strongly inversely correlated (ρ = - 0.71, 95% confidence interval: - 0.53 to - 0.85, P < 0.0001), while reverse fragility indices were moderately correlated to P values (ρ = 0.5, 95% confidence interval: 0.37-0.62, P < 0.0001). A fragility index of 1 resulted from P values between 0.039 and 0.003, which resulted in S values between 4 and 8. CONCLUSIONS Fragility indices, reverse fragility indices, and their respective fragility quotients of paediatric surgical trials are low. The fragility index can be viewed as no more than a transformed P value with even more substantial limitations. Its inherent penalisation of small studies irrespective of their clinical relevance is particularly harmful for paediatric surgery. Consequently, the fragility index should be avoided.
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Affiliation(s)
- Arne Schröder
- Klinik für Kinder- und Jugendmedizin, Klinikum Dortmund, Dortmund, Germany
| | - Oliver J Muensterer
- Kinderchirurgische Klinik und Poliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität München, München, Germany
- Klinik und Poliklinik für Kinderchirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Christina Oetzmann von Sochaczewski
- Klinik und Poliklinik für Kinderchirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Germany.
- Sektion Kinderchirurgie der Klinik und Poliklinik für Allgemein, Viszeral, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
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Affiliation(s)
| | - Alex Helman
- National Academies of Sciences, Engineering, and Medicine, Washington, DC
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23
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Tanne JH. US must urgently correct ethnic and racial disparities in clinical trials, says report. BMJ 2022; 377:o1292. [PMID: 35605987 DOI: 10.1136/bmj.o1292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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25
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Helanterä I, Snyder J, Åsberg A, Cruzado JM, Bell S, Legendre C, Tedesco-Silva H, Barcelos GT, Geissbühler Y, Prieto L, Christian JB, Scalfaro E, Dreyer NA. Demonstrating Benefit-Risk Profiles of Novel Therapeutic Strategies in Kidney Transplantation: Opportunities and Challenges of Real-World Evidence. Transpl Int 2022; 35:10329. [PMID: 35592446 PMCID: PMC9110654 DOI: 10.3389/ti.2022.10329] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/29/2021] [Accepted: 03/11/2022] [Indexed: 11/28/2022]
Abstract
While great progress has been made in transplantation medicine, long-term graft failure and serious side effects still pose a challenge in kidney transplantation. Effective and safe long-term treatments are needed. Therefore, evidence of the lasting benefit-risk of novel therapies is required. Demonstrating superiority of novel therapies is unlikely via conventional randomized controlled trials, as long-term follow-up in large sample sizes pose statistical and operational challenges. Furthermore, endpoints generally accepted in short-term clinical trials need to be translated to real-world (RW) care settings, enabling robust assessments of novel treatments. Hence, there is an evidence gap that calls for innovative clinical trial designs, with RW evidence (RWE) providing an opportunity to facilitate longitudinal transplant research with timely translation to clinical practice. Nonetheless, the current RWE landscape shows considerable heterogeneity, with few registries capturing detailed data to support the establishment of new endpoints. The main recommendations by leading scientists in the field are increased collaboration between registries for data harmonization and leveraging the development of technology innovations for data sharing under high privacy standards. This will aid the development of clinically meaningful endpoints and data models, enabling future long-term research and ultimately establish optimal long-term outcomes for transplant patients.
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Affiliation(s)
- Ilkka Helanterä
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Jon Snyder
- Hennepin Healthcare Research Institute, Minneapolis, MN, United States
| | - Anders Åsberg
- Department of Transplantation Medicine, Oslo University Hospital-Rikshospitalet, Oslo, Norway
- Department of Pharmacy, University of Oslo, Oslo, Norway
| | - Josep Maria Cruzado
- Department of Nephrology, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
- Bellvitge Biomedical Research Institute-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Clinical Sciences Department, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Samira Bell
- Division of Population Health and Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
- The Scottish Renal Registry, Scottish Health Audits, Public Health and Intelligence, Information Services, Glasgow, United Kingdom
| | - Christophe Legendre
- Hôpital Necker, Assistance Publique Hôpitaux de Paris (AP-HP) and Université Paris Descartes, Paris, France
| | - Hélio Tedesco-Silva
- Nephrology Division, Hospital do Rim, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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DeVito NJ, Goldacre B. New EU trial reporting regulations must be enforced. BMJ 2022; 376:o410. [PMID: 35181578 DOI: 10.1136/bmj.o410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Nicholas J DeVito
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ben Goldacre
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Affiliation(s)
| | - Kelly E Lloyd
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Nicholas J DeVito
- DataLab and Centre for Evidence Based Medicine, University of Oxford, Oxford, UK
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Sharib J, Slingluff CL, Beasley GM. Melanoma trials that defined surgical management: Overview of trials that established NCCN margin guidelines. J Surg Oncol 2022; 125:28-33. [PMID: 34897715 PMCID: PMC8682801 DOI: 10.1002/jso.26717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 10/06/2021] [Indexed: 01/03/2023]
Abstract
Since the observation that clearance of all visible and microscopic tumors from cutaneous melanoma is critical to prevent a recurrence, wide surgical margins have been central to surgical dogma. In the last several decades, more conservative margin widths have been vigorously studied by surgical investigators to lessen wound complications, the need for reconstruction, and healthcare costs. This review summarizes surgeon-led clinical trials that define current guidelines and highlights the challenges to initiate and perform trials today.
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Affiliation(s)
- Jeremy Sharib
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Craig L Slingluff
- Department of Surgery, University of Virginia, Charlottesville, Virginia, USA
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O'Grady C. Poor trials of health steps are worse than none, scientists say. Science 2021; 374:1180-1181. [PMID: 34855506 DOI: 10.1126/science.acx9739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
[Figure: see text].
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30
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Proudfoot AG, Kalakoutas A, Meade S, Griffiths MJD, Basir M, Burzotta F, Chih S, Fan E, Haft J, Ibrahim N, Kruit N, Lim HS, Morrow DA, Nakata J, Price S, Rosner C, Roswell R, Samaan MA, Samsky MD, Thiele H, Truesdell AG, van Diepen S, Voeltz MD, Irving PM. Contemporary Management of Cardiogenic Shock: A RAND Appropriateness Panel Approach. Circ Heart Fail 2021; 14:e008635. [PMID: 34807723 PMCID: PMC8692411 DOI: 10.1161/circheartfailure.121.008635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Current practice in cardiogenic shock is guided by expert opinion in guidelines and scientific statements from professional societies with limited high quality randomized trial data to inform optimal patient management. An international panel conducted a modified Delphi process with the intent of identifying aspects of cardiogenic shock care where there was uncertainty regarding optimal patient management. METHODS An 18-person multidisciplinary panel comprising international experts was convened. A modified RAND/University of California Los Angeles appropriateness methodology was used. A survey comprising 70 statements was completed. Participants anonymously rated the appropriateness of each statement on a scale of 1 to 9: 1 to 3 inappropriate, 4 to 6 uncertain, and 7 to 9 appropriate. A summary of the results was discussed as a group, and the survey was iterated and completed again before final analysis. RESULTS There was broad alignment with current international guidelines and consensus statements. Overall, 44 statements were rated as appropriate, 19 as uncertain, and 7 as inappropriate. There was no disagreement with a disagreement index <1 for all statements. Routine fluid administration was deemed to be inappropriate. Areas of uncertainty focused panel on pre-PCI interventions, the use of right heart catheterization to guide management, routine use of left ventricular unloading strategies, and markers of futility when considering escalation to mechanical circulatory support. CONCLUSIONS While there was broad alignment with current guidance, an expert panel found several aspects of care where there was clinical equipoise, further highlighting the need for randomized controlled trials to better guide patient management and decision making in cardiogenic shock.
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Affiliation(s)
- Alastair G Proudfoot
- Perioperative Medicine Department, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
- Clinic For Anaesthesiology & Intensive Care, Charité-Universitätsmedizin Berlin corporate member of Freie Universität Berlin and Humboldt Univesität zu, Berlin, Germany
- Department of Anaesthesiology & Intensive Care, German Heart Centre Berlin, Germany
- Queen Mary University of London, London, UK
- Corresponding author: Alastair Proudfoot, Barts Heart Centre, St Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, Mobile: 07779011194,
| | | | - Susanna Meade
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Mark JD Griffiths
- Perioperative Medicine Department, Barts Heart Centre, St Bartholomew’s Hospital, London, UK
- National Heart & Lung Institute, Imperial College London, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Mir Basir
- Department of Cardiology, Henry Ford Health System, Detroit, MI USA
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Sharon Chih
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, Department of Medicine and Division of Respirology, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, Toronto, ON, Canada
| | - Jonathan Haft
- Department of Cardiac Surgery, University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI, USA
| | | | - Natalie Kruit
- Department of Anaesthesia, Westmead Hospital, Sydney, NSW, Australia
| | - Hoong Sern Lim
- Department of Cardiology, University of Birmingham NHS Foundation Trust, Birmingham, UK
| | - David A. Morrow
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jun Nakata
- Division of Cardiovascular Intensive Care, Department of Cardiology, Nippon Medical School Hospital, Tokyo, Japan
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - Carolyn Rosner
- Inova Heart and Vascular Institute, Falls Church, VA, USA
| | | | - Mark A Samaan
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Marc D. Samsky
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | - Sean van Diepen
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Peter M Irving
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- School of Immunology and Microbial Sciences, King’s College London, UK
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Igelström E, Campbell M, Craig P, Katikireddi SV. Cochrane's risk of bias tool for non-randomized studies (ROBINS-I) is frequently misapplied: A methodological systematic review. J Clin Epidemiol 2021; 140:22-32. [PMID: 34437948 PMCID: PMC8809341 DOI: 10.1016/j.jclinepi.2021.08.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We aimed to review how 'Risk of Bias In Non-randomized Studies-of Interventions' (ROBINS-I), a Cochrane risk of bias assessment tool, has been used in recent systematic reviews. STUDY DESIGN AND SETTING Database and citation searches were conducted in March 2020 to identify recently published reviews using ROBINS-I. Reported ROBINS-I assessments and data on how ROBINS-I was used were extracted from each review. Methodological quality of reviews was assessed using AMSTAR 2 ('A MeaSurement Tool to Assess systematic Reviews'). RESULTS Of 181 hits, 124 reviews were included. Risk of bias was serious/critical in 54% of assessments on average, most commonly due to confounding. Quality of reviews was mostly low, and modifications and incorrect use of ROBINS-I were common, with 20% reviews modifying the rating scale, 20% understating overall risk of bias, and 19% including critical-risk of bias studies in evidence synthesis. Poorly conducted reviews were more likely to report low/moderate risk of bias (predicted probability 57% [95% CI: 47-67] in critically low-quality reviews, 31% [19-46] in high/moderate-quality reviews). CONCLUSION Low-quality reviews frequently apply ROBINS-I incorrectly, and may thus inappropriately include or give too much weight to uncertain evidence. Readers should be aware that such problems can lead to incorrect conclusions in reviews.
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Affiliation(s)
- Erik Igelström
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square 99 Berkeley Street, Glasgow, G3 7HR.
| | - Mhairi Campbell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square 99 Berkeley Street, Glasgow, G3 7HR
| | - Peter Craig
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square 99 Berkeley Street, Glasgow, G3 7HR
| | - Srinivasa Vittal Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square 99 Berkeley Street, Glasgow, G3 7HR
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Affiliation(s)
- Jennifer E Balkus
- Department of Epidemiology, University of Washington School of Public Health, Seattle
| | - Jodie Dionne-Odom
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham
| | - Harold C Wiesenfeld
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
- Magee-Womens Research Institute, Pittsburgh, Pennsylvania
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Abstract
The coronavirus disease 2019 (COVID-19) pandemic has presented unique challenges to stroke care and research internationally. In particular, clinical trials in stroke are vulnerable to the impacts of the pandemic at multiple stages, including design, recruitment, intervention, follow-up, and interpretation of outcomes. A carefully considered approach is required to ensure the appropriate conduct of stroke trials during the pandemic and to maintain patient and participant safety. This has been recently addressed by the International Council for Harmonisation which, in November 2019, released an addendum to the Statistical Principles for Clinical Trials guidelines entitled Estimands and Sensitivity Analysis in Clinical Trials. In this article, we present the International Council for Harmonisation estimand framework for the design and conduct of clinical trials, with a specific focus on its application to stroke clinical trials. This framework aims to align the clinical and scientific objectives of a trial with its design and end points. It also encourages the prospective consideration of potential postrandomization intercurrent events which may occur during a trial and either impact the ability to measure an end point or its interpretation. We describe the different categories of such events and the proposed strategies for dealing with them, specifically focusing on the COVID-19 pandemic as a source of intercurrent events. We also describe potential practical impacts posed by the COVID-19 pandemic on trials, health systems, study groups, and participants, all of which should be carefully reviewed by investigators to ensure an adequate practical and statistical strategy is in place to protect trial integrity. We provide examples of the implementation of the estimand framework within hypothetical stroke trials in intracerebral hemorrhage and stroke recovery. While the focus of this article is on COVID-19 impacts, the strategies and principles proposed are well suited for other potential events or issues, which may impact clinical trials in the field of stroke.
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Affiliation(s)
- Nawaf Yassi
- Departments of Medicine and Neurology, Melbourne Brain Centre, The Royal Melbourne Hospital (N.Y., B.C.V.C., L.C.), University of Melbourne, Parkville, Australia
- Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia (N.Y.)
| | - Kathryn S Hayward
- Department of Physiotherapy, Melbourne School of Health Sciences (K.S.H.), University of Melbourne, Parkville, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, Australia (K.S.H., B.C.V.C.)
| | - Bruce C V Campbell
- Departments of Medicine and Neurology, Melbourne Brain Centre, The Royal Melbourne Hospital (N.Y., B.C.V.C., L.C.), University of Melbourne, Parkville, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, Australia (K.S.H., B.C.V.C.)
| | - Leonid Churilov
- Departments of Medicine and Neurology, Melbourne Brain Centre, The Royal Melbourne Hospital (N.Y., B.C.V.C., L.C.), University of Melbourne, Parkville, Australia
- Melbourne Medical School (L.C.), University of Melbourne, Parkville, Australia
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Abstract
IMPORTANCE A systematic assessment of existing research should justify the conduct and inform the design of new clinical research but is often lacking. There is little research on the barriers to and factors facilitating systematic evidence assessments. OBJECTIVE To examine the practices and attitudes of Swiss stakeholders and international funders regarding conducting systematic evidence assessments in academic clinical trials. DESIGN, SETTING, AND PARTICIPANTS In this qualitative study, individual semistructured qualitative interviews were conducted between February and August 2020 with 48 Swiss stakeholder groups (27 primary investigators, 9 funders and sponsors, 6 clinical trial support organizations, and 6 ethics committee members) and between January and March 2021 with 9 international funders of clinical trials from North America and Europe with a reputation for requiring systematic evidence synthesis in applications for academic clinical trials. MAIN OUTCOMES AND MEASURES The main outcomes were practices and attitudes of Swiss stakeholders and international funders regarding conducting systematic evidence assessments in academic clinical trials. Interviews were analyzed using conventional content analysis. RESULTS Of the 57 participants, 40 (70.2%) were male. Participants universally acknowledged that a comprehensive understanding of the previous evidence is important but reported wide variation regarding how this should be achieved. Participants reported that the conduct of formal systematic reviews was currently not expected before most clinical trials, but most international funders reported expecting a systematic search for the existing evidence. Whereas time and resources were reported by all participants as barriers to conducting systematic reviews, the Swiss research ecosystem was reported not to be as supportive of a systematic approach compared with international settings. CONCLUSIONS AND RELEVANCE In this qualitative study, Swiss stakeholders and international funders generally agreed that new clinical trials should be justified by a systematic evidence assessment but that barriers on individual, organizational, and political levels kept them from implementing it. More explicit requirements from funders appear to be needed to clarify the required level of comprehensiveness in summarizing existing evidence for different types of clinical trials.
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Affiliation(s)
- Stuart McLennan
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University of Basel and University Hospital Basel, Basel, Switzerland
- Institute of History and Ethics in Medicine, TUM School of Medicine, Technical University of Munich, Munich, Germany
| | - Barbara Nussbaumer-Streit
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation, Danube University Krems, Krems, Austria
| | - Lars G. Hemkens
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University of Basel and University Hospital Basel, Basel, Switzerland
- Meta-Research Innovation Center at Stanford, Stanford University, Stanford, California
- Meta-Research Innovation Center Berlin, Berlin Institute of Health, Berlin, Germany
| | - Matthias Briel
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University of Basel and University Hospital Basel, Basel, Switzerland
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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Imperial MZ, Phillips PPJ, Nahid P, Savic RM. Precision-Enhancing Risk Stratification Tools for Selecting Optimal Treatment Durations in Tuberculosis Clinical Trials. Am J Respir Crit Care Med 2021; 204:1086-1096. [PMID: 34346856 PMCID: PMC8663006 DOI: 10.1164/rccm.202101-0117oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 01/15/2021] [Accepted: 07/28/2021] [Indexed: 12/04/2022] Open
Abstract
Rationale: No evidence-based tools exist to enhance precision in the selection of patient-specific optimal treatment durations to study in tuberculosis clinical trials. Objectives: To develop risk stratification tools that assign patients with tuberculosis into risk groups of unfavorable outcome and inform selection of optimal treatment duration for each patient strata to study in clinical trials. Methods: Publicly available data from four phase 3 trials, each evaluating treatment duration shortening from 6 to 4 months, were used to develop parametric time-to-event models that describe unfavorable outcomes. Regimen, baseline, and on-treatment characteristics were evaluated as predictors of outcomes. Exact regression coefficients of predictors were used to assign risk groups and predict optimal treatment durations. Measurements and Main Results: The parametric model had an area under the receiver operating characteristic curve of 0.72. A six-item risk score (HIV status, smear grade, sex, cavitary disease status, body mass index, and Month 2 culture status) successfully grouped participants into low (1,060/3,791; 28%), moderate (1,740/3,791; 46%), and high (991/3,791; 26%) risk, requiring treatment durations of 4, 6, and greater than 6 months, respectively, to reach a target cure rate of 93% when receiving standard-dose rifamycin-containing regimens. With current one-duration-fits-all approaches, high-risk groups have a 3.7-fold (95% confidence interval, 2.7-5.1) and 2.4-fold (1.9-2.9) higher hazard risk of unfavorable outcomes compared with low- and moderate-risk groups, respectively. Four-month regimens were noninferior to the standard 6-month regimen in the low-risk group. Conclusions: Our model discrimination was modest but consistent with current models of unfavorable outcomes. Our results showed that stratified medicine approaches are feasible and may achieve high cure rates in all patients with tuberculosis. An interactive risk stratification tool is provided to facilitate decision-making in the regimen development pathway.
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Affiliation(s)
- Marjorie Z. Imperial
- Department of Bioengineering and Therapeutic Sciences
- University of California, San Francisco, Center for Tuberculosis, and
| | - Patrick P. J. Phillips
- University of California, San Francisco, Center for Tuberculosis, and
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, California
| | - Payam Nahid
- University of California, San Francisco, Center for Tuberculosis, and
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, California
| | - Radojka M. Savic
- Department of Bioengineering and Therapeutic Sciences
- University of California, San Francisco, Center for Tuberculosis, and
- Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, California
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Helfer B, Leonardi-Bee J, Mundell A, Parr C, Ierodiakonou D, Garcia-Larsen V, Kroeger CM, Dai Z, Man A, Jobson J, Dewji F, Kunc M, Bero L, Boyle RJ. Conduct and reporting of formula milk trials: systematic review. BMJ 2021; 375:n2202. [PMID: 34645600 PMCID: PMC8513520 DOI: 10.1136/bmj.n2202] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To systematically review the conduct and reporting of formula trials. DESIGN Systematic review. DATA SOURCES Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched from 1 January 2006 to 31 December 2020. REVIEW METHODS Intervention trials comparing at least two formula products in children less than three years of age were included, but not trials of human breast milk or fortifiers of breast milk. Data were extracted in duplicate and primary outcome data were synthesised for meta-analysis with a random effects model weighted by the inverse variance method. Risk of bias was evaluated with Cochrane risk of bias version 2.0, and risk of undermining breastfeeding was evaluated according to published consensus guidance. Primary outcomes of the trials included in the systematic review were identified from clinical trial registries, protocols, or trial publications. RESULTS 22 201 titles were screened and 307 trials were identified that were published between 2006 and 2020, of which 73 (24%) trials in 13 197 children were prospectively registered. Another 111 unpublished but registered trials in 17 411 children were identified. Detailed analysis was undertaken for 125 trials (23 757 children) published since 2015. Seventeen (14%) of these recently published trials were conducted independently of formula companies, 26 (21%) were prospectively registered with a clear aim and primary outcome, and authors or sponsors shared prospective protocols for 11 (9%) trials. Risk of bias was low in five (4%) and high in 100 (80%) recently published trials, mainly because of inappropriate exclusions from analysis and selective reporting. For 68 recently published superiority trials, a pooled standardised mean difference of 0.51 (range -0.43 to 3.29) was calculated with an asymmetrical funnel plot (Egger's test P<0.001), which reduced to 0.19 after correction for asymmetry. Primary outcomes were reported by authors as favourable in 86 (69%) trials, and 115 (92%) abstract conclusions were favourable. One of 38 (3%) trials in partially breastfed infants reported adequate support for breastfeeding and 14 of 87 (16%) trials in non-breastfed infants confirmed the decision not to breastfeed was firmly established before enrolment in the trial. CONCLUSIONS The results show that formula trials lack independence or transparency, and published outcomes are biased by selective reporting. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2018 CRD42018091928.
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Affiliation(s)
- Bartosz Helfer
- National Heart and Lung Institute, Imperial College London, London, UK
- Institute of Psychology, University of Wroclaw, Wroclaw, Poland
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Callum Parr
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Despo Ierodiakonou
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Vanessa Garcia-Larsen
- National Heart and Lung Institute, Imperial College London, London, UK
- Program in Human Nutrition, Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cynthia M Kroeger
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Zhaoli Dai
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Amy Man
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Jessica Jobson
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Fatemah Dewji
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Michelle Kunc
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Lisa Bero
- Center for Bioethics and Humanities, Schools of Medicine and Public Health, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Robert J Boyle
- National Heart and Lung Institute, Imperial College London, London, UK
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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Török ME, Underwood BR, Toshner M, Waddington C, Sidhom E, Sharrocks K, Bousfield R, Summers C, Saunders C, McIntyre Z, Morris H, Piper J, Calderon G, Dennis S, Assari T, de Rotrou AM, Shaw A, Bradley J, O’Brien J, Rintoul RC, Smith I, Bullmore E, Chatterjee K. Challenges and opportunities for conducting a vaccine trial during the COVID-19 pandemic in the United Kingdom. Clin Trials 2021; 18:615-621. [PMID: 34154428 PMCID: PMC8479147 DOI: 10.1177/17407745211024764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/17/2022]
Abstract
The COVID-19 pandemic has resulted in unprecedented challenges for healthcare systems worldwide. It has also stimulated research in a wide range of areas including rapid diagnostics, novel therapeutics, use of technology to track patients and vaccine development. Here, we describe our experience of rapidly setting up and delivering a novel COVID-19 vaccine trial, using clinical and research staff and facilities in three National Health Service Trusts in Cambridgeshire, United Kingdom. We encountered and overcame a number of challenges including differences in organisational structures, research facilities available, staff experience and skills, information technology and communications infrastructure, and research training and assessment procedures. We overcame these by setting up a project team that included key members from all three organisations that met at least daily by teleconference. This group together worked to identify the best practices and procedures and to harmonise and cascade these to the wider trial team. This enabled us to set up the trial within 25 days and to recruit and vaccinate the participants within a further 23 days. The lessons learned from our experiences could be used to inform the conduct of clinical trials during a future infectious disease pandemic or public health emergency.
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Affiliation(s)
- M Estée Török
- Department of Medicine, University of Cambridge, Cambridge, UK
- Departments of Infectious Diseases & Microbiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Public Health England, Clinical Microbiology and Public Health Laboratory, Cambridge, UK
| | - Benjamin R Underwood
- Windsor Research Unit, Fulbourn Hospital, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Gnodde Goldman Sachs Translational Neuroscience Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Mark Toshner
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Respiratory Medicine, Royal Papworth Hospital, Cambridge, UK
| | - Claire Waddington
- Department of Medicine, University of Cambridge, Cambridge, UK
- Departments of Infectious Diseases & Microbiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emad Sidhom
- Windsor Research Unit, Fulbourn Hospital, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
- Gnodde Goldman Sachs Translational Neuroscience Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Katherine Sharrocks
- Departments of Infectious Diseases & Microbiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Public Health England, Clinical Microbiology and Public Health Laboratory, Cambridge, UK
| | - Rachel Bousfield
- Departments of Infectious Diseases & Microbiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Public Health England, Clinical Microbiology and Public Health Laboratory, Cambridge, UK
| | - Charlotte Summers
- Department of Medicine, University of Cambridge, Cambridge, UK
- John V Farman Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Caroline Saunders
- NIHR Cambridge Clinical Research Facility, Cambridge Clinical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Zoe McIntyre
- Office for Translational Research, University of Cambridge, Cambridge, UK
| | - Helen Morris
- NIHR Cambridge Clinical Research Facility, Cambridge Clinical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jo Piper
- NIHR Cambridge Clinical Research Facility, Cambridge Clinical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Gloria Calderon
- Windsor Research Unit, Fulbourn Hospital, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Sarah Dennis
- Department of Respiratory Medicine, Royal Papworth Hospital, Cambridge, UK
| | - Tracy Assari
- Research & Development Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Ashley Shaw
- Medical Director’s Office, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - John Bradley
- Department of Medicine, University of Cambridge, Cambridge, UK
- Research & Development Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - John O’Brien
- Gnodde Goldman Sachs Translational Neuroscience Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Robert C Rintoul
- Department of Respiratory Medicine, Royal Papworth Hospital, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Ian Smith
- Department of Respiratory Medicine, Royal Papworth Hospital, Cambridge, UK
| | - Ed Bullmore
- Gnodde Goldman Sachs Translational Neuroscience Unit, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Krishna Chatterjee
- NIHR Cambridge Clinical Research Facility, Cambridge Clinical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Institute of Metabolic Science, University of Cambridge, Cambridge, UK
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Affiliation(s)
- Monica M Bertagnolli
- From Brigham and Women's Hospital, Boston (M.M.B.), and the Food and Drug Administration, Silver Spring, MD (H.S.)
| | - Harpreet Singh
- From Brigham and Women's Hospital, Boston (M.M.B.), and the Food and Drug Administration, Silver Spring, MD (H.S.)
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40
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Shaw JL, Semmens E, Okihiro M, Lewis JL, Hirschfeld M, VanWagoner TM, Stephens L, Easa D, Ross JL, Graham N, Watson SE, Szyld EG, Dillard DA, Pyles LA, Darden PM, Carlson JC, Smith PG, McCulloh RJ, Snowden JN, Adeky SH, Singleton R. Best Practices for Conducting Clinical Trials With Indigenous Children in the United States. Am J Public Health 2021; 111:1645-1653. [PMID: 34436921 PMCID: PMC8494399 DOI: 10.2105/ajph.2021.306372] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 11/04/2022]
Abstract
We provide guidance for conducting clinical trials with Indigenous children in the United States. We drew on extant literature and our experience to describe 3 best practices for the ethical and effective conduct of clinical trials with Indigenous children. Case examples of pediatric research conducted with American Indian, Alaska Native, and Native Hawaiian communities are provided to illustrate these practices. Ethical and effective clinical trials with Indigenous children require early and sustained community engagement, building capacity for Indigenous research, and supporting community oversight and ownership of research. Effective engagement requires equity, trust, shared interests, and mutual benefit among partners over time. Capacity building should prioritize developing Indigenous researchers. Supporting community oversight and ownership of research means that investigators should plan for data-sharing agreements, return or destruction of data, and multiple regulatory approvals. Indigenous children must be included in clinical trials to reduce health disparities and improve health outcomes in these pediatric populations. Establishment of the Environmental Influences on Child Health Outcomes Institutional Development Award States Pediatric Clinical Trials Network (ECHO ISPCTN) in 2016 creates a unique and timely opportunity to increase Indigenous children's participation in state-of-the-art clinical trials.
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Affiliation(s)
- Jennifer L Shaw
- Jennifer L. Shaw and Denise A. Dillard are with the Southcentral Foundation Research Department, Anchorage, AK. Rosalyn Singleton is with the Alaska Native Tribal Health Consortium, Anchorage. May Okihiro and David Easa are with the University of Hawaii at Manoa, Honolulu. Erin Semmens, Paul G. Smith, and Niki Graham are with the University of Montana, Missoula. Johnnye L. Lewis is with the University of New Mexico Health Sciences Center, Albuquerque. Matthew Hirschfeld is with the Alaska Native Medical Center, Anchorage. Timothy M. VanWagoner, Paul M. Darden, Edgardo G. Szyld, and Lancer Stephens are with the University of Oklahoma Health Sciences Center, Oklahoma City. Judith L. Ross is with the Alfred I. duPont Hospital for Children, Wilmington, DE. Sara E. Watson is with the University of Louisville, Louisville, KY. Lee A. Pyles is with the West Virginia University, Morgantown. John C. Carlson is with Tulane University, New Orleans, LA. Russell J. McCulloh is with the University of Nebraska Medical Center, Omaha. Jessica N. Snowden is with the University of Arkansas for Medical Sciences, Little Rock. Sarah H. Adeky is with the Ramah Navajo Community, Pinehill, NM
| | - Erin Semmens
- Jennifer L. Shaw and Denise A. Dillard are with the Southcentral Foundation Research Department, Anchorage, AK. Rosalyn Singleton is with the Alaska Native Tribal Health Consortium, Anchorage. May Okihiro and David Easa are with the University of Hawaii at Manoa, Honolulu. Erin Semmens, Paul G. Smith, and Niki Graham are with the University of Montana, Missoula. Johnnye L. Lewis is with the University of New Mexico Health Sciences Center, Albuquerque. Matthew Hirschfeld is with the Alaska Native Medical Center, Anchorage. Timothy M. VanWagoner, Paul M. Darden, Edgardo G. Szyld, and Lancer Stephens are with the University of Oklahoma Health Sciences Center, Oklahoma City. Judith L. Ross is with the Alfred I. duPont Hospital for Children, Wilmington, DE. Sara E. Watson is with the University of Louisville, Louisville, KY. Lee A. Pyles is with the West Virginia University, Morgantown. John C. Carlson is with Tulane University, New Orleans, LA. Russell J. McCulloh is with the University of Nebraska Medical Center, Omaha. Jessica N. Snowden is with the University of Arkansas for Medical Sciences, Little Rock. Sarah H. Adeky is with the Ramah Navajo Community, Pinehill, NM
| | - May Okihiro
- Jennifer L. Shaw and Denise A. Dillard are with the Southcentral Foundation Research Department, Anchorage, AK. Rosalyn Singleton is with the Alaska Native Tribal Health Consortium, Anchorage. May Okihiro and David Easa are with the University of Hawaii at Manoa, Honolulu. Erin Semmens, Paul G. Smith, and Niki Graham are with the University of Montana, Missoula. Johnnye L. Lewis is with the University of New Mexico Health Sciences Center, Albuquerque. Matthew Hirschfeld is with the Alaska Native Medical Center, Anchorage. Timothy M. VanWagoner, Paul M. Darden, Edgardo G. Szyld, and Lancer Stephens are with the University of Oklahoma Health Sciences Center, Oklahoma City. Judith L. Ross is with the Alfred I. duPont Hospital for Children, Wilmington, DE. Sara E. Watson is with the University of Louisville, Louisville, KY. Lee A. Pyles is with the West Virginia University, Morgantown. John C. Carlson is with Tulane University, New Orleans, LA. Russell J. McCulloh is with the University of Nebraska Medical Center, Omaha. Jessica N. Snowden is with the University of Arkansas for Medical Sciences, Little Rock. Sarah H. Adeky is with the Ramah Navajo Community, Pinehill, NM
| | - Johnnye L Lewis
- Jennifer L. Shaw and Denise A. Dillard are with the Southcentral Foundation Research Department, Anchorage, AK. Rosalyn Singleton is with the Alaska Native Tribal Health Consortium, Anchorage. May Okihiro and David Easa are with the University of Hawaii at Manoa, Honolulu. Erin Semmens, Paul G. Smith, and Niki Graham are with the University of Montana, Missoula. Johnnye L. Lewis is with the University of New Mexico Health Sciences Center, Albuquerque. Matthew Hirschfeld is with the Alaska Native Medical Center, Anchorage. Timothy M. VanWagoner, Paul M. Darden, Edgardo G. Szyld, and Lancer Stephens are with the University of Oklahoma Health Sciences Center, Oklahoma City. Judith L. Ross is with the Alfred I. duPont Hospital for Children, Wilmington, DE. Sara E. Watson is with the University of Louisville, Louisville, KY. Lee A. Pyles is with the West Virginia University, Morgantown. John C. Carlson is with Tulane University, New Orleans, LA. Russell J. McCulloh is with the University of Nebraska Medical Center, Omaha. Jessica N. Snowden is with the University of Arkansas for Medical Sciences, Little Rock. Sarah H. Adeky is with the Ramah Navajo Community, Pinehill, NM
| | - Matthew Hirschfeld
- Jennifer L. Shaw and Denise A. Dillard are with the Southcentral Foundation Research Department, Anchorage, AK. Rosalyn Singleton is with the Alaska Native Tribal Health Consortium, Anchorage. May Okihiro and David Easa are with the University of Hawaii at Manoa, Honolulu. Erin Semmens, Paul G. Smith, and Niki Graham are with the University of Montana, Missoula. Johnnye L. Lewis is with the University of New Mexico Health Sciences Center, Albuquerque. Matthew Hirschfeld is with the Alaska Native Medical Center, Anchorage. Timothy M. VanWagoner, Paul M. Darden, Edgardo G. Szyld, and Lancer Stephens are with the University of Oklahoma Health Sciences Center, Oklahoma City. Judith L. Ross is with the Alfred I. duPont Hospital for Children, Wilmington, DE. Sara E. Watson is with the University of Louisville, Louisville, KY. Lee A. Pyles is with the West Virginia University, Morgantown. John C. Carlson is with Tulane University, New Orleans, LA. Russell J. McCulloh is with the University of Nebraska Medical Center, Omaha. Jessica N. Snowden is with the University of Arkansas for Medical Sciences, Little Rock. Sarah H. Adeky is with the Ramah Navajo Community, Pinehill, NM
| | - Timothy M VanWagoner
- Jennifer L. Shaw and Denise A. Dillard are with the Southcentral Foundation Research Department, Anchorage, AK. Rosalyn Singleton is with the Alaska Native Tribal Health Consortium, Anchorage. May Okihiro and David Easa are with the University of Hawaii at Manoa, Honolulu. Erin Semmens, Paul G. Smith, and Niki Graham are with the University of Montana, Missoula. Johnnye L. Lewis is with the University of New Mexico Health Sciences Center, Albuquerque. Matthew Hirschfeld is with the Alaska Native Medical Center, Anchorage. Timothy M. VanWagoner, Paul M. Darden, Edgardo G. Szyld, and Lancer Stephens are with the University of Oklahoma Health Sciences Center, Oklahoma City. Judith L. Ross is with the Alfred I. duPont Hospital for Children, Wilmington, DE. Sara E. Watson is with the University of Louisville, Louisville, KY. Lee A. Pyles is with the West Virginia University, Morgantown. John C. Carlson is with Tulane University, New Orleans, LA. Russell J. McCulloh is with the University of Nebraska Medical Center, Omaha. Jessica N. Snowden is with the University of Arkansas for Medical Sciences, Little Rock. Sarah H. Adeky is with the Ramah Navajo Community, Pinehill, NM
| | - Lancer Stephens
- Jennifer L. Shaw and Denise A. Dillard are with the Southcentral Foundation Research Department, Anchorage, AK. Rosalyn Singleton is with the Alaska Native Tribal Health Consortium, Anchorage. May Okihiro and David Easa are with the University of Hawaii at Manoa, Honolulu. Erin Semmens, Paul G. Smith, and Niki Graham are with the University of Montana, Missoula. Johnnye L. Lewis is with the University of New Mexico Health Sciences Center, Albuquerque. Matthew Hirschfeld is with the Alaska Native Medical Center, Anchorage. Timothy M. VanWagoner, Paul M. Darden, Edgardo G. Szyld, and Lancer Stephens are with the University of Oklahoma Health Sciences Center, Oklahoma City. Judith L. Ross is with the Alfred I. duPont Hospital for Children, Wilmington, DE. Sara E. Watson is with the University of Louisville, Louisville, KY. Lee A. Pyles is with the West Virginia University, Morgantown. John C. Carlson is with Tulane University, New Orleans, LA. Russell J. McCulloh is with the University of Nebraska Medical Center, Omaha. Jessica N. Snowden is with the University of Arkansas for Medical Sciences, Little Rock. Sarah H. Adeky is with the Ramah Navajo Community, Pinehill, NM
| | - David Easa
- Jennifer L. Shaw and Denise A. Dillard are with the Southcentral Foundation Research Department, Anchorage, AK. Rosalyn Singleton is with the Alaska Native Tribal Health Consortium, Anchorage. May Okihiro and David Easa are with the University of Hawaii at Manoa, Honolulu. Erin Semmens, Paul G. Smith, and Niki Graham are with the University of Montana, Missoula. Johnnye L. Lewis is with the University of New Mexico Health Sciences Center, Albuquerque. Matthew Hirschfeld is with the Alaska Native Medical Center, Anchorage. Timothy M. VanWagoner, Paul M. Darden, Edgardo G. Szyld, and Lancer Stephens are with the University of Oklahoma Health Sciences Center, Oklahoma City. Judith L. Ross is with the Alfred I. duPont Hospital for Children, Wilmington, DE. Sara E. Watson is with the University of Louisville, Louisville, KY. Lee A. Pyles is with the West Virginia University, Morgantown. John C. Carlson is with Tulane University, New Orleans, LA. Russell J. McCulloh is with the University of Nebraska Medical Center, Omaha. Jessica N. Snowden is with the University of Arkansas for Medical Sciences, Little Rock. Sarah H. Adeky is with the Ramah Navajo Community, Pinehill, NM
| | - Judith L Ross
- Jennifer L. Shaw and Denise A. Dillard are with the Southcentral Foundation Research Department, Anchorage, AK. Rosalyn Singleton is with the Alaska Native Tribal Health Consortium, Anchorage. May Okihiro and David Easa are with the University of Hawaii at Manoa, Honolulu. Erin Semmens, Paul G. Smith, and Niki Graham are with the University of Montana, Missoula. Johnnye L. Lewis is with the University of New Mexico Health Sciences Center, Albuquerque. Matthew Hirschfeld is with the Alaska Native Medical Center, Anchorage. Timothy M. VanWagoner, Paul M. Darden, Edgardo G. Szyld, and Lancer Stephens are with the University of Oklahoma Health Sciences Center, Oklahoma City. Judith L. Ross is with the Alfred I. duPont Hospital for Children, Wilmington, DE. Sara E. Watson is with the University of Louisville, Louisville, KY. Lee A. Pyles is with the West Virginia University, Morgantown. John C. Carlson is with Tulane University, New Orleans, LA. Russell J. McCulloh is with the University of Nebraska Medical Center, Omaha. Jessica N. Snowden is with the University of Arkansas for Medical Sciences, Little Rock. Sarah H. Adeky is with the Ramah Navajo Community, Pinehill, NM
| | - Niki Graham
- Jennifer L. Shaw and Denise A. Dillard are with the Southcentral Foundation Research Department, Anchorage, AK. Rosalyn Singleton is with the Alaska Native Tribal Health Consortium, Anchorage. May Okihiro and David Easa are with the University of Hawaii at Manoa, Honolulu. Erin Semmens, Paul G. Smith, and Niki Graham are with the University of Montana, Missoula. Johnnye L. Lewis is with the University of New Mexico Health Sciences Center, Albuquerque. Matthew Hirschfeld is with the Alaska Native Medical Center, Anchorage. Timothy M. VanWagoner, Paul M. Darden, Edgardo G. Szyld, and Lancer Stephens are with the University of Oklahoma Health Sciences Center, Oklahoma City. Judith L. Ross is with the Alfred I. duPont Hospital for Children, Wilmington, DE. Sara E. Watson is with the University of Louisville, Louisville, KY. Lee A. Pyles is with the West Virginia University, Morgantown. John C. Carlson is with Tulane University, New Orleans, LA. Russell J. McCulloh is with the University of Nebraska Medical Center, Omaha. Jessica N. Snowden is with the University of Arkansas for Medical Sciences, Little Rock. Sarah H. Adeky is with the Ramah Navajo Community, Pinehill, NM
| | - Sara E Watson
- Jennifer L. Shaw and Denise A. Dillard are with the Southcentral Foundation Research Department, Anchorage, AK. Rosalyn Singleton is with the Alaska Native Tribal Health Consortium, Anchorage. May Okihiro and David Easa are with the University of Hawaii at Manoa, Honolulu. Erin Semmens, Paul G. Smith, and Niki Graham are with the University of Montana, Missoula. Johnnye L. Lewis is with the University of New Mexico Health Sciences Center, Albuquerque. Matthew Hirschfeld is with the Alaska Native Medical Center, Anchorage. Timothy M. VanWagoner, Paul M. Darden, Edgardo G. Szyld, and Lancer Stephens are with the University of Oklahoma Health Sciences Center, Oklahoma City. Judith L. Ross is with the Alfred I. duPont Hospital for Children, Wilmington, DE. Sara E. Watson is with the University of Louisville, Louisville, KY. Lee A. Pyles is with the West Virginia University, Morgantown. John C. Carlson is with Tulane University, New Orleans, LA. Russell J. McCulloh is with the University of Nebraska Medical Center, Omaha. Jessica N. Snowden is with the University of Arkansas for Medical Sciences, Little Rock. Sarah H. Adeky is with the Ramah Navajo Community, Pinehill, NM
| | - Edgardo G Szyld
- Jennifer L. Shaw and Denise A. Dillard are with the Southcentral Foundation Research Department, Anchorage, AK. Rosalyn Singleton is with the Alaska Native Tribal Health Consortium, Anchorage. May Okihiro and David Easa are with the University of Hawaii at Manoa, Honolulu. Erin Semmens, Paul G. Smith, and Niki Graham are with the University of Montana, Missoula. Johnnye L. Lewis is with the University of New Mexico Health Sciences Center, Albuquerque. Matthew Hirschfeld is with the Alaska Native Medical Center, Anchorage. Timothy M. VanWagoner, Paul M. Darden, Edgardo G. Szyld, and Lancer Stephens are with the University of Oklahoma Health Sciences Center, Oklahoma City. Judith L. Ross is with the Alfred I. duPont Hospital for Children, Wilmington, DE. Sara E. Watson is with the University of Louisville, Louisville, KY. Lee A. Pyles is with the West Virginia University, Morgantown. John C. Carlson is with Tulane University, New Orleans, LA. Russell J. McCulloh is with the University of Nebraska Medical Center, Omaha. Jessica N. Snowden is with the University of Arkansas for Medical Sciences, Little Rock. Sarah H. Adeky is with the Ramah Navajo Community, Pinehill, NM
| | - Denise A Dillard
- Jennifer L. Shaw and Denise A. Dillard are with the Southcentral Foundation Research Department, Anchorage, AK. Rosalyn Singleton is with the Alaska Native Tribal Health Consortium, Anchorage. May Okihiro and David Easa are with the University of Hawaii at Manoa, Honolulu. Erin Semmens, Paul G. Smith, and Niki Graham are with the University of Montana, Missoula. Johnnye L. Lewis is with the University of New Mexico Health Sciences Center, Albuquerque. Matthew Hirschfeld is with the Alaska Native Medical Center, Anchorage. Timothy M. VanWagoner, Paul M. Darden, Edgardo G. Szyld, and Lancer Stephens are with the University of Oklahoma Health Sciences Center, Oklahoma City. Judith L. Ross is with the Alfred I. duPont Hospital for Children, Wilmington, DE. Sara E. Watson is with the University of Louisville, Louisville, KY. Lee A. Pyles is with the West Virginia University, Morgantown. John C. Carlson is with Tulane University, New Orleans, LA. Russell J. McCulloh is with the University of Nebraska Medical Center, Omaha. Jessica N. Snowden is with the University of Arkansas for Medical Sciences, Little Rock. Sarah H. Adeky is with the Ramah Navajo Community, Pinehill, NM
| | - Lee A Pyles
- Jennifer L. Shaw and Denise A. Dillard are with the Southcentral Foundation Research Department, Anchorage, AK. Rosalyn Singleton is with the Alaska Native Tribal Health Consortium, Anchorage. May Okihiro and David Easa are with the University of Hawaii at Manoa, Honolulu. Erin Semmens, Paul G. Smith, and Niki Graham are with the University of Montana, Missoula. Johnnye L. Lewis is with the University of New Mexico Health Sciences Center, Albuquerque. Matthew Hirschfeld is with the Alaska Native Medical Center, Anchorage. Timothy M. VanWagoner, Paul M. Darden, Edgardo G. Szyld, and Lancer Stephens are with the University of Oklahoma Health Sciences Center, Oklahoma City. Judith L. Ross is with the Alfred I. duPont Hospital for Children, Wilmington, DE. Sara E. Watson is with the University of Louisville, Louisville, KY. Lee A. Pyles is with the West Virginia University, Morgantown. John C. Carlson is with Tulane University, New Orleans, LA. Russell J. McCulloh is with the University of Nebraska Medical Center, Omaha. Jessica N. Snowden is with the University of Arkansas for Medical Sciences, Little Rock. Sarah H. Adeky is with the Ramah Navajo Community, Pinehill, NM
| | - Paul M Darden
- Jennifer L. Shaw and Denise A. Dillard are with the Southcentral Foundation Research Department, Anchorage, AK. Rosalyn Singleton is with the Alaska Native Tribal Health Consortium, Anchorage. May Okihiro and David Easa are with the University of Hawaii at Manoa, Honolulu. Erin Semmens, Paul G. Smith, and Niki Graham are with the University of Montana, Missoula. Johnnye L. Lewis is with the University of New Mexico Health Sciences Center, Albuquerque. Matthew Hirschfeld is with the Alaska Native Medical Center, Anchorage. Timothy M. VanWagoner, Paul M. Darden, Edgardo G. Szyld, and Lancer Stephens are with the University of Oklahoma Health Sciences Center, Oklahoma City. Judith L. Ross is with the Alfred I. duPont Hospital for Children, Wilmington, DE. Sara E. Watson is with the University of Louisville, Louisville, KY. Lee A. Pyles is with the West Virginia University, Morgantown. John C. Carlson is with Tulane University, New Orleans, LA. Russell J. McCulloh is with the University of Nebraska Medical Center, Omaha. Jessica N. Snowden is with the University of Arkansas for Medical Sciences, Little Rock. Sarah H. Adeky is with the Ramah Navajo Community, Pinehill, NM
| | - John C Carlson
- Jennifer L. Shaw and Denise A. Dillard are with the Southcentral Foundation Research Department, Anchorage, AK. Rosalyn Singleton is with the Alaska Native Tribal Health Consortium, Anchorage. May Okihiro and David Easa are with the University of Hawaii at Manoa, Honolulu. Erin Semmens, Paul G. Smith, and Niki Graham are with the University of Montana, Missoula. Johnnye L. Lewis is with the University of New Mexico Health Sciences Center, Albuquerque. Matthew Hirschfeld is with the Alaska Native Medical Center, Anchorage. Timothy M. VanWagoner, Paul M. Darden, Edgardo G. Szyld, and Lancer Stephens are with the University of Oklahoma Health Sciences Center, Oklahoma City. Judith L. Ross is with the Alfred I. duPont Hospital for Children, Wilmington, DE. Sara E. Watson is with the University of Louisville, Louisville, KY. Lee A. Pyles is with the West Virginia University, Morgantown. John C. Carlson is with Tulane University, New Orleans, LA. Russell J. McCulloh is with the University of Nebraska Medical Center, Omaha. Jessica N. Snowden is with the University of Arkansas for Medical Sciences, Little Rock. Sarah H. Adeky is with the Ramah Navajo Community, Pinehill, NM
| | - Paul G Smith
- Jennifer L. Shaw and Denise A. Dillard are with the Southcentral Foundation Research Department, Anchorage, AK. Rosalyn Singleton is with the Alaska Native Tribal Health Consortium, Anchorage. May Okihiro and David Easa are with the University of Hawaii at Manoa, Honolulu. Erin Semmens, Paul G. Smith, and Niki Graham are with the University of Montana, Missoula. Johnnye L. Lewis is with the University of New Mexico Health Sciences Center, Albuquerque. Matthew Hirschfeld is with the Alaska Native Medical Center, Anchorage. Timothy M. VanWagoner, Paul M. Darden, Edgardo G. Szyld, and Lancer Stephens are with the University of Oklahoma Health Sciences Center, Oklahoma City. Judith L. Ross is with the Alfred I. duPont Hospital for Children, Wilmington, DE. Sara E. Watson is with the University of Louisville, Louisville, KY. Lee A. Pyles is with the West Virginia University, Morgantown. John C. Carlson is with Tulane University, New Orleans, LA. Russell J. McCulloh is with the University of Nebraska Medical Center, Omaha. Jessica N. Snowden is with the University of Arkansas for Medical Sciences, Little Rock. Sarah H. Adeky is with the Ramah Navajo Community, Pinehill, NM
| | - Russell J McCulloh
- Jennifer L. Shaw and Denise A. Dillard are with the Southcentral Foundation Research Department, Anchorage, AK. Rosalyn Singleton is with the Alaska Native Tribal Health Consortium, Anchorage. May Okihiro and David Easa are with the University of Hawaii at Manoa, Honolulu. Erin Semmens, Paul G. Smith, and Niki Graham are with the University of Montana, Missoula. Johnnye L. Lewis is with the University of New Mexico Health Sciences Center, Albuquerque. Matthew Hirschfeld is with the Alaska Native Medical Center, Anchorage. Timothy M. VanWagoner, Paul M. Darden, Edgardo G. Szyld, and Lancer Stephens are with the University of Oklahoma Health Sciences Center, Oklahoma City. Judith L. Ross is with the Alfred I. duPont Hospital for Children, Wilmington, DE. Sara E. Watson is with the University of Louisville, Louisville, KY. Lee A. Pyles is with the West Virginia University, Morgantown. John C. Carlson is with Tulane University, New Orleans, LA. Russell J. McCulloh is with the University of Nebraska Medical Center, Omaha. Jessica N. Snowden is with the University of Arkansas for Medical Sciences, Little Rock. Sarah H. Adeky is with the Ramah Navajo Community, Pinehill, NM
| | - Jessica N Snowden
- Jennifer L. Shaw and Denise A. Dillard are with the Southcentral Foundation Research Department, Anchorage, AK. Rosalyn Singleton is with the Alaska Native Tribal Health Consortium, Anchorage. May Okihiro and David Easa are with the University of Hawaii at Manoa, Honolulu. Erin Semmens, Paul G. Smith, and Niki Graham are with the University of Montana, Missoula. Johnnye L. Lewis is with the University of New Mexico Health Sciences Center, Albuquerque. Matthew Hirschfeld is with the Alaska Native Medical Center, Anchorage. Timothy M. VanWagoner, Paul M. Darden, Edgardo G. Szyld, and Lancer Stephens are with the University of Oklahoma Health Sciences Center, Oklahoma City. Judith L. Ross is with the Alfred I. duPont Hospital for Children, Wilmington, DE. Sara E. Watson is with the University of Louisville, Louisville, KY. Lee A. Pyles is with the West Virginia University, Morgantown. John C. Carlson is with Tulane University, New Orleans, LA. Russell J. McCulloh is with the University of Nebraska Medical Center, Omaha. Jessica N. Snowden is with the University of Arkansas for Medical Sciences, Little Rock. Sarah H. Adeky is with the Ramah Navajo Community, Pinehill, NM
| | - Sarah H Adeky
- Jennifer L. Shaw and Denise A. Dillard are with the Southcentral Foundation Research Department, Anchorage, AK. Rosalyn Singleton is with the Alaska Native Tribal Health Consortium, Anchorage. May Okihiro and David Easa are with the University of Hawaii at Manoa, Honolulu. Erin Semmens, Paul G. Smith, and Niki Graham are with the University of Montana, Missoula. Johnnye L. Lewis is with the University of New Mexico Health Sciences Center, Albuquerque. Matthew Hirschfeld is with the Alaska Native Medical Center, Anchorage. Timothy M. VanWagoner, Paul M. Darden, Edgardo G. Szyld, and Lancer Stephens are with the University of Oklahoma Health Sciences Center, Oklahoma City. Judith L. Ross is with the Alfred I. duPont Hospital for Children, Wilmington, DE. Sara E. Watson is with the University of Louisville, Louisville, KY. Lee A. Pyles is with the West Virginia University, Morgantown. John C. Carlson is with Tulane University, New Orleans, LA. Russell J. McCulloh is with the University of Nebraska Medical Center, Omaha. Jessica N. Snowden is with the University of Arkansas for Medical Sciences, Little Rock. Sarah H. Adeky is with the Ramah Navajo Community, Pinehill, NM
| | - Rosalyn Singleton
- Jennifer L. Shaw and Denise A. Dillard are with the Southcentral Foundation Research Department, Anchorage, AK. Rosalyn Singleton is with the Alaska Native Tribal Health Consortium, Anchorage. May Okihiro and David Easa are with the University of Hawaii at Manoa, Honolulu. Erin Semmens, Paul G. Smith, and Niki Graham are with the University of Montana, Missoula. Johnnye L. Lewis is with the University of New Mexico Health Sciences Center, Albuquerque. Matthew Hirschfeld is with the Alaska Native Medical Center, Anchorage. Timothy M. VanWagoner, Paul M. Darden, Edgardo G. Szyld, and Lancer Stephens are with the University of Oklahoma Health Sciences Center, Oklahoma City. Judith L. Ross is with the Alfred I. duPont Hospital for Children, Wilmington, DE. Sara E. Watson is with the University of Louisville, Louisville, KY. Lee A. Pyles is with the West Virginia University, Morgantown. John C. Carlson is with Tulane University, New Orleans, LA. Russell J. McCulloh is with the University of Nebraska Medical Center, Omaha. Jessica N. Snowden is with the University of Arkansas for Medical Sciences, Little Rock. Sarah H. Adeky is with the Ramah Navajo Community, Pinehill, NM
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Braun RG, Heitsch L, Cole JW, Lindgren AG, de Havenon A, Dude JA, Lohse KR, Cramer SC, Worrall BB. Domain-Specific Outcomes for Stroke Clinical Trials: What the Modified Rankin Isn't Ranking. Neurology 2021; 97:367-377. [PMID: 34172537 PMCID: PMC8397584 DOI: 10.1212/wnl.0000000000012231] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 04/20/2021] [Indexed: 11/15/2022] Open
Abstract
Global outcome measures that are widely used in stroke clinical trials, such as the modified Rankin Scale (mRS), lack sufficient detail to detect changes within specific domains (e.g., sensory, motor, visual, linguistic, or cognitive function). Yet such data are vital for understanding stroke recovery and its mechanisms. Poststroke deficits in specific domains differ in their rate and degree of recovery and in their effects on overall independence and quality of life. For example, even in a patient with complete recovery of strength, persistent deficits in the nonmotor domains such as language and cognition may make a return to independent living impossible. In such cases, global measures based solely on the patient's degree of independence would overlook a complete recovery in the motor domain. Capturing these important aspects of recovery demands a domain-specific approach. If stroke outcomes trials are to incorporate finer-grained recovery metrics-which can require substantial time, effort, and expertise to implement-efficiency must be a priority. In this article, we discuss how commonly collected clinical data from the NIH Stroke Scale can guide the judicious selection of relevant recovery domains for more detailed testing. Our overarching goal is to make the implementation of domain-specific testing more feasible for large-scale clinical trials on stroke recovery.
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Affiliation(s)
- Robynne G Braun
- From the Department of Neurology (R.G.B., J.W.C.), University of Maryland, Baltimore; Department of Emergency Medicine (L.H.), Washington University, St. Louis, MO; Department of Clinical Sciences, Lund (A.L.), Lund University; Department of Neurology (A.G.L.), Skåne University Hospital, Lund, Sweden; Departments of Neurology (A.d.H.) and Health and Kinesiology (J.A.D., K.R.L.), University of Utah, Salt Lake City; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; and Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville.
| | - Laura Heitsch
- From the Department of Neurology (R.G.B., J.W.C.), University of Maryland, Baltimore; Department of Emergency Medicine (L.H.), Washington University, St. Louis, MO; Department of Clinical Sciences, Lund (A.L.), Lund University; Department of Neurology (A.G.L.), Skåne University Hospital, Lund, Sweden; Departments of Neurology (A.d.H.) and Health and Kinesiology (J.A.D., K.R.L.), University of Utah, Salt Lake City; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; and Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville
| | - John W Cole
- From the Department of Neurology (R.G.B., J.W.C.), University of Maryland, Baltimore; Department of Emergency Medicine (L.H.), Washington University, St. Louis, MO; Department of Clinical Sciences, Lund (A.L.), Lund University; Department of Neurology (A.G.L.), Skåne University Hospital, Lund, Sweden; Departments of Neurology (A.d.H.) and Health and Kinesiology (J.A.D., K.R.L.), University of Utah, Salt Lake City; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; and Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville
| | - Arne G Lindgren
- From the Department of Neurology (R.G.B., J.W.C.), University of Maryland, Baltimore; Department of Emergency Medicine (L.H.), Washington University, St. Louis, MO; Department of Clinical Sciences, Lund (A.L.), Lund University; Department of Neurology (A.G.L.), Skåne University Hospital, Lund, Sweden; Departments of Neurology (A.d.H.) and Health and Kinesiology (J.A.D., K.R.L.), University of Utah, Salt Lake City; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; and Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville
| | - Adam de Havenon
- From the Department of Neurology (R.G.B., J.W.C.), University of Maryland, Baltimore; Department of Emergency Medicine (L.H.), Washington University, St. Louis, MO; Department of Clinical Sciences, Lund (A.L.), Lund University; Department of Neurology (A.G.L.), Skåne University Hospital, Lund, Sweden; Departments of Neurology (A.d.H.) and Health and Kinesiology (J.A.D., K.R.L.), University of Utah, Salt Lake City; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; and Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville
| | - Jason A Dude
- From the Department of Neurology (R.G.B., J.W.C.), University of Maryland, Baltimore; Department of Emergency Medicine (L.H.), Washington University, St. Louis, MO; Department of Clinical Sciences, Lund (A.L.), Lund University; Department of Neurology (A.G.L.), Skåne University Hospital, Lund, Sweden; Departments of Neurology (A.d.H.) and Health and Kinesiology (J.A.D., K.R.L.), University of Utah, Salt Lake City; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; and Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville
| | - Keith R Lohse
- From the Department of Neurology (R.G.B., J.W.C.), University of Maryland, Baltimore; Department of Emergency Medicine (L.H.), Washington University, St. Louis, MO; Department of Clinical Sciences, Lund (A.L.), Lund University; Department of Neurology (A.G.L.), Skåne University Hospital, Lund, Sweden; Departments of Neurology (A.d.H.) and Health and Kinesiology (J.A.D., K.R.L.), University of Utah, Salt Lake City; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; and Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville
| | - Steven C Cramer
- From the Department of Neurology (R.G.B., J.W.C.), University of Maryland, Baltimore; Department of Emergency Medicine (L.H.), Washington University, St. Louis, MO; Department of Clinical Sciences, Lund (A.L.), Lund University; Department of Neurology (A.G.L.), Skåne University Hospital, Lund, Sweden; Departments of Neurology (A.d.H.) and Health and Kinesiology (J.A.D., K.R.L.), University of Utah, Salt Lake City; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; and Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville
| | - Bradford B Worrall
- From the Department of Neurology (R.G.B., J.W.C.), University of Maryland, Baltimore; Department of Emergency Medicine (L.H.), Washington University, St. Louis, MO; Department of Clinical Sciences, Lund (A.L.), Lund University; Department of Neurology (A.G.L.), Skåne University Hospital, Lund, Sweden; Departments of Neurology (A.d.H.) and Health and Kinesiology (J.A.D., K.R.L.), University of Utah, Salt Lake City; Department of Neurology (S.C.C.), University of California, Los Angeles; California Rehabilitation Institute (S.C.C.), Los Angeles; and Departments of Neurology and Public Health Sciences (B.B.W.), University of Virginia, Charlottesville
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Pereira GC, Prates G, Medina M, Ferreira C, Latorraca CDOC, Pacheco RL, Martimbianco ALC, Riera R. High frequency of spin bias in controlled trials of cannabis derivatives and their synthetic analogues: A meta-epidemiologic study. J Clin Epidemiol 2021; 140:3-12. [PMID: 34450305 DOI: 10.1016/j.jclinepi.2021.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the frequency and perform a qualitative analysis of spin bias in publications of controlled trials assessing the therapeutic use of cannabis derivatives and their synthetic analogues. STUDY DESIGN AND SETTING Meta-epidemiologic study carried out at the Universidade Federal de São Paulo, Brazil. RESULTS A total of 65 publications with at least one efficacy primary outcome were considered. The results analysis for the primary outcome indicated statistically significant effects in 44.6% (29/65) of the publications, and 70.7% (45/65) of the conclusions were considered favorable to the intervention. Among the 36 publications that found statistically nonsignificant results for the primary outcome, 44.4% (16/36) presented conclusions favorable to or recommending the intervention, which represents spin bias according to the definition adopted in this study. Qualitative analysis of the 16 studies with spin bias showed selective outcomes reporting (elevating secondary outcomes that had positive results or reporting only subgroup results), deviations from the planned statistical analysis, and failure to consider or report uncertainty in the estimates of treatment effects. CONCLUSION The frequency of spin bias among publications of controlled trials with statistically nonsignificant results assessing the therapeutic use of cannabis derivatives and their synthetic analogues reached 44.4%. When not observed by readers, such deviation can lead to misconduct in clinical practice through the adoption of interventions that are not effective or whose effectiveness is uncertain.
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Affiliation(s)
| | - Gabriela Prates
- Universidade Federal de São Paulo (Unifesp), São Paulo - SP, Brazil
| | - Matheus Medina
- Universidade Federal de São Paulo (Unifesp), São Paulo - SP, Brazil
| | | | | | - Rafael Leite Pacheco
- Centro Universitário São Camilo (CUSC), São Paulo - SP, Brazil. Hospital Sírio-Libanês. Universidade Federal de São Paulo (Unifesp). Oxford-Brazil EBM Alliance.
| | | | - Rachel Riera
- Centre of Health Technology Assessment, Hospital Sírio-Libanês, São Paulo, Brazil. Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo - SP, Brazil. Oxford-Brazil EBM Alliance
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Affiliation(s)
- Michael A Steinman
- Division of Geriatrics, Department of Medicine, University of California, San Francisco
- San Francisco VA Health Care System, San Francisco
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Kenneth E Schmader
- Division of Geriatrics, Department of Medicine, Duke University, Durham, North Carolina
- Durham VA Health Care System, Durham, North Carolina
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Retzer A, Calvert M, Ahmed K, Keeley T, Armes J, Brown JM, Calman L, Gavin A, Glaser AW, Greenfield DM, Lanceley A, Taylor RM, Velikova G, Brundage M, Efficace F, Mercieca‐Bebber R, King MT, Kyte D. International perspectives on suboptimal patient-reported outcome trial design and reporting in cancer clinical trials: A qualitative study. Cancer Med 2021; 10:5475-5487. [PMID: 34219395 PMCID: PMC8366078 DOI: 10.1002/cam4.4111] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 04/26/2021] [Accepted: 06/04/2021] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Evidence suggests that the patient-reported outcome (PRO) content of cancer trial protocols is frequently inadequate and non-reporting of PRO findings is widespread. This qualitative study examined the factors influencing suboptimal PRO protocol content, implementation, and reporting, and use of PRO data during clinical interactions. METHODS Semi-structured interviews were conducted with four stakeholder groups: (1) trialists and chief investigators; (2) people with lived experience of cancer; (3) international experts in PRO cancer trial design; (4) journal editors, funding panelists, and regulatory agencies. Data were analyzed using directed thematic analysis with an iterative coding frame. RESULTS Forty-four interviews were undertaken. Several factors were identified that could influenced effective integration of PROs into trials and subsequent findings. Participants described (1) late inclusion of PROs in trial design; (2) PROs being considered a lower priority outcome compared to survival; (3) trialists' reluctance to collect or report PROs due to participant burden, missing data, and perceived reticence of journals to publish; (4) lack of staff training. Strategies to address these included training research personnel and improved communication with site staff and patients regarding the value of PROs. Examples of good practice were identified. CONCLUSION Misconceptions relating to PRO methodology and its use may undermine their planning, collection, and reporting. There is a role for funding, regulatory, methodological, and journalistic institutions to address perceptions around the value of PROs, their position within the trial outcomes hierarchy, that PRO training and guidance is available, signposted, and readily accessible, with accompanying measures to ensure compliance with international best practice guidelines.
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Affiliation(s)
- Ameeta Retzer
- Centre for Patient‐Reported Outcomes ResearchInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
- NIHR ARC West MidlandsLondonUK
| | - Melanie Calvert
- Centre for Patient‐Reported Outcomes ResearchInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
- NIHR ARC West MidlandsLondonUK
- Birmingham Health Partners Centre for Regulatory Science and InnovationUniversity of BirminghamBirminghamUK
- NIHR Birmingham Biomedical Research Centre and NIHR Surgical Reconstruction and Microbiology Research CentreUniversity Hospitals Birmingham NHS Foundation Trust and University of BirminghamBirminghamUK
| | - Khaled Ahmed
- Centre for Patient‐Reported Outcomes ResearchInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
| | - Thomas Keeley
- Centre for Patient‐Reported Outcomes ResearchInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
- GlaxoSmithKline (formerly of CPROR, University of BirminghamBirminghamUK
| | - Jo Armes
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- School of Health SciencesUniversity of SurreyGuildfordUK
- NIHR ARC KentLondonUK
| | | | - Lynn Calman
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- Macmillan Survivorship Research GroupHealth SciencesUniversity of SouthamptonSouthamptonUK
| | - Anna Gavin
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- N. Ireland Cancer RegistryCentre for Public HealthQueens UniversityBelfastUK
| | - Adam W. Glaser
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- Leeds Institute of Medical Research at St James’sUniversity of LeedsLeedsUK
| | - Diana M. Greenfield
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- Sheffield Teaching Hospital NHS Foundation Trust and University of SheffieldSheffieldUK
| | - Anne Lanceley
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- UCL Elizabeth Garrett Anderson Institute for Women’s HealthMedical School BuildingUniversity College LondonLondonUK
| | - Rachel M. Taylor
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- Centre for Nurse, Midwife and Allied Health Profession Led Research (CNMARUniversity College London Hospitals NHS Foundation TrustLondonUK
| | - Galina Velikova
- Leeds Institute of Medical Research at St James’sUniversity of LeedsLeedsUK
| | - Michael Brundage
- Queen’s Department of OncologyQueen’s Cancer Research InstituteKingstonONCanada
| | - Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMAHealth Outcomes Research UnitRomeItaly
| | - Rebecca Mercieca‐Bebber
- School of PsychologyUniversity of SydneySydneyNSWAustralia
- University of SydneyNHMRC Clinical Trials CentreSydneyNSWAustralia
| | | | - Derek Kyte
- Centre for Patient‐Reported Outcomes ResearchInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
- NIHR Birmingham Biomedical Research Centre and NIHR Surgical Reconstruction and Microbiology Research CentreUniversity Hospitals Birmingham NHS Foundation Trust and University of BirminghamBirminghamUK
- UK National Cancer Research Institute (NCRI) Psychosocial Oncology and Survivorship CSG Subgroup: Understanding and Measuring the Consequences of Cancer and its TreatmentLondonUK
- School of Applied Health & CommunityUniversity of WorcesterWorcesterUK
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Erber AC, Ewing V, Turner M, Molla M, Murbe G, Enquoselassie F, Davey G, Lang T. Setting up a pragmatic clinical trial in a low-resource setting: A qualitative assessment of GoLBeT, a trial of podoconiosis management in Northern Ethiopia. PLoS Negl Trop Dis 2021; 15:e0009582. [PMID: 34319977 PMCID: PMC8370641 DOI: 10.1371/journal.pntd.0009582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 08/17/2021] [Accepted: 06/21/2021] [Indexed: 11/23/2022] Open
Abstract
Background Clinical trials are often perceived as being expensive, difficult and beyond the capacity of healthcare workers in low-resource settings. However, in order to improve healthcare coverage, the World Health Organization (WHO) World Health Report 2013 stated that all countries need to become generators as well as recipients of data. This study is a methodological examination of the steps and processes involved in setting up the Gojjam Lymphoedema Best Practice Trial (GoLBeT; ISRCTN67805210), a highly pragmatic clinical trial conducted in northern Ethiopia. Challenges to the trial and strategies used to deal with them were explored, together with the reasons for delays. Methodology and principal findings Qualitative research methods were used to analyse emails and reports from the period between trial inception and recruitment. This analysis was complemented by interviews with key informants from the trial operational team. The Global Health Research Process Map was used as a framework against which to compare the steps involved in setting up the trial. A mini-group discussion was conducted with the trial operational team after study completion for reflection and further recommendations. This study showed that the key areas of difficulty in setting up and planning this trial were: the study design, that is, deciding on the study endpoint, where and how best to measure it, and assuring statistical power; recruitment and appropriate training of staff; planning for data quality; and gaining regulatory approvals. Collaboration, for example with statisticians, the trial steering committee, the study monitors, and members of the local community was essential to successfully setting up the trial. Conclusions and significance Lessons learnt from this trial might guide others planning pragmatic trials in settings where research is not common, allowing them to anticipate possible challenges and address them through trial design, planning and operational delivery. We also hope that this example might encourage similar pragmatic studies to be undertaken. Such studies are rarely undertaken or locally led, but are an accessible and efficient way to drive improved outcomes in public health. Podoconiosis is a disease of the lymphatic vessels of the lower extremities, caused by chronic exposure to irritant soils. It results in leg swelling, commonly complicated by acute dermatolymphangioadenitis (ADLA, or ‘acute attacks’), characterised by severe pain, fever and disability. The Gojjam Lymphoedema Best Practice Trial (GoLBeT) trial is a successfully completed randomised controlled trial of podoconiosis treatment that was conducted in the highlands of northern Ethiopia. In this study we report the steps involved in the setup of this trial, from inception to recruitment. The challenges faced are discussed, along with recommendations on how these could be overcome.
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Affiliation(s)
- Astrid C. Erber
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Victoria Ewing
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Mark Turner
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Office for National Statistics, Government Buildings, Newport, United Kingdom
| | - Meseret Molla
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gharib Murbe
- Centre for Global Health Research, Brighton & Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | | | - Gail Davey
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Health Research, Brighton & Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Trudie Lang
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
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Kanazawa J, Gianella S, Concha-Garcia S, Taylor J, Kaytes A, Christensen C, Patel H, Ndukwe S, Rawlings S, Hendrickx S, Little S, Brown B, Smith D, Dubé K. Ethical and practical considerations for interventional HIV cure-related research at the end-of-life: A qualitative study with key stakeholders in the United States. PLoS One 2021; 16:e0254148. [PMID: 34270612 PMCID: PMC8284787 DOI: 10.1371/journal.pone.0254148] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/18/2021] [Indexed: 12/19/2022] Open
Abstract
Background A unique window of opportunity currently exists to generate ethical and practical considerations presented by interventional HIV cure-related research at the end-of-life (EOL). Because participants would enroll in these studies for almost completely altruistic reasons, they are owed the highest ethical standards, safeguards, and protections. This qualitative empirical ethics study sought to identify ethical and practical considerations for interventional HIV cure-related research at the EOL. Methods and findings We conducted 20 in-depth interviews and three virtual focus groups (N = 36) with four key stakeholder groups in the United States: 1) bioethicists, 2) people with HIV, 3) HIV care providers, and 4) HIV cure researchers. This study produced six key themes to guide the ethical implementation of interventional HIV cure-related research at the EOL: 1) all stakeholder groups supported this research conditioned upon a clearly delineated respect for participant contribution and autonomy, participant understanding and comprehension of the risks associated with the specific intervention(s) to be tested, and broad community support for testing of the proposed intervention(s); 2) to ensure acceptable benefit-risk profiles, researchers should focus on limiting the risks of unintended effects and minimizing undue pain and suffering at the EOL; 3) only well-vetted interventions that are supported by solid pre-clinical data should be tested in the EOL translational research model; 4) the informed consent process must be robust and include process consent; 5) research protocols should be flexible and adopt a patient/participant centered approach to minimize burdens and ensure their overall comfort and safety; and 6) a participant’s next-of-kin/loved ones should be a major focus of EOL research but only if the participant consents to such involvement. Conclusions To our knowledge, this empirical ethics study generated the first ethical and practical considerations for interventional HIV cure-related research at the EOL. The ethical complexities of such research must be considered now. We must navigate this ethical conundrum so that we are good stewards of the participants’ extremely altruistic gifts by maximizing the impact and social value of this research. We hope that this study will serve as the foundation for future research and discussion on this topic.
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Affiliation(s)
- John Kanazawa
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Sara Gianella
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Susanna Concha-Garcia
- HIV Neurobehavioral Research Program (HNRP), California NeuroAIDS Tissue Network, University of California San Diego, San Diego, California, United States of America
| | - Jeff Taylor
- AVRC Community Advisory Board, University of California San Diego, San Diego, California, United States of America
- HIV + Aging Research Project–Palm Springs (HARP-PS), Palm Springs, California, United States of America
| | - Andy Kaytes
- AVRC Community Advisory Board, University of California San Diego, San Diego, California, United States of America
| | - Christopher Christensen
- HIV + Aging Research Project–Palm Springs (HARP-PS), Palm Springs, California, United States of America
| | - Hursch Patel
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Samuel Ndukwe
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Stephen Rawlings
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
- AntiViral Research Center (AVRC), University of California at San Diego, San Diego, California, United States of America
| | - Steven Hendrickx
- AntiViral Research Center (AVRC), University of California at San Diego, San Diego, California, United States of America
| | - Susan Little
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside, Riverside, California, United States of America
| | - Davey Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
- AntiViral Research Center (AVRC), University of California at San Diego, San Diego, California, United States of America
| | - Karine Dubé
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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Abstract
Clinical trials play a critical role in discovering new treatments, but the path to regulatory approval can be cumbersome and time consuming. Efforts to increase the efficiency and interpretability of clinical trials within the neuro-oncology community have focused on standardization of response assessment, development of consensus guidelines for clinical trial conduct, decentralization of clinical trials, removal of barriers to clinical trial accrual, and re-examination of patient eligibility criteria.
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Affiliation(s)
- Eudocia Q Lee
- Center for Neuro-Oncology, Dana-Farber Cancer Institute, Boston, MA, 02215, USA.
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Webster A, Hafeez S, Lewis R, Griffins C, Warren-Oseni K, Patel E, Hansen VN, Hall E, Huddart R, Miles E, McNair HA. The Development of Therapeutic Radiographers in Imaging and Adaptive Radiotherapy Through Clinical Trial Quality Assurance. Clin Oncol (R Coll Radiol) 2021; 33:461-467. [PMID: 33766503 DOI: 10.1016/j.clon.2021.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/29/2021] [Accepted: 02/17/2021] [Indexed: 02/06/2023]
Abstract
AIMS Adaptive radiotherapy (ART) is an emerging advanced treatment option for bladder cancer patients. Therapeutic radiographers (RTTs) are central to the successful delivery of this treatment. The purpose of this work was to evaluate the image-guided radiotherapy (IGRT) and ART experience of RTTs before participating in the RAIDER trial. A plan of the day (PoD) quality assurance programme was then implemented. Finally, the post-trial experience of RTTs was evaluated, together with the impact of trial quality assurance participation on their routine practice. MATERIALS AND METHODS A pre-trial questionnaire to assess the experience of the RTT staff group in IGRT and ART in bladder cancer was sent to each centre. Responses were grouped according to experience. The PoD quality assurance programme was implemented, and the RAIDER trial commenced. During stage 1 of the trial, RTTs reported difficulties in delivering PoD and the quality assurance programme was updated accordingly. A follow-up questionnaire was sent assessing experience in IGRT and ART post-trial. Any changes in routine practice were also recorded. RESULTS The experience of RTTs in IGRT and ART pre-trial varied. For centres deemed to have RTTs with more experience, the initial PoD quality assurance programme was streamlined. For RTTs without ART experience, the full quality assurance programme was implemented, of which 508 RTTs completed. The quality assurance programme was updated (as the trial recruited) and it was mandated that at least one representative RTT (regardless of pre-trial experience) participated in the update in real-time. The purpose of the updated quality assurance programme was to provide further support to RTTs in delivering a complex treatment. Engagement with the updated quality assurance programme was high, with RTTs in 24/33 centres participating in the real-time online workshop. All 33 UK centres reported all RTTs reviewed the updated training offline. Post-trial, the RTTs' experience in IGRT and ART was increased. CONCLUSION Overall, 508 RTTs undertook the PoD quality assurance programme. There was a high engagement of RTTs in the PoD quality assurance programme and trial. RTTs increased their experience in IGRT and ART and subsequently updated their practice for bladder cancer and other treatment sites.
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Affiliation(s)
- A Webster
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, London, UK.
| | - S Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - R Lewis
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - C Griffins
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | | | - E Patel
- University College Hospital, London, UK
| | - V N Hansen
- Odense University Hospital, Odense, Denmark
| | - E Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - R Huddart
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - E Miles
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, London, UK
| | - H A McNair
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
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Amatya AK, Fiero MH, Bloomquist EW, Sinha AK, Lemery SJ, Singh H, Ibrahim A, Donoghue M, Fashoyin-Aje LA, de Claro RA, Gormley NJ, Amiri-Kordestani L, Sridhara R, Theoret MR, Kluetz PG, Pazdur R, Beaver JA, Tang S. Subgroup Analyses in Oncology Trials: Regulatory Considerations and Case Examples. Clin Cancer Res 2021; 27:5753-5756. [PMID: 34117032 DOI: 10.1158/1078-0432.ccr-20-4912] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/15/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022]
Abstract
Subgroup analyses are assessments of treatment effects based on certain patient characteristics out of the total study population and are important for interpretation of pivotal oncology trials. However, appropriate use of subgroup analyses results for regulatory decision-making and product labeling is challenging. Typically, drugs approved by the FDA are indicated for use in the total patient population studied; however, there are examples of restriction to a subgroup of patients despite positive study results in the entire study population and also extension of an indication to the entire study population despite positive results appearing primarily in one or more subgroups. In this article, we summarize key issues related to subgroup analyses in the benefit-risk assessment of cancer drugs and provide case examples to illustrate approaches that the FDA Oncology Center of Excellence has taken when considering the appropriate patient population for cancer drug approval. In general, if a subgroup is of interest, the subgroup analysis should be hypothesis-driven and have adequate sample size to demonstrate evidence of a treatment effect. In addition to statistical efficacy considerations, the decision on what subgroups to include in labeling relies on the pathophysiology of the disease, mechanistic justification, safety data, and external information available. The oncology drug review takes the totality of the data into consideration during the decision-making process to ensure the indication granted and product labeling appropriately reflect the scientific evidence to support patient population for whom the drug is safe and effective.
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Affiliation(s)
- Anup K Amatya
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of Biostatistics, Silver Spring, Maryland.
| | - Mallorie H Fiero
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of Biostatistics, Silver Spring, Maryland
| | - Erik W Bloomquist
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of Biostatistics, Silver Spring, Maryland
| | - Arup K Sinha
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of Biostatistics, Silver Spring, Maryland
| | - Steven J Lemery
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Silver Spring, Maryland
- US Food and Drug Administration, Oncology Center of Excellence, Silver Spring, Maryland
| | - Harpreet Singh
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Silver Spring, Maryland
- US Food and Drug Administration, Oncology Center of Excellence, Silver Spring, Maryland
| | - Amna Ibrahim
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Silver Spring, Maryland
- US Food and Drug Administration, Oncology Center of Excellence, Silver Spring, Maryland
| | - Martha Donoghue
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Silver Spring, Maryland
- US Food and Drug Administration, Oncology Center of Excellence, Silver Spring, Maryland
| | - Lola A Fashoyin-Aje
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Silver Spring, Maryland
- US Food and Drug Administration, Oncology Center of Excellence, Silver Spring, Maryland
| | - R Angelo de Claro
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Silver Spring, Maryland
- US Food and Drug Administration, Oncology Center of Excellence, Silver Spring, Maryland
| | - Nicole J Gormley
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Silver Spring, Maryland
- US Food and Drug Administration, Oncology Center of Excellence, Silver Spring, Maryland
| | - Laleh Amiri-Kordestani
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Silver Spring, Maryland
- US Food and Drug Administration, Oncology Center of Excellence, Silver Spring, Maryland
| | - Rajeshwari Sridhara
- US Food and Drug Administration, Oncology Center of Excellence, Silver Spring, Maryland
| | - Marc R Theoret
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Silver Spring, Maryland
- US Food and Drug Administration, Oncology Center of Excellence, Silver Spring, Maryland
| | - Paul G Kluetz
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Silver Spring, Maryland
- US Food and Drug Administration, Oncology Center of Excellence, Silver Spring, Maryland
| | - Richard Pazdur
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Silver Spring, Maryland
- US Food and Drug Administration, Oncology Center of Excellence, Silver Spring, Maryland
| | - Julia A Beaver
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of New Drugs, Office of Oncologic Diseases, Silver Spring, Maryland
- US Food and Drug Administration, Oncology Center of Excellence, Silver Spring, Maryland
| | - Shenghui Tang
- US Food and Drug Administration, Center for Drug Evaluation and Research, Office of Biostatistics, Silver Spring, Maryland
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McLennan S, Griessbach A, Briel M. Practices and Attitudes of Swiss Stakeholders Regarding Investigator-Initiated Clinical Trial Funding Acquisition and Cost Management. JAMA Netw Open 2021; 4:e2111847. [PMID: 34076698 PMCID: PMC8173375 DOI: 10.1001/jamanetworkopen.2021.11847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Randomized clinical trials (RCTs) are an essential method of evaluating health care interventions and a cornerstone for evidence-based health care. However, RCTs have become increasingly complex and costly, which is particularly challenging for independent investigator-initiated clinical trials (IICTs). IICTs have an essential role in clinical research, and it is important that efforts are made to ensure IICTs are adequately funded and are conducted cost-effectively. OBJECTIVE To examine the practices and attitudes of Swiss stakeholders regarding IICT funding acquisition and cost management. DESIGN, SETTING, AND PARTICIPANTS For this qualitative study, interviews were conducted in Switzerland between February and August 2020. The purposive sample comprised 48 stakeholders from 4 different groups: primary investigators (n = 27), funders and sponsors (n = 9), clinical trial support organizations (n = 6), and ethics committee members (n = 6). MAIN OUTCOMES AND MEASURES Practices and attitudes of stakeholders regarding IICT funding acquisition and cost management were assessed using individual semistructured qualitative interviews. Interviews were analyzed using conventional content analysis. RESULTS After interviews with 48 IICT stakeholders (75% male presenting), these participants identified a systemic problem of IICTs being underfunded, which can lead to compromises being made regarding the quality and conduct of IICTs. Participants identified 2 overarching and interconnected groups of reasons why IICTs in Switzerland are regularly underfunded. First, it was reported that IICT budget estimations are often inaccurate because of poor planning and preparation, unforeseeable events, investigators intentionally underestimating budgets, and limited budget assessment and oversight. Second, with the exception of a specific IICT funding program by the Swiss National Science Foundation, it was reported that limited funding sources and unrealistic expectation of funders led to underlying challenges in getting IICTs fully funded. A number of measures that could help reduce the underfunding of IICTs were identified, including improving the support of investigators and IICTs, strengthening networking and guidance, harmonizing and simplifying bureaucracy, and increasing public funding of IICTs. CONCLUSIONS AND RELEVANCE This study highlights the inadequate expertise of Swiss stakeholders to correctly, systematically, and reproducibly calculate RCT budgets and the need for transparency on trial costs as well as training in budgeting practices. Limited financial resources for academic clinical research and issues regarding the professional planning and conduct of IICTs are persistent issues that many other countries also face.
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Affiliation(s)
- Stuart McLennan
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University of Basel and University Hospital Basel, Basel, Switzerland
- Institute of History and Ethics in Medicine, Technical University of Munich, Munich, Germany
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Alexandra Griessbach
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Matthias Briel
- Department of Clinical Research, Basel Institute for Clinical Epidemiology and Biostatistics, University of Basel and University Hospital Basel, Basel, Switzerland
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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