1
|
Clinical trials in Bosnia and Herzegovina: Challenges and future perspectives. Contemp Clin Trials Commun 2022; 28:100953. [PMID: 35800034 PMCID: PMC9254004 DOI: 10.1016/j.conctc.2022.100953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/25/2022] [Accepted: 06/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background Clinical trials (CTs) are research investigations in which participants receive medical treatments, interventions, or tests to assess their safety and efficacy. Each planned clinical is registered through local or national medical agencies, which may differ in the amount of administrative and legal procedures. The objective of this study was to systematically analyze the registration process for clinical trials in Bosnia and Herzegovina in comparison to other Balkan countries. Methods The search strategy was based using two online databases: Clinicaltrials.gov (CTGR) and Cortellis Clinical Trials Intelligence (cTi). Search engines included studies until 26th April 2021 and countries were compared in terms of the number of studies, status, type, funding, clinical phases and demographic data. Results The total number of clinical trials from Bosnia and Herzegovina recorded in the CTGR database was 219, while the cTi database comprised 254 registered studies. The total number of reported clinical trials in CTGR and cTi databases were highest in Serbia (n = 1229, n = 1438), followed by Croatia (n = 1142, n = 1300), and Slovenia (n = 801, n = 948), respectively. However, the highest number of clinical trials per capita is in Slovenia (3.85e-4 in CTGR; 4.56e-4 in cTi), followed by Croatia (2.78e-4 in CTGR; 3.17e-4 in cTi), Serbia (1.41e-4 in CTGR; 1.65e-4 in cTi), and Bosnia and Herzegovina (0.67e-4 CTGR; 0.78e-4 cTi). Conclusion Our analysis showed that Bosnia has the lowest number of clinical trials in the Balkans. Furthermore, the registration process is complex and longer than in developed countries. Since the healthcare system has been in a transition in the past decade, clinical trials are underutilized as a tool for the improvement of patient care. The clinical trial registration process could be improved by establishing an ethical committee at the state level and by enabling a parallel submission process to ethical committees and databases.
Collapse
|
2
|
Mathebula L, Mapahla L, Nurkhametova D, Ziganshina LE, Mazinu M, Jordan E, Ndwandwe DE, Kredo T. Planned, ongoing and completed tuberculosis treatment trials in Brazil, Russia, India, China and South Africa: a 2019 cross-sectional descriptive analysis. BMJ Open 2022; 12:e057941. [PMID: 35680261 PMCID: PMC9185397 DOI: 10.1136/bmjopen-2021-057941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
UNLABELLED Tuberculosis (TB) remains a deadly challenge globally and Brazil, Russia, India, China and South Africa (BRICS) are among the countries with the highest TB burden. The objective of this study is to identify and describe ongoing, planned and completed TB trials conducted in the BRICS countries registered in WHO-International Clinical Trial Registry Platform (WHO-ICTRP); to report selective outcome reporting by comparing primary outcomes in published trials with their prespecified outcomes in registry records and to evaluate the time to publication. METHODS AND ANALYSIS We searched the WHO-ICTRP portal (20 January 2019) and the Russian Federation Registry (30 March 2019) to identify TB trials conducted in BRICS countries. We included only registered clinical trials conducted wholly in BRICS countries or with at least one recruitment centre in one of the BRICS countries that were investigating TB treatment. RESULTS The search of the WHO-ICTRP yielded 408 trials and additional 32 trials were identified from the Russian registry. Of those, 253 were included in the analysis. We found that 77 trials were multicountry trials, followed by trials in China (55), India (53), South Africa (34), Russia (23) and Brazil (11). 163 trials were registered prospectively, 69 retrospectively and 21 trials had no registration status. Most trials (207) evaluated TB treatment, followed by 29 behaviour change interventions, 13 nutritional supplementation, 4 surgical treatment and 2 assessing rehabilitation. Based on ICJME recommendation of publishing 12 months after completion of trial, we found that 156 trials were completed 12 or more months by date and 101 trials had publications. Thirty-one of the 101 trials with publication had evidence of selective outcome reporting. The median time to publication was 25 months (IQR 15-37) from the time of anticipated end date stated in the registry. CONCLUSION TB trials conducted in BRICS countries are collaborative, mostly drug treatment oriented, potentially affecting policies. Selective outcome reporting remains a problem both for prospectively and retrospectively registered trials, only small fraction of which gets to publication.
Collapse
Affiliation(s)
- Lindi Mathebula
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
- Department of Global Health, Stellenbosch University, Tygerberg, South Africa
| | - Lovemore Mapahla
- Department of Global Health, Stellenbosch University, Tygerberg, South Africa
- Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Dilyara Nurkhametova
- Cochrane Russia, Russian Medical Academy for Continuing Professional Education of the Ministry of Health, Moscow, Russian Federation
| | - Liliya Eugenevna Ziganshina
- Cochrane Russia, Russian Medical Academy for Continuing Professional Education of the Ministry of Health, Moscow, Russian Federation
- Kazan Medical University and RUDN University, Moscow, Russian Federation
| | - Mikateko Mazinu
- Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Esme Jordan
- Biostatistics Unit, South African Medical Research Council, Tygerberg, South Africa
- Statistics and Population Studies Department, University of the Western Cape, Bellville, South Africa
| | | | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
- Faculty of Medicine and Health Sciences, Division of Clinical Pharmacology, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
3
|
Edem B, Onwuchekwa C, Wariri O, Nkereuwem E, Nkereuwem OO, Williams V. Trends in clinical trial registration in sub-Saharan Africa between 2010 and 2020: a cross-sectional review of three clinical trial registries. Trials 2021; 22:472. [PMID: 34289892 PMCID: PMC8293494 DOI: 10.1186/s13063-021-05423-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/05/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Prospective registration of clinical trials is an ethical, scientific, and legal requirement that serves several functions, including minimising research wastage and publication bias. Sub-Saharan Africa (SSA) is increasingly hosting clinical trials over the past few years, and there is limited literature on trends in clinical trial registration and reporting in SSA. Therefore, we set out to determine the trends in clinical trials registered in SSA countries between 2010 and July 2020. METHODS A cross-sectional study design was used to describe the type of clinical trials that are conducted in SSA from 1 January 2010 to 31 July 2020. The registries searched were ClinicalTrials.gov (CTG), the Pan African Clinical Trials Register (PACTR), and the International Standard Randomized Controlled Trial Number (ISRCTN). Data were extracted into Excel and imported into STATA for descriptive analysis. RESULTS CTG had the highest number of registered trials at 2622, followed by PACTR with 1501 and ISRCTN with 507 trials. Trials were observed to increase gradually from 2010 and peaked at 2018-2019. Randomised trials were the commonest type, accounting for at least 80% across the three registries. Phase three trials investigating drugs targeted at infections/infestations were the majority. Few completed trials had their results posted: 58% in ISRCTN and 16.5% in CTG, thus suggesting reporting bias. CONCLUSION Despite the gradual increase in clinical trials registered during the period, recent trends suggest a drop in the number of trials registered across the region. Strengthening national and regional regulatory capacity will improve clinical trial registration and minimise reporting bias in completed clinical trials.
Collapse
Affiliation(s)
- Bassey Edem
- Department of Vaccines and Immunity, Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia.
| | - Chukwuemeka Onwuchekwa
- Department of Vaccines and Immunity, Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Oghenebrume Wariri
- Department of Vaccines and Immunity, Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Esin Nkereuwem
- Department of Vaccines and Immunity, Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Oluwatosin O Nkereuwem
- Department of Vaccines and Immunity, Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Victor Williams
- Unit of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
4
|
Hohlfeld ASJ, Mathebula L, Pienaar ED, Abrams A, Lutje V, Ndwandwe D, Kredo T. Tuberculosis treatment intervention trials in Africa: A cross-sectional bibliographic study and spatial analysis. PLoS One 2021; 16:e0248621. [PMID: 33739989 PMCID: PMC7978376 DOI: 10.1371/journal.pone.0248621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 03/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background Mycobacterium Tuberculosis (TB) poses a substantial burden in sub-Saharan Africa and is the leading cause of death amongst infectious diseases. Randomised controlled trials (RCTs) are regarded as the gold standard for evaluating the effectiveness of interventions. We aimed to describe published TB treatment trials conducted in Africa. Methods This is a cross-sectional study of published TB trials conducted in at least one African country. In November 2019, we searched three databases using the validated Africa search filter and Cochrane’s sensitive trial string. Published RCTs conducted in at least one African country were included for analysis. Records were screened for eligibility. Co-reviewers assisted with duplicate data extraction. Extracted data included: the country where studies were conducted, publication dates, ethics statement, trial registration number, participant’s age range. We used Cochrane’s Risk of Bias criteria to assess methodological quality. Results We identified 10,495 records; 175 trials were eligible for inclusion. RCTs were published between 1952 and 2019. The median sample size was 206 participants (interquartile range: 73–657). Most trials were conducted in South Africa (n = 83) and were drug therapy trials (n = 130). First authors were from 30 countries globally. South Africa had the most first authors (n = 55); followed by the United States of America (USA) (n = 28) and Great Britain (n = 14) with fewer other African countries contributing to the first author tally. Children under 13 years of age eligible to participate in the trials made up 17/175 trials (9.71%). International governments (n = 29) were the most prevalent funders. Ninety-four trials provided CONSORT flow diagrams. Methodological quality such as allocation concealment and blinding were poorly reported or unclear in most trials. Conclusions By mapping African TB trials, we were able to identify potential research gaps. Many of the global north’s researchers were found to be the lead authors in these African trials. Few trials tested behavioural interventions compared to drugs, and far fewer tested interventions on children compared to adults to improve TB outcomes. Lastly, funders and researchers should ensure better methodological quality reporting of trials.
Collapse
Affiliation(s)
- Ameer S. J. Hohlfeld
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town, South Africa
- * E-mail:
| | - Lindi Mathebula
- Communicable Disease Control, Department of Health, Western Cape, Cape Town, South Africa
| | - Elizabeth D. Pienaar
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town, South Africa
| | - Amber Abrams
- Future Water Institute, University of Cape Town, Cape Town, South Africa
| | - Vittoria Lutje
- Cochrane Infectious Diseases Group, Liverpool, United Kingdom
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town, South Africa
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town, South Africa
- Clinical Pharmacology Division, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| |
Collapse
|
5
|
Xu Y, Dong M, Liu X. Characteristics and trends of clinical studies primarily sponsored by China in WHO primary registries between 2009 and 2018: a cross-sectional survey. BMJ Open 2020; 10:e037262. [PMID: 33444176 PMCID: PMC7682458 DOI: 10.1136/bmjopen-2020-037262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To analyse characteristics and developmental trends of clinical study registration primarily sponsored by China's institutions during 2009-2018. SETTING Registration information registered prior to 31 December 2018 was obtained from the International Clinical Trials Registry Platform (ICTRP) source registries, including Chinese Clinical Trial Registry, ClinicalTrials.gov, Australian New Zealand Clinical Trials Registry and International Standard Randomised Controlled Trial Number. Registration information on other ICTRP source registries was collected from the ICTRP. DESIGN A cross-sectional analysis was performed. The studies sponsored by mainland China's institutions (not including institutions in Hong Kong SAR, Macau SAR or Taiwan of China) as of 31 December 2018 were filtered. For duplicate registrations, only the records with the earliest registration date were included. Global registrations were summarised for comparison. RESULTS A total of 32 557 China-sponsored studies and 478 261 global studies were included. The registered China-sponsored studies, increased from a cumulative number of 1333 in 2009 to 32 557 in 2018, were less likely to have industry involvement (14% vs 30%) and more likely to be registered prospectively (63% vs 45%) than the global registrations during 2009-2018. The top three most studied health conditions were lung cancer (4.2%), diabetes (3.8%) and ischaemic heart disease (3.2%). Depression and depressive disorders and chronic obstructive pulmonary disease (COPD) each represented 1.1% of registered China-sponsored studies. Phase 2 and phase 3 trials together accounted for 30%, notably lower than the global level (53%). The registered studies responding to an individual participant data (IPD) sharing plan had increased since 2016, but the proportions of studies indicating 'yes' were still at a low level and accounted for 5% of the registered China-sponsored studies and global registrations. CONCLUSIONS Clinical study registration activity in China has been substantial during 2009-2018. Some diseases with a high disease burden in China (depression and depressive disorders and COPD) were underrepresented by the proportion of registered studies. The accessibility of IPD merits improvement.
Collapse
Affiliation(s)
- Yang Xu
- Huaxi Medical Journal Press, West China Hospital, Sichuan University, Chengdu, China
| | - Min Dong
- Huaxi Medical Journal Press, West China Hospital, Sichuan University, Chengdu, China
| | - Xuemei Liu
- Huaxi Medical Journal Press, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
6
|
|
7
|
Feizabadi M, Fahimnia F, Mosavi Jarrahi A, Naghshineh N, Tofighi S. Iranian clinical trials: An analysis of registered trials in International Clinical Trial Registry Platform (ICTRP). J Evid Based Med 2017; 10:91-96. [PMID: 28444844 DOI: 10.1111/jebm.12248] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 02/28/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVE This study investigated and analyzed Iranian clinical trials registered in the ICTRP portal by the end of 2015. The goal was to determine which diseases are currently being studied and whether these are diseases that carry the greatest burden of disease according to regional and WHO statistics. MATERIALS AND METHODS Information on clinical trials carried out in Iran was downloaded from the portal of the International Clinical Trials Registry website. By the end of 2015, 10,341 studies were registered from Iran. After removing duplicate and observational studies, 10,211 studies remained for analysis. The 2016 edition of the International Classification of Diseases was used to classify the diseases. RESULTS The frequency of studies was found to be mental and behavioral disorders (10.44%), diseases of the genitourinary system (10.2%), and endocrine, nutritional, and metabolic diseases (10.01%). Gastrointestinal and dermatologic diseases made up more than 12% of studies, but bear only 0.84% of the burden of disease in Iran. CONCLUSION The results showed that, despite an increase in registration of clinical trials in Iran, most studies registered were conducted on diseases, which form only a small percentage of the total disease burden of the country.
Collapse
Affiliation(s)
- Mansoureh Feizabadi
- Faculty of Management, Department of Information Science and Knowledge Studies, Tehran University, Tehran, Iran
- Library and Information Science, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Fatima Fahimnia
- Faculty of Management, Department of Information Science and Knowledge Studies, Tehran University, Tehran, Iran
| | - Alireza Mosavi Jarrahi
- Department of Social Medicine, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nader Naghshineh
- Faculty of Management, Department of Information Science and Knowledge Studies, Tehran University, Tehran, Iran
| | - Shahram Tofighi
- Department of Health Economics and Management, Baqiyatallah University of Medical Sciences, Tehran, Iran
| |
Collapse
|
8
|
Rodríguez-Feria P, Cuervo LG. Progress in trial registration in Latin America and the Caribbean, 2007-2013. Rev Panam Salud Publica 2017; 41:e31. [PMID: 31363353 PMCID: PMC6612714 DOI: 10.26633/rpsp.2017.31] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 06/26/2016] [Indexed: 12/13/2022] Open
Abstract
This descriptive study identifies trends in clinical trial registration in the World Health Organization International Clinical Trial Registry Platform (ICTRP) for Latin America and the Caribbean (LAC), from 2007–2013, and provides adjusted estimates for registration rates by population and publications (2007–2011). Trends and data are presented by subregion and language in interactive graphs, including annual registration rates by population (2007–2011) and publications (LILACS and MEDLINE) listed in SCIENTI Network (Science and Technology Indicators). Of the 11 945 clinical trials involving LAC countries, 8 282 were in South America, with Brazil leading at 4 070 (49%); 2 421 in North and Central America, with Mexico leading at 1 886 (78%); and 1 242 in the Caribbean, with Puerto Rico leading at 857 (69%). After adjusting by population and publication rates Chile, Panama, Argentina, and Peru led registration rates per 1 million inhabitants. Variations in the number of trials per year are quite substantial. Clinical trial registration increased in a steady yet inconsistent way. The implementation of the Policy on Research for Health has been followed by an increase in countries that require registration and have established clinical trial registries. However, there is room for improvement in adherence throughout LAC. Trial registration is offered gratis by Brazilian, Cuban, Peruvian, and United States registries, among others.
Collapse
Affiliation(s)
- Pablo Rodríguez-Feria
- Office of Knowledge Management, Bioethics, and Research Pan American Health Organization (PAHO) / Regional Office of the World Health Organization (WHO) Washington, DC United States of America Office of Knowledge Management, Bioethics, and Research, Pan American Health Organization (PAHO) / Regional Office of the World Health Organization (WHO), Washington, DC, United States of America
| | - Luis Gabriel Cuervo
- Office of Knowledge Management, Bioethics, and Research Pan American Health Organization (PAHO) / Regional Office of the World Health Organization (WHO) Washington, DC United States of America Office of Knowledge Management, Bioethics, and Research, Pan American Health Organization (PAHO) / Regional Office of the World Health Organization (WHO), Washington, DC, United States of America
| |
Collapse
|
9
|
A change roadmap towards research paradigm in low-resource countries: retinoblastoma model in Egypt. Int Ophthalmol 2016; 37:111-118. [DOI: 10.1007/s10792-016-0233-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/11/2016] [Indexed: 10/21/2022]
|