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Meyhoff TS, Jensen AKG, Perner A, Goligher EC, Campbell MK, Møller MH, Granholm A. Adaptations and Heterogeneity of Treatment Effects in Platform Trials-Protocol for Two Methodological Studies. Acta Anaesthesiol Scand 2025; 69:e70044. [PMID: 40331329 PMCID: PMC12056685 DOI: 10.1111/aas.70044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2025] [Accepted: 04/09/2025] [Indexed: 05/08/2025]
Abstract
BACKGROUND Adaptive platform trials bring opportunities for improved infrastructure and effective advancement in medical care but are methodologically complex. Assessment of heterogeneity of treatment effects (HTE) according to participant characteristics and adaptations, including adaptive stopping, are important methodological features in these trials, which may be approached in multiple ways. We aim to characterise the assessment of HTE and use of adaptations, including their key methodological features, in adaptive platform trials. METHODS This protocol outlines two methodological studies, which will be based on a common, systematic literature search and data extraction. We will include adaptive platform trials conducted from 2005 onwards. Screening and data extraction will be performed independently and in duplicate. In Study I, we will assess methods used to evaluate HTE, and in Study II, we will assess adaptations and stopping rules in the included trials. DISCUSSION The two proposed methodological studies will provide an overview of important methodological features regarding the assessment of HTE and adaptations used in adaptive platform trials. Better knowledge of available methods to assess these features can improve the conditions for designing adaptive platform trials and identify areas for further development.
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Affiliation(s)
- Tine Sylvest Meyhoff
- Department of Intensive CareCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
| | - Aksel Karl Georg Jensen
- Department of Intensive CareCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
- Section of Biostatistics, Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
| | - Anders Perner
- Department of Intensive CareCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Ewan C. Goligher
- Interdepartmental Division of Critical Care MedicineUniversity of TorontoTorontoCanada
| | | | - Morten Hylander Møller
- Department of Intensive CareCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
- Department of Clinical MedicineUniversity of CopenhagenCopenhagenDenmark
| | - Anders Granholm
- Department of Intensive CareCopenhagen University Hospital – RigshospitaletCopenhagenDenmark
- Section of Biostatistics, Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
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2
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Massonnaud CR, Schönenberger CM, Chiaborelli M, Ehrenzeller S, Griessbach A, Gillibert A, Briel M, Laouénan C. Characteristics, design, and statistical methods in platform trials: a systematic review. J Clin Epidemiol 2025; 184:111827. [PMID: 40349734 DOI: 10.1016/j.jclinepi.2025.111827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2025] [Revised: 04/27/2025] [Accepted: 05/05/2025] [Indexed: 05/14/2025]
Abstract
BACKGROUND AND OBJECTIVE Platform trials (PTs) are gaining popularity in clinical research due to their innovative and flexible methodologies. The objective was to determine the characteristics, methodological, and statistical practices in PTs. METHODS We identified PTs from trial registries and bibliographic databases up to August 2024. Eligible PTs were randomized controlled trials studying multiple interventions within a single population, with flexibility to add or drop arms. Data were extracted on trial status, design, statistical methods, and reporting practices. RESULTS We identified 189 PTs. Most focused on infectious diseases (77, including 57 for COVID-19) and oncology (68). PT initiation peaked during the COVID-19 pandemic but has since stabilized at 84 active PTs, with 25 in planning. A complete master protocol was available for 47% (89/189) of PTs. Bayesian designs featured in 58/189 PTs vs. 56/189 frequentist trials, 20/189 trials utilizing both (unclear in 55/189 PTs). Overall, 25/111 trials (23%) were designed without a predetermined target sample size, all of which were Bayesian. Among these, 16 were explicitly reported as "perpetual" trials. The number of interim analyses was predetermined in 18% (10/57) of Bayesian trials vs. 58% (28/48) of frequentist trials. Simulations to evaluate operating characteristics were used in 93% (39/42) of Bayesian trials. Simulation reports were available in 67% (26/39) of cases, and the procedures were detailed for 62% (24/39) of trials. Only two trials shared the simulation code. CONCLUSION PTs remain popular and increasingly diverse. Efforts to enhance transparency and reporting, especially in complex Bayesian PTs, are essential to ensure reliability and broader acceptance.
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Affiliation(s)
- Clément R Massonnaud
- Université Paris Cité, Inserm, IAME, Paris F-75018, France; AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, Paris F-75018, France.
| | - Christof Manuel Schönenberger
- CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Malena Chiaborelli
- CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Selina Ehrenzeller
- CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexandra Griessbach
- CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Matthias Briel
- CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Cédric Laouénan
- Université Paris Cité, Inserm, IAME, Paris F-75018, France; AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, Paris F-75018, France
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3
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Curley MAQ, Kalvas LB, Perry-Eaddy MA, Asaro LA, Wypij D. A Decision-Making Grid for Coenrollment in Multiple Clinical Trials. Nurs Res 2025; 74:241-245. [PMID: 39679895 DOI: 10.1097/nnr.0000000000000802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2024]
Abstract
BACKGROUND Although subject coenrollment into multiple trials is desirable, thoughtful consideration is required to avoid compromising each trial's scientific integrity. OBJECTIVE We developed a Decision-Making Grid (GRID) to help investigators determine whether a clinical trial is compatible with a second clinical trial, thus allowing coenrollment, or if it should be considered competing, prohibiting coenrollment. METHODS The GRID evaluates 21 elements across four domains: scientific integrity, data interpretation, feasibility/burden, and additional considerations. Optimally, each principal investigator shares their protocol, completes the GRID independently, and then meets to compare their perspectives, seeking a mutually acceptable agreement. RESULTS The GRID has facilitated coenrollment decision-making for the RESTORE and PROSpect pediatric critical care clinical trials. In RESTORE , five trials were reviewed; one was approved for coenrollment, and four were deemed competing. In PROSpect , 26 trials have been reviewed; 20 are approved for coenrollment, and six were deemed competing. In both RESTORE and PROSpect , the principal investigators of multiple trials arranged a mutually acceptable sharing agreement. DISCUSSION The GRID provides a systematic process to help investigators evaluate the effect of coenrollment in multiple clinical trials.
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4
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Granholm A, Møller MH, Kaas‐Hansen BS, Jensen AKG, Munch MW, Kjær MN, Andersen LW, Schjørring OL, Rasmussen BS, Meyhoff TS, Larsen RF, Thorsen‐Meyer H, Collet MO, Meier NF, Estrup S, Mathiesen O, Maagaard M, Poulsen LM, Strøm T, Christensen S, Bruun CRL, Keus F, Rossing P, Granfeldt A, Brøchner AC, Itenov TS, Cronhjort M, Laake JH, Hästbacka J, Pfortmueller CA, Siegemund M, Sigurdsson MI, Andersen LPK, Placido D, Lange T, Perner A. INCEPT: The Intensive Care Platform Trial-Design and protocol. Acta Anaesthesiol Scand 2025; 69:e70023. [PMID: 40084471 PMCID: PMC11907384 DOI: 10.1111/aas.70023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2025] [Accepted: 03/06/2025] [Indexed: 03/16/2025]
Abstract
BACKGROUND Adult intensive care unit (ICU) patients receive many interventions, but few are supported by high-certainty evidence. Randomised clinical trials (RCTs) are essential for trustworthy comparisons of intervention effects, but conventional RCTs are costly, cumbersome, inflexible, and often turn out inconclusive. Adaptive platform trials may mitigate these issues and have higher probabilities of obtaining conclusive results faster and at lower costs per participant. METHODS The Intensive Care Platform Trial (INCEPT) is an investigator-initiated, pragmatic, randomised, embedded, multifactorial, international, adaptive platform trial including adults acutely admitted to ICUs. INCEPT will assess comparable groups of interventions (primarily commonly used interventions with clinical uncertainty and practice variation) nested in domains. Interventions may be either open-label or masked. New domains will continuously be added to the platform. INCEPT assesses multiple core outcomes selected following substantial stakeholder involvement: mortality, days alive without life support/out of hospital/free of delirium, health-related quality of life, cognitive function, and safety outcomes. Each domain will use one of these core outcomes as the primary outcome. INCEPT primarily uses Bayesian statistical methods with neutral, minimally informative or sceptical priors, adjustment for important prognostic baseline variables, and calculation of absolute and relative differences in the intention-to-treat populations. Domains and intervention arms may be stopped for superiority/inferiority, practical equivalence, or futility according to pre-specified adaptation rules evaluated using statistical simulation or at pre-specified maximum sample sizes. Domains may use response-adaptive randomisation, meaning that more participants will be allocated to interventions with higher probabilities of being superior. CONCLUSIONS INCEPT provides an efficient, pragmatic, and flexible platform for comparing the effects of many interventions used in adult ICU patients. The adaptive design enables the trial to use accumulating data to improve the treatment of future participants. INCEPT will provide high-certainty, conclusive evidence for many interventions, directly inform clinical practice, and thus improve patient-important outcomes.
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Affiliation(s)
- Anders Granholm
- Department of Intensive CareCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
- Section of Biostatistics, Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
| | - Morten Hylander Møller
- Department of Intensive CareCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
- Department of Clinical Medicine, Faculty of Health SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Benjamin Skov Kaas‐Hansen
- Department of Intensive CareCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
- Section of Biostatistics, Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
| | - Aksel Karl Georg Jensen
- Department of Intensive CareCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
- Section of Biostatistics, Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
| | - Marie Warrer Munch
- Department of Intensive CareCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
| | - Maj‐Brit Nørregaard Kjær
- Department of Intensive CareCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
| | - Lars Wiuff Andersen
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of Anesthesiology and Intensive CareAarhus University HospitalAarhusDenmark
- Prehospital Emergency Medical Services, Central Region DenmarkAarhusDenmark
| | - Olav Lilleholt Schjørring
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
- Department of Anaesthesia and Intensive CareAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Bodil Steen Rasmussen
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
- Department of Anaesthesia and Intensive CareAalborg University HospitalAalborgDenmark
- Department of Clinical MedicineAalborg UniversityAalborgDenmark
| | - Tine Sylvest Meyhoff
- Department of Intensive CareCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
| | - Rikke Faebo Larsen
- Department of Intensive CareCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
| | - Hans‐Christian Thorsen‐Meyer
- Department of Intensive CareCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
| | - Marie Oxenbøll Collet
- Department of Intensive CareCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
- Department of Clinical Medicine, Faculty of Health SciencesUniversity of CopenhagenCopenhagenDenmark
| | - Nick Frørup Meier
- Department of Intensive CareCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
| | - Stine Estrup
- Department of Intensive CareCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
| | - Ole Mathiesen
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
- Department of Clinical Medicine, Faculty of Health SciencesUniversity of CopenhagenCopenhagenDenmark
- Department of Anaesthesiology and Intensive CareZealand University HospitalKøgeDenmark
| | - Mathias Maagaard
- Department of Anaesthesiology and Intensive CareZealand University HospitalKøgeDenmark
| | - Lone Musaeus Poulsen
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
- Department of Anaesthesiology and Intensive CareZealand University HospitalKøgeDenmark
| | - Thomas Strøm
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
- Department of Anaesthesia and Critical Care MedicineOdense University HospitalOdenseDenmark
- Department of Anaesthesia and Critical Care Medicine, Hospital SønderjyllandUniversity Hospital of Southern DenmarkOdenseDenmark
| | - Steffen Christensen
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of Anesthesiology and Intensive CareAarhus University HospitalAarhusDenmark
| | | | - Frederik Keus
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
- Department of Critical Care, University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
| | - Peter Rossing
- Department of Clinical Medicine, Faculty of Health SciencesUniversity of CopenhagenCopenhagenDenmark
- Steno Diabetes Center CopenhagenHerlevDenmark
| | - Asger Granfeldt
- Department of Clinical MedicineAarhus UniversityAarhusDenmark
- Department of Anesthesiology and Intensive CareAarhus University HospitalAarhusDenmark
| | - Anne Craveiro Brøchner
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
- Department of Anaesthesia and Intensive CareLillebælt HospitalKoldingDenmark
| | - Theis Skovsgaard Itenov
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
- Department of Clinical Medicine, Faculty of Health SciencesUniversity of CopenhagenCopenhagenDenmark
- Department of Anesthesiology and Intensive CareBispebjerg and Frederiksberg HospitalsCopenhagenDenmark
| | - Maria Cronhjort
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
- Department of Clinical Science and EducationSödersjukhuset, Karolinska InstitutetStockholmSweden
- Department of Clinical SciencesDanderyd Hospital, Karolinska InstitutetStockholmSweden
| | - Jon Henrik Laake
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
- Department of Anaesthesia and Intensive Care Medicine, Division of Emergencies and Critical Care, RikshospitaletOslo University HospitalOsloNorway
- Department of Research and Development, Division of Emergencies and Critical Care, RikshospitaletOslo University HospitalOsloNorway
| | - Johanna Hästbacka
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
- Department of Intensive Care, Tampere University HospitalWellbeing Services County of Pirkanmaa and Tampere UniversityTampereFinland
| | - Carmen Andrea Pfortmueller
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
- Department of Intensive Care Medicine, InselspitalUniversity Hospital BernBernSwitzerland
| | - Martin Siegemund
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
- Intensive Care UnitUniversity Hospital BaselBaselSwitzerland
| | - Martin Ingi Sigurdsson
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
- Faculty of MedicineUniversity of IcelandReykjavikIceland
- Department of Anesthesiology and Critical Care MedicineLandspitali—the National University Hospital of ReykjavikReykjavikIceland
| | - Lars Peter Kloster Andersen
- Department of Clinical Medicine, Faculty of Health SciencesUniversity of CopenhagenCopenhagenDenmark
- Department of Anaesthesiology and Intensive CareZealand University HospitalKøgeDenmark
| | - Davide Placido
- Department of Intensive CareCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
- Novo Nordisk Foundation Center for Protein ResearchUniversity of CopenhagenCopenhagenDenmark
| | - Theis Lange
- Section of Biostatistics, Department of Public HealthUniversity of CopenhagenCopenhagenDenmark
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
| | - Anders Perner
- Department of Intensive CareCopenhagen University Hospital–RigshospitaletCopenhagenDenmark
- Collaboration for Research in Intensive Care (CRIC)CopenhagenDenmark
- Department of Clinical Medicine, Faculty of Health SciencesUniversity of CopenhagenCopenhagenDenmark
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5
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Mahar RK, McGlothlin A, Dymock M, Barina L, Bonten M, Bowen A, Cheng MP, Daneman N, Goodman AL, Lee TC, Lewis RJ, Lumley T, McLean ARD, McQuilten Z, Mora J, Paterson DL, Price DJ, Roberts J, Snelling T, Tverring J, Webb SA, Yahav D, Davis JS, Tong SYC, Marsh JA. Statistical documentation for multi-disease, multi-domain platform trials: our experience with the Staphylococcus aureus Network Adaptive Platform trial. Trials 2025; 26:49. [PMID: 39934879 PMCID: PMC11817021 DOI: 10.1186/s13063-024-08684-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Accepted: 12/04/2024] [Indexed: 02/13/2025] Open
Abstract
Platform trials have become widely adopted across multiple disease areas over recent years, however, guidelines for operationalising these trials have not kept pace. We outline a series of documents that summarise the statistical components, and implicit processes, of the Staphylococcus aureus Network Adaptive Platform (SNAP) trial to provide an informal template for other researchers and reviewers of platform trials. We briefly summarise the content and role of the core protocol, statistical appendix, domain-specific appendices, simulation report, statistical implementation guides, data safety and monitoring committee (DSMC) reports, and domain-specific statistical analysis plans and final reports, and a transparent governance structure that ensures separate blinded and unblinded statistical teams. In the absence of guidelines or checklists for platform trial statistical documents, we hope to provide useful guidance to others in terms of what has worked so far for the SNAP trial, stimulate discussion, and inform a future consensus.Trial registration NCT05137119 . Registered on 30 November 2021.
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Affiliation(s)
- Robert K Mahar
- Centre for Epidemiology, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia.
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Australia.
- Methods and Implementation Support for Clinical Research Hub, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia.
| | | | - Michael Dymock
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Lauren Barina
- Department of Infectious Diseases, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Marc Bonten
- Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- European Clinical Research Alliance On Infectious Diseases, Utrecht, the Netherlands
| | - Asha Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Perth Children's Hospital, Nedlands, WA, Australia
| | - Matthew P Cheng
- Division of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montreal, Canada
- McGill University, Montreal, Canada
| | - Nick Daneman
- Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Anna L Goodman
- MRC Clinical Trials Unit at University College London, London, UK
- Centre for Infection Diagnostics Research at King's College, London, UK
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Todd C Lee
- Division of Infectious Diseases and Medical Microbiology, McGill University Health Centre, Montreal, Canada
| | - Roger J Lewis
- Berry Consultants, LLC, Austin, TX, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Thomas Lumley
- Department of Statistics, University of Auckland, Auckland, New Zealand
| | - Alistair R D McLean
- Methods and Implementation Support for Clinical Research Hub, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
| | - Zoe McQuilten
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
- Department of Haematology, Alfred Health, Melbourne, Australia
| | - Jocelyn Mora
- Department of Infectious Diseases, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - David L Paterson
- ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - David J Price
- Centre for Epidemiology, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
- Department of Infectious Diseases, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Jason Roberts
- Faculty of Medicine, University of Queensland Centre for Clinical Research, University of Queensland, Brisbane, Australia
- Herston Infectious Diseases Institute, Metro North Health, Brisbane, Australia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Division of Anaesthesiology, Critical Care, Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Montpellier, France
| | - Tom Snelling
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, WA, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Jonas Tverring
- Department of Infectious Diseases, Helsingborg Hospital, Helsingborg, Sweden
- Department of Clinical Sciences Helsingborg, Lund University, Lund, Sweden
| | - Steve A Webb
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
| | - Dafna Yahav
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Joshua S Davis
- Infection Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Sydney, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Steven Y C Tong
- Department of Infectious Diseases, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, at the, Peter Doherty Institute for Infection and Immunity , Melbourne, Australia
| | - Julie A Marsh
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Medical School, Centre for Child Health Research, University of Western Australia, Perth, Australia
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6
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Zeraatkar D, Ling M, Kirsh S, Jassal T, Pitre T, Chakraborty S, Turner T, Turkstra L, McIntyre RS, Izcovich A, Mbuagbaw L, Agoritsas T, Flottorp SA, Garner P, Couban RJ, Busse JW. Interventions for the management of post-COVID-19 condition (long COVID): protocol for a living systematic review and network meta-analysis. BMJ Open 2025; 15:e086407. [PMID: 39920063 PMCID: PMC11808878 DOI: 10.1136/bmjopen-2024-086407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 11/01/2024] [Indexed: 02/09/2025] Open
Abstract
BACKGROUND Up to 15% of survivors of COVID-19 infection experience long-term health effects, including fatigue, myalgia and impaired cognitive function, termed post-COVID-19 condition or long COVID. Several trials that study the benefits and harms of various interventions to manage long COVID have been published and hundreds more are planned or are ongoing. Trustworthy systematic reviews that clarify the benefits and harms of interventions are critical to promote evidence-based practice. OBJECTIVE To create and maintain a living systematic review and network meta-analysis addressing the benefits and harms of pharmacologic and non-pharmacologic interventions for the treatment and management of long COVID. METHODS Eligible trials will randomise adults with long COVID to pharmacologic or non-pharmacologic interventions, placebo, sham or usual care. We will identify eligible studies by searching MEDLINE, EMBASE, CINAHL, PsycINFO, AMED and CENTRAL from inception, without language restrictions.Reviewers will work independently and in duplicate to screen search records, collect data from eligible trials, including trial and patient characteristics and outcomes of interest and assess risk of bias. Our outcomes of interest will include patient-reported fatigue, pain, postexertional malaise, changes in education or employment status, cognitive function, mental health, dyspnoea, quality of life, physical function, recovery and serious adverse events.For each outcome, when possible, we will perform a frequentist random-effects network meta-analysis. When there are compelling reasons to suspect that certain interventions are only applicable or effective for a subtype of long COVID, we will perform separate network meta-analyses. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach will guide our assessment of the certainty of evidence.We will update our living review biannually, on the publication of a seminal trial, or when new evidence emerges that may change clinical practice. CONCLUSION This living systematic review and network meta-analysis will provide comprehensive, trustworthy and up-to-date summaries of the evidence addressing the benefits and harms of interventions for the treatment and management of long COVID. We will make our findings available publicly and work with guideline-producing organisations to inform their recommendations. ETHICS AND DISSEMINATION The study describes the protocol for a systematic review that uses data from published trial reports. Therefore, the study is exempt from ethics review. We intend to deposit all data in a public repository and publish each iteration of the living review online.
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Affiliation(s)
- Dena Zeraatkar
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Michael Ling
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Kirsh
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Tanvir Jassal
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Tyler Pitre
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Chakraborty
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Tari Turner
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lyn Turkstra
- School of Rehabilitation Science and Program in Neuroscience, McMaster University, Hamilton, Ontario, Canada
| | - Roger S McIntyre
- Department of Psychiatry and Pharmacology, University of Toronto, Toronto, Ontario, Canada
| | - Ariel Izcovich
- Department of Medicine, Universidad del Salvador, Buenos Aires, Argentina
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Division General Internal Medicine, Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland
- The MAGIC Evidence Ecosystem Foundation, Oslo, Norway
| | - Signe A Flottorp
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Paul Garner
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Rachel J Couban
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
| | - Jason W Busse
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Pattison NA, O’Gara G, Cuthbertson BH, Rose L. The legacy of the COVID-19 pandemic on critical care research: A descriptive interview study. J Intensive Care Soc 2025; 26:53-60. [PMID: 39660273 PMCID: PMC11626551 DOI: 10.1177/17511437241301921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2024] Open
Abstract
Background The COVID-19 pandemic challenged both research and clinical teams in critical care to collaborate on research solutions to new clinical problems. Although an effective, nationally coordinated response helped facilitate critical care research, reprioritisation of research efforts towards COVID-19 studies had significant consequences for existing and planned research activity in critical care. Aims Our aim was to explore the impact of the COVID-19 pandemic research prioritisation policies and practices on critical care research funded prior to the pandemic, the conduct of pandemic research, and implications for ongoing and future critical care research. Methods We undertook a descriptive qualitative study recruiting research-active clinician researchers and research delivery team members working in critical care. We conducted digitally recorded, semi-structured interviews in 2021-2022. Framework Analysis was used to analyse the data. Results We interviewed 22 participants comprising principal investigators, senior trial coordinators and research delivery nurses from across the UK. Six themes were identified: Unit, organisational and national factors; Study specific factors; Resources; Individual/clinician factors; Family/patient factors; Contextual factors. These themes explained how a nationally coordinated response during the pandemic affected individuals, studies and wider organisations in managing the research response in critical care, highlighting future implications for critical care research. Conclusion Harnessing the collective response seen in the COVID-19 pandemic in critical care could better support integration of research activity into routine critical care activities. Future endeavours should focus on workforce preparations, contingency planning, strategies for study prioritisation and integration of research as part of the continuum of clinical care.
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Affiliation(s)
- Natalie A. Pattison
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
- East and North Herts NHS Trust, Stevenage, Hertfordshire, UK
- Imperial College London, Imperial College Healthcare NHS Trust, London, UK
| | - Geraldine O’Gara
- Kings College London, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Brian H Cuthbertson
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Anesthesiology and Pain Medicine, University of Toronto. Toronto, ON, Canada
| | - Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, UK
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8
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Duraj T, Kalamian M, Zuccoli G, Maroon JC, D'Agostino DP, Scheck AC, Poff A, Winter SF, Hu J, Klement RJ, Hickson A, Lee DC, Cooper I, Kofler B, Schwartz KA, Phillips MCL, Champ CE, Zupec-Kania B, Tan-Shalaby J, Serfaty FM, Omene E, Arismendi-Morillo G, Kiebish M, Cheng R, El-Sakka AM, Pflueger A, Mathews EH, Worden D, Shi H, Cincione RI, Spinosa JP, Slocum AK, Iyikesici MS, Yanagisawa A, Pilkington GJ, Chaffee A, Abdel-Hadi W, Elsamman AK, Klein P, Hagihara K, Clemens Z, Yu GW, Evangeliou AE, Nathan JK, Smith K, Fortin D, Dietrich J, Mukherjee P, Seyfried TN. Clinical research framework proposal for ketogenic metabolic therapy in glioblastoma. BMC Med 2024; 22:578. [PMID: 39639257 PMCID: PMC11622503 DOI: 10.1186/s12916-024-03775-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 11/14/2024] [Indexed: 12/07/2024] Open
Abstract
Glioblastoma (GBM) is the most aggressive primary brain tumor in adults, with a universally lethal prognosis despite maximal standard therapies. Here, we present a consensus treatment protocol based on the metabolic requirements of GBM cells for the two major fermentable fuels: glucose and glutamine. Glucose is a source of carbon and ATP synthesis for tumor growth through glycolysis, while glutamine provides nitrogen, carbon, and ATP synthesis through glutaminolysis. As no tumor can grow without anabolic substrates or energy, the simultaneous targeting of glycolysis and glutaminolysis is expected to reduce the proliferation of most if not all GBM cells. Ketogenic metabolic therapy (KMT) leverages diet-drug combinations that inhibit glycolysis, glutaminolysis, and growth signaling while shifting energy metabolism to therapeutic ketosis. The glucose-ketone index (GKI) is a standardized biomarker for assessing biological compliance, ideally via real-time monitoring. KMT aims to increase substrate competition and normalize the tumor microenvironment through GKI-adjusted ketogenic diets, calorie restriction, and fasting, while also targeting glycolytic and glutaminolytic flux using specific metabolic inhibitors. Non-fermentable fuels, such as ketone bodies, fatty acids, or lactate, are comparatively less efficient in supporting the long-term bioenergetic and biosynthetic demands of cancer cell proliferation. The proposed strategy may be implemented as a synergistic metabolic priming baseline in GBM as well as other tumors driven by glycolysis and glutaminolysis, regardless of their residual mitochondrial function. Suggested best practices are provided to guide future KMT research in metabolic oncology, offering a shared, evidence-driven framework for observational and interventional studies.
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Affiliation(s)
- Tomás Duraj
- Biology Department, Boston College, Chestnut Hill, MA, 02467, USA.
| | | | - Giulio Zuccoli
- Neuroradiology, Private Practice, Philadelphia, PA, 19103, USA
| | - Joseph C Maroon
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, 15213, USA
| | - Dominic P D'Agostino
- Department of Molecular Pharmacology and Physiology, University of South Florida Morsani College of Medicine, Tampa, FL, 33612, USA
| | - Adrienne C Scheck
- Department of Child Health, University of Arizona College of Medicine, Phoenix, Phoenix, AZ, 85004, USA
| | - Angela Poff
- Department of Molecular Pharmacology and Physiology, University of South Florida Morsani College of Medicine, Tampa, FL, 33612, USA
| | - Sebastian F Winter
- Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, 02114, USA
| | - Jethro Hu
- Cedars-Sinai Cancer, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Rainer J Klement
- Department of Radiotherapy and Radiation Oncology, Leopoldina Hospital Schweinfurt, 97422, Schweinfurt, Germany
| | | | - Derek C Lee
- Biology Department, Boston College, Chestnut Hill, MA, 02467, USA
| | - Isabella Cooper
- Ageing Biology and Age-Related Diseases Group, School of Life Sciences, University of Westminster, London, W1W 6UW, UK
| | - Barbara Kofler
- Research Program for Receptor Biochemistry and Tumor Metabolism, Department of Pediatrics, University Hospital of the Paracelsus Medical University, Müllner Hauptstr. 48, 5020, Salzburg, Austria
| | - Kenneth A Schwartz
- Department of Medicine, Michigan State University, East Lansing, MI, 48824, USA
| | - Matthew C L Phillips
- Department of Neurology, Waikato Hospital, Hamilton, 3204, New Zealand
- Department of Medicine, University of Auckland, Auckland, 1142, New Zealand
| | - Colin E Champ
- Exercise Oncology & Resiliency Center and Department of Radiation Oncology, Allegheny Health Network, Pittsburgh, PA, 15212, USA
| | | | - Jocelyn Tan-Shalaby
- School of Medicine, University of Pittsburgh, Veteran Affairs Pittsburgh Healthcare System, Pittsburgh, PA, 15240, USA
| | - Fabiano M Serfaty
- Department of Clinical Medicine, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, 20550-170, Brazil
- Serfaty Clínicas, Rio de Janeiro, RJ, 22440-040, Brazil
| | - Egiroh Omene
- Department of Oncology, Cross Cancer Institute, Edmonton, AB, T6G 1Z2, Canada
| | - Gabriel Arismendi-Morillo
- Department of Medicine, Faculty of Health Sciences, University of Deusto, 48007, Bilbao (Bizkaia), Spain
- Facultad de Medicina, Instituto de Investigaciones Biológicas, Universidad del Zulia, Maracaibo, 4005, Venezuela
| | | | - Richard Cheng
- Cheng Integrative Health Center, Columbia, SC, 29212, USA
| | - Ahmed M El-Sakka
- Metabolic Terrain Institute of Health, East Congress Street, Tucson, AZ, 85701, USA
| | - Axel Pflueger
- Pflueger Medical Nephrologyand , Internal Medicine Services P.L.L.C, 6 Nelson Road, Monsey, NY, 10952, USA
| | - Edward H Mathews
- Department of Physiology, Faculty of Health Sciences, University of Pretoria, Pretoria, 0002, South Africa
| | | | - Hanping Shi
- Department of Gastrointestinal Surgery and Department of Clinical Nutrition, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, China
| | - Raffaele Ivan Cincione
- Department of Clinical and Experimental Medicine, University of Foggia, 71122, Foggia, Puglia, Italy
| | - Jean Pierre Spinosa
- Integrative Oncology, Breast and Gynecologic Oncology Surgery, Private Practice, Rue Des Terreaux 2, 1002, Lausanne, Switzerland
| | | | - Mehmet Salih Iyikesici
- Department of Medical Oncology, Altınbaş University Bahçelievler Medical Park Hospital, Istanbul, 34180, Turkey
| | - Atsuo Yanagisawa
- The Japanese College of Intravenous Therapy, Tokyo, 150-0013, Japan
| | | | - Anthony Chaffee
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth, 6009, Australia
| | - Wafaa Abdel-Hadi
- Clinical Oncology Department, Cairo University, Giza, 12613, Egypt
| | - Amr K Elsamman
- Neurosurgery Department, Cairo University, Giza, 12613, Egypt
| | - Pavel Klein
- Mid-Atlantic Epilepsy and Sleep Center, 6410 Rockledge Drive, Suite 610, Bethesda, MD, 20817, USA
| | - Keisuke Hagihara
- Department of Advanced Hybrid Medicine, Graduate School of Medicine, Osaka University, Osaka, 565-0871, Japan
| | - Zsófia Clemens
- International Center for Medical Nutritional Intervention, Budapest, 1137, Hungary
| | - George W Yu
- George W, Yu Foundation For Nutrition & Health and Aegis Medical & Research Associates, Annapolis, MD, 21401, USA
| | - Athanasios E Evangeliou
- Department of Pediatrics, Medical School, Aristotle University of Thessaloniki, Papageorgiou Hospital, Efkarpia, 56403, Thessaloniki, Greece
| | - Janak K Nathan
- Dr. DY Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, 411018, India
| | - Kris Smith
- Barrow Neurological Institute, Dignity Health St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA
| | - David Fortin
- Université de Sherbrooke, Sherbrooke, QC, J1K 2R1, Canada
| | - Jorg Dietrich
- Department of Neurology, Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, 02114, USA
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Zeraatkar D, Ling M, Kirsh S, Jassal T, Shahab M, Movahed H, Talukdar JR, Walch A, Chakraborty S, Turner T, Turkstra L, McIntyre RS, Izcovich A, Mbuagbaw L, Agoritsas T, Flottorp SA, Garner P, Pitre T, Couban RJ, Busse JW. Interventions for the management of long covid (post-covid condition): living systematic review. BMJ 2024; 387:e081318. [PMID: 39603702 PMCID: PMC11600537 DOI: 10.1136/bmj-2024-081318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2024] [Indexed: 11/29/2024]
Abstract
OBJECTIVE To compare the effectiveness of interventions for the management of long covid (post-covid condition). DESIGN Living systematic review. DATA SOURCES Medline, Embase, CINAHL, PsycInfo, Allied and Complementary Medicine Database, and Cochrane Central Register of Controlled Trials from inception to December 2023. ELIGIBILITY CRITERIA Trials that randomised adults (≥18 years) with long covid to drug or non-drug interventions, placebo or sham, or usual care. RESULTS 24 trials with 3695 patients were eligible. Four trials (n=708 patients) investigated drug interventions, eight (n=985) physical activity or rehabilitation, three (n=314) behavioural, four (n=794) dietary, four (n=309) medical devices and technologies, and one (n=585) a combination of physical exercise and mental health rehabilitation. Moderate certainty evidence suggested that, compared with usual care, an online programme of cognitive behavioural therapy (CBT) probably reduces fatigue (mean difference -8.4, 95% confidence interval (CI) -13.11 to -3.69; Checklist for Individual Strength fatigue subscale; range 8-56, higher scores indicate greater impairment) and probably improves concentration (mean difference -5.2, -7.97 to -2.43; Checklist for Individual Strength concentration problems subscale; range 4-28; higher scores indicate greater impairment). Moderate certainty evidence suggested that, compared with usual care, an online, supervised, combined physical and mental health rehabilitation programme probably leads to improvement in overall health, with an estimated 161 more patients per 1000 (95% CI 61 more to 292 more) experiencing meaningful improvement or recovery, probably reduces symptoms of depression (mean difference -1.50, -2.41 to -0.59; Hospital Anxiety and Depression Scale depression subscale; range 0-21; higher scores indicate greater impairment), and probably improves quality of life (0.04, 95% CI 0.00 to 0.08; Patient-Reported Outcomes Measurement Information System 29+2 Profile; range -0.022-1; higher scores indicate less impairment). Moderate certainty evidence suggested that intermittent aerobic exercise 3-5 times weekly for 4-6 weeks probably improves physical function compared with continuous exercise (mean difference 3.8, 1.12 to 6.48; SF-36 physical component summary score; range 0-100; higher scores indicate less impairment). No compelling evidence was found to support the effectiveness of other interventions, including, among others, vortioxetine, leronlimab, combined probiotics-prebiotics, coenzyme Q10, amygdala and insula retraining, combined L-arginine and vitamin C, inspiratory muscle training, transcranial direct current stimulation, hyperbaric oxygen, a mobile application providing education on long covid. CONCLUSION Moderate certainty evidence suggests that CBT and physical and mental health rehabilitation probably improve symptoms of long covid. SYSTEMATIC REVIEW REGISTRATION Open Science Framework https://osf.io/9h7zm/. READERS' NOTE This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication.
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Affiliation(s)
- Dena Zeraatkar
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Michael Ling
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Sarah Kirsh
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Tanvir Jassal
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Mahnoor Shahab
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Hamed Movahed
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Jhalok Ronjan Talukdar
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Alicia Walch
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Samantha Chakraborty
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tari Turner
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lyn Turkstra
- School of Rehabilitation Science and Program in Neuroscience, McMaster University, ON, Canada
| | - Roger S McIntyre
- Department of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Ariel Izcovich
- Department of Medicine, Universidad del Salvador, Buenos Aires, Argentina
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Thomas Agoritsas
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Division General Internal Medicine, Department of Medicine, University Hospitals of Geneva, Geneva, Switzerland
- The MAGIC Evidence Ecosystem Foundation, Oslo, Norway
| | - Signe A Flottorp
- Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Oslo, Norway
| | - Paul Garner
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tyler Pitre
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rachel J Couban
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Jason W Busse
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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10
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Bryant A, Quach H. Biomarker-directed therapy in multiple myeloma. Curr Opin Oncol 2024; 36:600-609. [PMID: 39246155 DOI: 10.1097/cco.0000000000001091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
PURPOSE OF REVIEW Multiple myeloma is currently treated with a one-size-fits-all approach despite significant heterogeneity in patient outcomes and disease molecular constitution. A personalised approach would tailor therapy to unique patient or disease characteristics. RECENT FINDINGS Well established prognostic biomarkers such as cytogenetic risk and patient frailty status are being evaluated as potential predictive biomarkers. Specifically, treatment intensity can be augmented in high-risk patients or conversely attenuated in those at lower risk or lower ability to withstand treatment toxicities. Alternatively, targeted therapy can be rationally designed to exploit vulnerable pathways in myeloma cells as identified using predictive biomarkers. The t(11;14) translocation, found in approximately 15-20% of myeloma cases, is a leading biomarker for response to BCL-2 inhibitors such as venetoclax. SUMMARY Active research efforts exploring venetoclax combination therapies, as well as new generation BCL-2 inhibitors are underway. Following the development of venetoclax, numerous other cellular pathways are under investigation as candidate predictive biomarkers to rationally inform newer targeted therapies in myeloma.
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Affiliation(s)
- Adam Bryant
- Liverpool Hospital, University of New South Wales, Sydney
| | - Hang Quach
- St Vincent's Hospital, University of Melbourne, Melbourne, Australia
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11
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Griessbach A, Schönenberger CM, Taji Heravi A, Gloy V, Agarwal A, Hallenberger TJ, Schandelmaier S, Janiaud P, Amstutz A, Covino M, Mall D, Speich B, Briel M. Characteristics, Progression, and Output of Randomized Platform Trials: A Systematic Review. JAMA Netw Open 2024; 7:e243109. [PMID: 38506807 PMCID: PMC10955344 DOI: 10.1001/jamanetworkopen.2024.3109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/24/2024] [Indexed: 03/21/2024] Open
Abstract
Importance Platform trials have become increasingly common, and evidence is needed to determine how this trial design is actually applied in current research practice. Objective To determine the characteristics, progression, and output of randomized platform trials. Evidence Review In this systematic review of randomized platform trials, Medline, Embase, Scopus, trial registries, gray literature, and preprint servers were searched, and citation tracking was performed in July 2022. Investigators were contacted in February 2023 to confirm data accuracy and to provide updated information on the status of platform trial arms. Randomized platform trials were eligible if they explicitly planned to add or drop arms. Data were extracted in duplicate from protocols, publications, websites, and registry entries. For each platform trial, design features such as the use of a common control arm, use of nonconcurrent control data, statistical framework, adjustment for multiplicity, and use of additional adaptive design features were collected. Progression and output of each platform trial were determined by the recruitment status of individual arms, the number of arms added or dropped, and the availability of results for each intervention arm. Findings The search identified 127 randomized platform trials with a total of 823 arms; most trials were conducted in the field of oncology (57 [44.9%]) and COVID-19 (45 [35.4%]). After a more than twofold increase in the initiation of new platform trials at the beginning of the COVID-19 pandemic, the number of platform trials has since declined. Platform trial features were often not reported (not reported: nonconcurrent control, 61 of 127 [48.0%]; multiplicity adjustment for arms, 98 of 127 [77.2%]; statistical framework, 37 of 127 [29.1%]). Adaptive design features were only used by half the studies (63 of 127 [49.6%]). Results were available for 65.2% of closed arms (230 of 353). Premature closure of platform trial arms due to recruitment problems was infrequent (5 of 353 [1.4%]). Conclusions and Relevance This systematic review found that platform trials were initiated most frequently during the COVID-19 pandemic and declined thereafter. The reporting of platform features and the availability of results were insufficient. Premature arm closure for poor recruitment was rare.
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Affiliation(s)
- Alexandra Griessbach
- CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christof Manuel Schönenberger
- CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ala Taji Heravi
- CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Viktoria Gloy
- CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Arnav Agarwal
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Stefan Schandelmaier
- CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Perrine Janiaud
- Pragmatic Evidence Lab, Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Alain Amstutz
- CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Manuela Covino
- CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - David Mall
- CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Benjamin Speich
- CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Matthias Briel
- CLEAR Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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The Rise of Adaptive Platform Trials in Critical Care. Am J Respir Crit Care Med 2024; 209:491-496. [PMID: 38271622 PMCID: PMC10919116 DOI: 10.1164/rccm.202401-0101cp] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/25/2024] [Indexed: 01/27/2024] Open
Abstract
As durable learning research systems, adaptive platform trials represent a transformative new approach to accelerating clinical evaluation and discovery in critical care. This Perspective provides a brief introduction to the concept of adaptive platform trials, describes several established and emerging platforms in critical care, and surveys some opportunities and challenges for their implementation and impact.
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