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Modi ND, Kichenadasse G, Hoffmann TC, Haseloff M, Logan JM, Veroniki AA, Venchiarutti RL, Smit AK, Tuffaha H, Jayasekara H, Manning-Bennet A, Morton E, McKinnon RA, Rowland A, Sorich MJ, Hopkins AM. A 10-year update to the principles for clinical trial data sharing by pharmaceutical companies: perspectives based on a decade of literature and policies. BMC Med 2023; 21:400. [PMID: 37872545 PMCID: PMC10594907 DOI: 10.1186/s12916-023-03113-0] [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: 05/09/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023] Open
Abstract
Data sharing is essential for promoting scientific discoveries and informed decision-making in clinical practice. In 2013, PhRMA/EFPIA recognised the importance of data sharing and supported initiatives to enhance clinical trial data transparency and promote scientific advancements. However, despite these commitments, recent investigations indicate significant scope for improvements in data sharing by the pharmaceutical industry. Drawing on a decade of literature and policy developments, this article presents perspectives from a multidisciplinary team of researchers, clinicians, and consumers. The focus is on policy and process updates to the PhRMA/EFPIA 2013 data sharing commitments, aiming to enhance the sharing and accessibility of participant-level data, clinical study reports, protocols, statistical analysis plans, lay summaries, and result publications from pharmaceutical industry-sponsored trials. The proposed updates provide clear recommendations regarding which data should be shared, when it should be shared, and under what conditions. The suggested improvements aim to develop a data sharing ecosystem that supports science and patient-centred care. Good data sharing principles require resources, time, and commitment. Notwithstanding these challenges, enhancing data sharing is necessary for efficient resource utilization, increased scientific collaboration, and better decision-making for patients and healthcare professionals.
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Affiliation(s)
- Natansh D Modi
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Ganessan Kichenadasse
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Flinders Centre for Innovation in Cancer, Department of Medical Oncology, Flinders Medical Centre, Adelaide, SA, Australia
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | | | - Jessica M Logan
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Areti A Veroniki
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Rebecca L Venchiarutti
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Amelia K Smit
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Haitham Tuffaha
- Centre for the Business and Economics of Health, The University of Queensland, Brisbane, QLD, Australia
| | - Harindra Jayasekara
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | | | - Erin Morton
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Ross A McKinnon
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Andrew Rowland
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Michael J Sorich
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Ashley M Hopkins
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
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Wu Y, Sun Y, Liu Y, Levis B, Krishnan A, He C, Neupane D, Patten SB, Cuijpers P, Ziegelstein RC, Benedetti A, Thombs BD. Depression screening tool accuracy individual participant data meta-analyses: data contribution was associated with multiple factors. J Clin Epidemiol 2023; 162:63-71. [PMID: 37619800 DOI: 10.1016/j.jclinepi.2023.08.006] [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: 05/16/2023] [Revised: 08/12/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVES To examine the proportion of eligible primary studies that contributed data, study characteristics associated with data contribution, and reasons for noncontribution using diagnostic test accuracy Individual Participant Data Meta-Analysis (IPDMA) data sets from the DEPRESsion Screening Data project. STUDY DESIGN AND SETTING We reviewed data set contributions from four IPDMAs. A multivariable logistic regression model was fitted to evaluate study factors associated with data contribution. RESULTS Of 456 eligible studies from four included IPDMAs, 295 (65%) contributed data. More recent year of publication and higher journal impact factor were associated with greater odds of data contribution. Studies conducted in Europe (excluding the United Kingdom), Oceania, Canada, the Middle East, Africa, and Central or South America (reference = the United States), that have recruitment from inpatient care or nonmedical settings (reference = outpatient), that reported screening accuracy results, or that drew negative conclusions (reference = positive conclusions) were more likely to contribute data. Studies of the Geriatric Depression Scale (reference = the Patient Health Questionnaire) or lacking funding information were negatively associated with data contribution. Over 80% of noncontributions were due to authors being unreachable or data being unavailable. CONCLUSION The study identified factors associated with data contribution that may support future research to promote data contribution to IPDMAs.
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Affiliation(s)
- Yin Wu
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ying Sun
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Yi Liu
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Brooke Levis
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, UK
| | - Ankur Krishnan
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Chen He
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Dipika Neupane
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Roy C Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Department of Psychology, McGill University, Montreal, Quebec, Canada; Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada; Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada.
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Modi ND, Abuhelwa AY, McKinnon RA, Boddy AV, Haseloff M, Wiese MD, Hoffmann TC, Perakslis ED, Rowland A, Sorich MJ, Hopkins AM. Audit of Data Sharing by Pharmaceutical Companies for Anticancer Medicines Approved by the US Food and Drug Administration. JAMA Oncol 2022; 8:1310-1316. [PMID: 35900732 PMCID: PMC9335250 DOI: 10.1001/jamaoncol.2022.2867] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Question What proportion of clinical trials that underpin registration of contemporary anticancer medicines are eligible for individual participant data (IPD) sharing with qualified researchers? Findings In this quality improvement study of the 304 trials that underpinned the US Food and Drug Administration (FDA) registration of 115 anticancer medicines over the past 10 years, 136 (45%) were eligible for IPD sharing. Meaning Although inroads have been made toward improving IPD transparency over the past 5 years, these findings suggest that a substantial portion of pivotal oncology trials that support the FDA registration of modern anticancer medicines remain unavailable to qualified researchers. Importance Emerging policies drafted by the pharmaceutical industry indicate that they will transparently share clinical trial data. These data offer an unparalleled opportunity to advance evidence-based medicine and support decision-making. Objective To evaluate the eligibility of independent, qualified researchers to access individual participant data (IPD) from oncology trials that supported US Food and Drug Administration (FDA) approval of new anticancer medicines within the past 10 years. Design, Setting, and Participants In this quality improvement study, a cross-sectional analysis was performed of pivotal clinical trials whose results supported FDA-approved anticancer medicines between January 1, 2011, and June 30, 2021. These trials’ results were identified from product labels. Exposures Eligibility for IPD sharing was confirmed by identification of a public listing of the trial as eligible for sharing or by receipt of a positive response from the sponsor to a standardized inquiry. Main Outcomes and Measures The main outcome was frequency of IPD sharing eligibility. Reasons for data sharing ineligibility were requested and collated, and company-, drug-, and trial-level subgroups were evaluated and presented using χ2 tests and forest plots. Results During the 10-year period examined, 115 anticancer medicines were approved by the FDA on the basis of evidence from 304 pharmaceutical industry–sponsored trials. Of these trials, 136 (45%) were eligible for IPD sharing and 168 (55%) were not. Data sharing rates differed substantially among industry sponsors, with the most common reason for not sharing trial IPD being that the collection of long-term follow-up data was still ongoing (89 of 168 trials [53%]). Of the top 10 anticancer medicines by global sales, nivolumab, pembrolizumab, and pomalidomide had the lowest eligibility rates for data sharing (<10% of trials). Conclusions and Relevance There has been a substantial increase in IPD sharing for industry-sponsored oncology trials over the past 5 years. However, this quality improvement study found that more than 50% of queried trials for FDA-approved anticancer medicines were ineligible for IPD sharing. Data accessibility would be substantially improved if, at the time of FDA registration of a medicine, all data that support the registration were made available.
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Affiliation(s)
- Natansh D Modi
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Ahmad Y Abuhelwa
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Ross A McKinnon
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Alan V Boddy
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Mark Haseloff
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Michael D Wiese
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Tammy C Hoffmann
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Eric D Perakslis
- Duke Forge, Duke University Medical Center, Durham, North Carolina
| | - Andrew Rowland
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Michael J Sorich
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Ashley M Hopkins
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Wieseler B, McGauran N. From publication bias to lost in information: why we need a central public portal for clinical trial data. BMJ Evid Based Med 2022; 27:74-76. [PMID: 33303480 PMCID: PMC8961768 DOI: 10.1136/bmjebm-2020-111566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 11/21/2022]
Affiliation(s)
- Beate Wieseler
- Institute for Quality and Efficiency in Health Care, Köln, Germany
| | - Natalie McGauran
- Institute for Quality and Efficiency in Health Care, Köln, Germany
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Abstract
The high prices of new anticancer drugs and the marginal added benefit perceived by some stakeholders have fuelled a debate on the value of anticancer drugs in the European Union, even though an agreed definition of what constitutes a drug's value does not exist. In this Perspective, we discuss the value of drugs from different viewpoints and objectives of decision makers: for regulators, assessment of the benefit-risk balance of a drug is a cornerstone for approval; payers rely on cost-effectiveness analyses carried out by health technology assessment agencies for reimbursement decisions; for patients, treatment choices are based on personal preferences and attitudes to risk; and clinicians can use several scales (such as the ESMO Magnitude of Clinical Benefit Scale (ESMO-MCBS)) that have been developed as an attempt to measure value objectively. Although a unique definition that fully captures the concept of value is unlikely to emerge, herein we discuss the importance of understanding different perspectives, and how regulators can help to inform different decision makers.
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Young MJ, Bodien YG, Edlow BL. Ethical Considerations in Clinical Trials for Disorders of Consciousness. Brain Sci 2022; 12:211. [PMID: 35203974 PMCID: PMC8870384 DOI: 10.3390/brainsci12020211] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 11/30/2022] Open
Abstract
As the clinical trial landscape for patients with disorders of consciousness (DoC) expands, consideration of associated ethical challenges and opportunities is of ever-increasing importance. Responsible conduct of research in the vulnerable population of persons with DoC, including those with coma, vegetative state/unresponsive wakefulness syndrome (VS/UWS), minimally conscious state (MCS), covert cortical processing (CCP), and cognitive motor dissociation (CMD), demands proactive deliberation of unique ethical issues that may arise and the adoption of robust protections to safeguard patients, surrogates, and other key stakeholders. Here we identify and critically evaluate four central categories of ethical considerations in clinical trials involving participants with DoC: (1) autonomy, respect for persons and informed consent of individuals with liminal consciousness; (2) balancing unknown benefits and risks, especially considering the epistemological gap between behavior and consciousness that complicates ordinary ascription of subjective states; (3) disclosure to surrogates and clinical teams of investigational results pertaining to consciousness; and (4) justice considerations, including equitable access to clinical trial enrollment across communities and geographies. We outline guiding principles and research opportunities for clinicians, neuroethicists, and researchers engaged in DoC clinical trials to advance ethical study design and deployment in this complex yet crucial area of investigation.
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Affiliation(s)
- Michael J. Young
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA; (Y.G.B.); (B.L.E.)
| | - Yelena G. Bodien
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA; (Y.G.B.); (B.L.E.)
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA 02114, USA
| | - Brian L. Edlow
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA; (Y.G.B.); (B.L.E.)
- Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA 02114, USA
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Osipenko L. Audit of data redaction practices in NICE technology appraisals from 1999 to 2019. BMJ Open 2021; 11:e051812. [PMID: 34615680 PMCID: PMC8496400 DOI: 10.1136/bmjopen-2021-051812] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 09/17/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To assess the extent and type of data redaction in all active technology appraisals (TA) and highly specialised technology (HST) evaluations issued by the National Institute for Health and Care Excellence (NICE) from its conception of the institute to September 2019. To propose policy recommendations for transparency. METHODS Structured audit to establish extent of data redaction-proportion of appraisals and specific data categories and assess redaction by: indication, appraisal process, manufacturer, type of data-price, adverse events (AEs), clinical (excluding AEs), incremental quality-adjusted life-years. Longitudinal analysis over 20 years. RESULTS All TAs with available documentation and active recommendations (n=408) and HSTs (n=10) published from March 2000 to 11 September 2019 have been assessed for data redaction. Overall, 333 TAs (81.6%) have data redaction, 86 (25.8%) of them are heavily redacted. Clinical data (excluding AEs) are redacted in 268 (65.7%) appraisals, AE data in 128 (31.4%), price in 238 (58.3%). In total, 87% of oncology appraisals have redacted data vs 78% of non-oncology appraisals. 91% of single TAs have redacted data vs 59% of multiple TAs. 25% of final guidance documents (e.g. Final Appraisal Determination - FAD) do not report one or more instance of clinical data. Data redaction increased substantially over time, and is currently at its highest level with 100% of TAs having at least some data redaction in 2019/2020, 96% of appraisals in 2018/2019% and 94% of appraisals in 2017/2018. All 10 HST evaluations have redacted data, with 4 of them being heavily redacted. CONCLUSIONS Documents supporting NICE TA and HST recommendations are significantly redacted, thereby concealing clinical and economic data of importance to patients, clinicians and researchers. Documents remain redacted on the NICE website for years. Policy change is required to ensure transparency of data underpinning NICE's decisions.
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Affiliation(s)
- Leeza Osipenko
- Health Policy, London School of Economics and Political Science, London, UK
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Mayo-Wilson E, Chen X, Qureshi R, Dickinson S, Golzarri-Arroyo L, Hong H, Görg C, Li T. Restoring invisible and abandoned trials of gabapentin for neuropathic pain: a clinical and methodological investigation. BMJ Open 2021; 11:e047785. [PMID: 34193496 PMCID: PMC8246349 DOI: 10.1136/bmjopen-2020-047785] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Gabapentin (Neurontin) is prescribed widely for conditions for which it has not been approved by regulators, including certain neuropathic pain conditions. There is limited evidence that gabapentin is safe and effective for the treatment of neuropathic pain. Published trial reports, and systematic reviews based on published trial reports, mislead patients and providers because information about gabapentin's harms has been published only partly. We confirmed that trials conducted by the drug developer have been abandoned, and we plan to conduct a restoration with support from the Restoring Invisible and Abandoned Trials Support Centre (https://restoringtrials.org/). METHODS AND ANALYSIS In this study, we will analyse and report the harms that were observed in six trials of gabapentin, which have not been reported publicly (eg, in journal articles). We will use clinical study reports and individual participant data to identify and report the harms observed in each individual trial and to summarise the harms observed across all six trials. We will report all adverse events observed in the included trials by sharing deidentified data and summary tables on the Open Science Framework (https://osf.io/w8puv/). Additionally, we will produce a summary report that describes differences between the randomised groups in each trial and across trials for prespecified harms outcomes. ETHICS AND DISSEMINATION We will use secondary data. This study was determined to be exempt from Institutional Review Board (IRB) review (protocol #1910607198).
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Affiliation(s)
- Evan Mayo-Wilson
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - Xiwei Chen
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - Riaz Qureshi
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stephanie Dickinson
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - Lilian Golzarri-Arroyo
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - Hwanhee Hong
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Carsten Görg
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado, USA
| | - Tianjing Li
- Department of Ophthalmology, University of Colorado, Denver, Colorado, USA
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Plott CF, Sharfstein JM. Global Regulatory Agencies and Data Transparency. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2021; 49:486-488. [PMID: 34665106 DOI: 10.1017/jme.2021.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Egilman et al. review the current data sharing practices of three global regulatory agencies - Health Canada, the European Medicines Agency and the Food and Drug Agency. While there has been progress towards increasing transparency over the past decade, progress has been slow.
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Bonini S, Maltese G. COVID-19 Clinical trials: Quality matters more than quantity. Allergy 2020; 75:2542-2547. [PMID: 32434272 PMCID: PMC7276803 DOI: 10.1111/all.14409] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/14/2020] [Accepted: 05/14/2020] [Indexed: 12/20/2022]
Abstract
Despite the ferment aroused in the scientific community by the COVID-19 outbreak and the over 11,000 papers listed in PubMed, published evidence on safe and effective drugs has not progressed yet at the same speed of the pandemic. However, clinical research is rapidly progressing, as shown by the hundreds of registered clinical trials on candidate drugs for COVID-19. Unfortunately, information on protocols of individual studies differs from registry to registry. Furthermore, study designs, criteria for stratification of patients and choice of outcomes are quite heterogeneous. All this makes data sharing and secondary analysis difficult. At last, small single centre studies and the use of drugs on a compassionate basis should be replaced by highly powered, multi-centre, multi-arm clinical trials, in order to provide the required evidence of safety and efficacy of novel or repurposed candidate drugs. Hopefully, the efforts of clinical researchers in the fight against the SARS Cov-2 will result into the identification of effective treatments. To make this possible, clinical research should be oriented by guidelines for more harmonized high-quality studies and by a united commitment of the scientific community to share personal knowledge and data. Allergists and clinical immunologists should have a leading role in this unprecedent challenge.
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Affiliation(s)
- Sergio Bonini
- Institute of Translational Pharmacology Italian National Research Council Rome Italy
| | - Giuseppe Maltese
- Epsom and St Helier University Hospitals Surrey UK
- Metabolic Medicine Cardiovascular Division King’s College London London UK
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Desai B, Mattingly TJ, van den Broek RWM, Pham N, Frailer M, Yang J, Perfetto EM. Peer Review and Transparency in Evidence-Source Selection in Value and Health Technology Assessment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:689-696. [PMID: 32540225 DOI: 10.1016/j.jval.2020.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 01/02/2020] [Accepted: 01/20/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Value and health technology assessment (V/HTA) is often used in clinical, access, and reimbursement decisions. V/HTA data-source selection may not be transparent, which is a necessary element for stakeholder understanding and trust and for fostering accountability among decision makers. Peer review is considered one mechanism for judging data trustworthiness. Our objective was (1) to use publicly available documentation of V/HTA methods to identify requirements for inclusion of peer-reviewed evidence sources, (2) to compare and contrast US and non-US approaches, and (3) to assess evidence sources used in published V/HTA reports. METHODS Publicly available methods documentation from 11 V/HTA organizations in North America and Europe were manually searched and abstracted for descriptions of requirements and recommendations regarding search strategy and evidence-source selection. The bibliographies of a subset of V/HTA reports published in 2018 were manually abstracted for evidence-source types used in each. RESULTS Heterogeneity in evidence-source retrieval and selection was observed across all V/HTA organizations, with more pronounced differences between US and non-US organizations. Not all documentation of organizations' methods address the evidence-source selection processes (7 of 11), and few explicitly reference peer-reviewed sources (3 of 11). Documentation of the evidence-source selection strategy was inconsistent across reports (6 of 13), and the level of detail provided varied across organizations. Some information on evidence-source selection was often included in confidential documentation and was not publicly available. CONCLUSIONS Disparities exist among V/HTA organizations in requirements and guidance regarding evidence-source selection. Standardization of evidence-source selection strategies and documentation could help improve V/HTA transparency and has implications for decision making based on report findings.
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Affiliation(s)
- Bansri Desai
- University of Maryland, School of Pharmacy, Baltimore, MD, USA.
| | | | | | - Ngan Pham
- University of Maryland, School of Pharmacy, Baltimore, MD, USA
| | - Megan Frailer
- University of Maryland, School of Pharmacy, Baltimore, MD, USA
| | - Joseph Yang
- University of Maryland, School of Pharmacy, Baltimore, MD, USA
| | - Eleanor M Perfetto
- University of Maryland, School of Pharmacy, Baltimore, MD, USA; National Health Council, Washington, DC, USA
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Cro S, Forbes G, Johnson NA, Kahan BC. Evidence of unexplained discrepancies between planned and conducted statistical analyses: a review of randomised trials. BMC Med 2020; 18:137. [PMID: 32466758 PMCID: PMC7257229 DOI: 10.1186/s12916-020-01590-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/09/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Choosing or altering the planned statistical analysis approach after examination of trial data (often referred to as 'p-hacking') can bias the results of randomised trials. However, the extent of this issue in practice is currently unclear. We conducted a review of published randomised trials to evaluate how often a pre-specified analysis approach is publicly available, and how often the planned analysis is changed. METHODS A review of randomised trials published between January and April 2018 in six leading general medical journals. For each trial, we established whether a pre-specified analysis approach was publicly available in a protocol or statistical analysis plan and compared this to the trial publication. RESULTS Overall, 89 of 101 eligible trials (88%) had a publicly available pre-specified analysis approach. Only 22/89 trials (25%) had no unexplained discrepancies between the pre-specified and conducted analysis. Fifty-four trials (61%) had one or more unexplained discrepancies, and in 13 trials (15%), it was impossible to ascertain whether any unexplained discrepancies occurred due to incomplete reporting of the statistical methods. Unexplained discrepancies were most common for the analysis model (n = 31, 35%) and analysis population (n = 28, 31%), followed by the use of covariates (n = 23, 26%) and the approach for handling missing data (n = 16, 18%). Many protocols or statistical analysis plans were dated after the trial had begun, so earlier discrepancies may have been missed. CONCLUSIONS Unexplained discrepancies in the statistical methods of randomised trials are common. Increased transparency is required for proper evaluation of results.
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Affiliation(s)
- Suzie Cro
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, 1st Floor, Stadium House, London, W12 7RH, UK.
| | - Gordon Forbes
- Department of Biostatistics and Health Informatics, Kings College London, London, UK
| | - Nicholas A Johnson
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, 1st Floor, Stadium House, London, W12 7RH, UK
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Ventresca M, Schünemann HJ, Macbeth F, Clarke M, Thabane L, Griffiths G, Noble S, Garcia D, Marcucci M, Iorio A, Zhou Q, Crowther M, Akl EA, Lyman GH, Gloy V, DiNisio M, Briel M. Obtaining and managing data sets for individual participant data meta-analysis: scoping review and practical guide. BMC Med Res Methodol 2020; 20:113. [PMID: 32398016 PMCID: PMC7218569 DOI: 10.1186/s12874-020-00964-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 03/30/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Shifts in data sharing policy have increased researchers' access to individual participant data (IPD) from clinical studies. Simultaneously the number of IPD meta-analyses (IPDMAs) is increasing. However, rates of data retrieval have not improved. Our goal was to describe the challenges of retrieving IPD for an IPDMA and provide practical guidance on obtaining and managing datasets based on a review of the literature and practical examples and observations. METHODS We systematically searched MEDLINE, Embase, and the Cochrane Library, until January 2019, to identify publications focused on strategies to obtain IPD. In addition, we searched pharmaceutical websites and contacted industry organizations for supplemental information pertaining to recent advances in industry policy and practice. Finally, we documented setbacks and solutions encountered while completing a comprehensive IPDMA and drew on previous experiences related to seeking and using IPD. RESULTS Our scoping review identified 16 articles directly relevant for the conduct of IPDMAs. We present short descriptions of these articles alongside overviews of IPD sharing policies and procedures of pharmaceutical companies which display certification of Principles for Responsible Clinical Trial Data Sharing via Pharmaceutical Research and Manufacturers of America or European Federation of Pharmaceutical Industries and Associations websites. Advances in data sharing policy and practice affected the way in which data is requested, obtained, stored and analyzed. For our IPDMA it took 6.5 years to collect and analyze relevant IPD and navigate additional administrative barriers. Delays in obtaining data were largely due to challenges in communication with study sponsors, frequent changes in data sharing policies of study sponsors, and the requirement for a diverse skillset related to research, administrative, statistical and legal issues. CONCLUSIONS Knowledge of current data sharing practices and platforms as well as anticipation of necessary tasks and potential obstacles may reduce time and resources required for obtaining and managing data for an IPDMA. Sufficient project funding and timeline flexibility are pre-requisites for successful collection and analysis of IPD. IPDMA researchers must acknowledge the additional and unexpected responsibility they are placing on corresponding study authors or data sharing administrators and should offer assistance in readying data for sharing.
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Affiliation(s)
- Matthew Ventresca
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Fergus Macbeth
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - Mike Clarke
- Northern Ireland Hub for Trials Methodology Research and Cochrane Individual Participant Data Meta-analysis Methods Group, Queen’s University Belfast, Belfast, UK
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Gareth Griffiths
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Wales, UK; Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, Wales, UK
| | - David Garcia
- Department of Medicine, University of Washington School of Medicine, Seattle, WA USA
| | - Maura Marcucci
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
- Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Alfonso Iorio
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
- Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Qi Zhou
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario Canada
| | - Elie A. Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Gary H. Lyman
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington USA
| | - Viktoria Gloy
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Marcello DiNisio
- Department of Medicine and Ageing Sciences, University G. D’Annunzio, Chieti-Pescara, Italy
| | - Matthias Briel
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario Canada
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
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Azar M, Benedetti A, Riehm KE, Imran M, Krishnan A, Chiovitti M, Sanchez T, Shrier I, Thombs BD. Individual participant data meta-analyses (IPDMA): data contribution was associated with trial corresponding author country, publication year, and journal impact factor. J Clin Epidemiol 2020; 124:16-23. [PMID: 32298776 DOI: 10.1016/j.jclinepi.2020.03.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 03/01/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The objectives were to determine the proportion of eligible randomized controlled trials (RCTs) that contributed data to individual participant data meta-analyses (IPDMAs) and explore associated factors. STUDY DESIGN AND SETTING IPDMAs with ≥10 eligible RCTs were identified by searching MEDLINE, EMBASE, CINAHL, and Cochrane May 1, 2015 to February 13, 2017. Mixed-effect logistic regression was used to identify factors associated with data contribution. RESULTS Of 774 eligible RCTs from 35 included IPDMAs, 517 (67%, 95% confidence interval [CI]: 63%-70%) contributed data. Compared to RCTs from journals with low-impact factors (0-2.4), RCTs from journals with higher impact factors were more likely to contribute data: impact factor 5.0-9.9, odds ratio [OR] 2.6, 95% CI: 1.37-4.86; impact factor: 10.0-19.9, OR: 5.7, 95% CI: 3.0-10.8; impact factor >20.0, OR: 4.6, 95% CI: 1.9-11.4. RCTs from the United Kingdom were more likely to contribute data than those from the United States (reference; OR: 2.4, 95% CI, 1.3-4.6). There was an increase in OR per publication year (OR: 1.05, 95% CI: 1.02-1.09). CONCLUSION The country where RCTs are conducted, impact factor of the journal where RCTs are published, and RCT publication year were associated with data contribution in IPDMAs with ≥10 eligible RCTs.
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Affiliation(s)
- Marleine Azar
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kira E Riehm
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Mahrukh Imran
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Ankur Krishnan
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Matthew Chiovitti
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Tatiana Sanchez
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Ian Shrier
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Department of Psychology, McGill University, Montreal, Quebec, Canada; Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada; Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada.
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Broes S, Verbaanderd C, Casteels M, Lacombe D, Huys I. Sharing of Clinical Trial Data and Samples: The Cancer Patient Perspective. Front Med (Lausanne) 2020; 7:33. [PMID: 32118017 PMCID: PMC7026937 DOI: 10.3389/fmed.2020.00033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 01/22/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction: Today, many initiatives and papers are devoted to clinical trial data (and to a lesser extent sample) sharing. Journal editors, pharmaceutical companies, funding agencies, governmental organizations, regulators, and clinical investigators have been debating the legal, ethical, and social implications of clinical data and sample sharing for several years. However, only little research has been conducted to unveil the patient perspective. Aim: To substantiate the current debate, we aimed to explore the attitudes of patients toward the re-use of clinical trial samples and data and to determine how they would prefer to be involved in this process. Materials and Methods: Sixteen in-depth interviews were conducted with cancer patients currently participating in a clinical trial. Results: This study indicates a general willingness of cancer patients participating in a clinical trial to allow re-use of their clinical trial data and/or samples by the original research team, and a generally open approach to share data and/or samples with other research teams, but some would like to be informed in this case. Despite divergent opinions about how patients prefer to be engaged, ranging from passive donors up to those explicitly wanting more control, participants expressed positive opinions toward technical solutions that allow indicating their preferences. Conclusion: Patients were open to sharing and re-use of data and samples to advance medical research but opinions varied on the level of patient involvement and the need for re-consent. A stratified approach for consent that allows individualization of data and sample sharing preferences may be useful, yet the implementation of such an approach warrants further research.
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Affiliation(s)
- Stefanie Broes
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Ciska Verbaanderd
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
- Anticancer Fund, Strombeek-Bever, Belgium
| | - Minne Casteels
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Denis Lacombe
- European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Isabelle Huys
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
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Ferran JM, Nevitt SJ. European Medicines Agency Policy 0070: an exploratory review of data utility in clinical study reports for academic research. BMC Med Res Methodol 2019; 19:204. [PMID: 31690260 PMCID: PMC6833240 DOI: 10.1186/s12874-019-0836-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 09/16/2019] [Indexed: 11/18/2022] Open
Abstract
Background Clinical study reports (CSRs) have been increasingly utilised within academic research in recent years. European Medicines Agency (EMA) Policy 0070 ‘Phase 1,’ which came into effect in January 2015, requires the publication of regulatory documents such as CSRs from central applications in an anonymised format. EMA Policy 0070 requires sponsors to demonstrate careful consideration of data utility within anonymised CSRs published within the scope of the policy, yet the concept of data utility is not clearly defined in the associated anonymisation guidance. Objective To review the use of data from CSRs in published academic research and to hypothesise the potential data utility of CSRs anonymised under the objectives of EMA Policy 0070 for future academic research. Methods Review of the objectives, research methodologies and findings of academic research reports using unpublished data from CSRs (prior to EMA Policy 0070). Semi-structured interviews with authors of academic research reports, including questions related to data utility of anonymised CSRs published under EMA Policy 0070. Results Thirteen academic research reports were identified and reviewed. The research purposes ranged from assessment of reporting bias, comparison of methods and results with published data sources, detailed evaluation of harms and adverse events, re-analysis and novel analyses including systematic reviews and meta-analysis. All of the examples identified required access to the methods and results sections of CSRs (including aggregated summary tables) and research purposes relating to evaluation of adverse events also required access to participant narratives. Retaining anonymised participant narratives relating to interventions, findings and events, while maintaining an acceptably low risk of participant re-identification, may provide an important gain in data utility and further understanding of drug safety profiles. Conclusions This work provides an initial insight into the previous use of CSR data and current practices for including regulatory data in academic research. This work also provides early guidance to qualitatively assess and document data utility within anonymised CSRs published under EMA Policy 0070.
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Affiliation(s)
| | - Sarah J Nevitt
- Department of Biostatistics, University of Liverpool, Block F, Waterhouse Building, 1-5 Brownlow Street, Liverpool, L69 3GL, UK.
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18
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Agache I, Annesi‐Maesano I, Bonertz A, Branca F, Cant A, Fras Z, Ingenrieth F, Namazova‐Baranova L, Odemyr M, Spanevello A, Vieths S, Yorgancioglu A, Alvaro‐Lozano M, Barber Hernandez D, Chivato T, Del Giacco S, Diamant Z, Eguiluz‐Gracia I, Wijk RG, Gevaert P, Graessel A, Hellings P, Hoffmann‐Sommergruber K, Jutel M, Lau S, Lauerma A, Maria Olaguibel J, O'Mahony L, Ozdemir C, Palomares O, Pfaar O, Sastre J, Scadding G, Schmidt‐Weber C, Schmid‐Grendelmeier P, Shamji M, Skypala I, Spinola M, Spranger O, Torres M, Vereda A, Bonini S. Prioritizing research challenges and funding for allergy and asthma and the need for translational research-The European Strategic Forum on Allergic Diseases. Allergy 2019; 74:2064-2076. [PMID: 31070805 DOI: 10.1111/all.13856] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/02/2019] [Accepted: 05/05/2019] [Indexed: 02/07/2023]
Abstract
The European Academy of Allergy and Clinical Immunology (EAACI) organized the first European Strategic Forum on Allergic Diseases and Asthma. The main aim was to bring together all relevant stakeholders and decision-makers in the field of allergy, asthma and clinical Immunology around an open debate on contemporary challenges and potential solutions for the next decade. The Strategic Forum was an upscaling of the EAACI White Paper aiming to integrate the Academy's output with the perspective offered by EAACI's partners. This collaboration is fundamental for adapting and integrating allergy and asthma care into the context of real-world problems. The Strategic Forum on Allergic Diseases brought together all partners who have the drive and the influence to make positive change: national and international societies, patients' organizations, regulatory bodies and industry representatives. An open debate with a special focus on drug development and biomedical engineering, big data and information technology and allergic diseases and asthma in the context of environmental health concluded that connecting science with the transformation of care and a joint agreement between all partners on priorities and needs are essential to ensure a better management of allergic diseases and asthma in the advent of precision medicine together with global access to innovative and affordable diagnostics and therapeutics.
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Affiliation(s)
| | - Isabella Annesi‐Maesano
- Department of Epidemiology of Allergic and Respiratory Diseases Medical School Saint Antoine, IPLESP, INSERM and Sorbonne Université Paris France
| | - Andreas Bonertz
- Federal Agency for Vaccines and Biomedicines Paul‐Ehrlich‐Institut Langen Germany
| | - Francesco Branca
- Department of Nutrition for Health and Development Geneva Switzerland
- WHO/HQ Geneva Switzerland
| | - Andrew Cant
- University of Newcastle Upon Tyne Newcastle upon Tyne UK
- European Society for Immunodeficiencies Geneva Switzerland
| | - Zlatko Fras
- Division of Medicine University Medical Centre Ljubljana Ljubljana Slovenia
- Medical Faculty University of Ljubljana Ljubljana Slovenia
- UEMS ‐ Union Europeenne des Medecins Specialistes/European Union of Medical Specialists Brussels Belgium
| | | | - Leyla Namazova‐Baranova
- Department of Pediatrics Russian National Research Medical University of MoH RF Moscow Russia
- Department of Pediatrics Central Clinical Hospital of MoSHE (Ministry of Science and High Education) Moscow Russian Federation
| | - Mikaela Odemyr
- European Federation of Allergy and Airways Diseases Patients’ Associations (EFA) Brussels Belgium
| | - Antonio Spanevello
- Dipartimento di Medicina e Chirurgia, Malattie dell'Apparato Respiratorio Università degli Studi dell'Insubria Varese – Como Italy
- Dipartimento di Medicina e Riabilitazione Cardio Respiratoria, U.O. di Pneumologia Riabilitativa Istituti Clinici Scientifici Maugeri, IRCCS Tradate Tradate Italy
| | - Stefan Vieths
- Federal Agency for Vaccines and Biomedicines Paul‐Ehrlich‐Institut Langen Germany
| | - Arzu Yorgancioglu
- Department of Pulmonology Celal Bayar University School of Medicine Manisa Turkey
| | - Montserat Alvaro‐Lozano
- Pediatric Allergy and Clinical Immunology Department Hospital Sant Joan de Déu Barcelona Barcelona Spain
| | - Domingo Barber Hernandez
- Department of Basic Medical Sciences, School of Medicine Universidad CEU San Pablo Madrid Spain
- RETIC ARADYAL RD16/0006/0015, Instituto de Salud Carlos III Madrid Spain
| | - Tomás Chivato
- School of Medicine University CEU San Pablo Madrid Spain
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health University of Cagliari Cagliari Italy
| | - Zuzana Diamant
- Department of Respiratory Medicine & Allergology, Institute for Clinical Science, Skane University Hospital Lund University Lund Sweden
- Department of Respiratory Medicine, First Faculty of Medicine Charles University and Thomayer Hospital Prague Czech Republic
| | - Ibon Eguiluz‐Gracia
- Allergy Unit IBIMA, Regional University Hospital of Malaga, UMA Malaga Spain
- ARADyAL Network RD16/0006/0001, Carlos III Health Institute Madrid Spain
| | - Roy Gert Wijk
- Section of Allergology, Department of Internal Medicine Erasmus Medical Center Rotterdam the Netherlands
| | - Philippe Gevaert
- Department of Otorhinolaryngology‐Head and Neck Surgery, Upper Airways Research Laboratory Ghent University Ghent Belgium
| | - Anke Graessel
- Allergy Therapeutics Worthing UK
- Bencard Allergie GmbH Munich Germany
| | - Peter Hellings
- Department of Otorhinolaryngology‐Head and Neck Surgery, Upper Airways Research Laboratory Ghent University Ghent Belgium
- Department of Otorhinolaryngology‐Head and Neck Surgery UZ Leuven Leuven Belgium
- Department of Otorhinolaryngology Academic Medical Center Amsterdam The Netherlands
| | | | - Marek Jutel
- Department of Clinical Immunology Wroclaw Medical University Wroclaw Poland
- “ALL‐MED” Medical Research Institute Wroclaw Poland
| | - Susanne Lau
- Department for Pediatric Pneumology, Immunology and Intensive Care Charité Universität Medizin Berlin Germany
| | - Antti Lauerma
- Dermatology and Allergology Helsinki University Hospital and University of Helsinki Helsinki Finland
| | | | - Liam O'Mahony
- Departments of Medicine and Microbiology APC Microbiome Ireland, National University of Ireland Cork Ireland
| | - Cevdet Ozdemir
- Department of Pediatric Basic Sciences, Institute of Child Health Istanbul University Istanbul Turkey
- Department of Pediatrics, Division of Pediatric Allergy & Immunology, Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
| | - Oscar Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry Complutense University of Madrid Madrid Spain
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Joaquin Sastre
- Department of Allergy Fundación Jimenez Diaz Madrid Spain
- Department of Medicine, Instituto Carlos III CIBERES, Universidad Autónoma de Madrid Madrid Spain
| | | | - Carsten Schmidt‐Weber
- Zentrums Allergie & Umwelt (ZAUM) Technische Universität und Helmholtz Zentrum München Germany
| | - Peter Schmid‐Grendelmeier
- Allergy Unit, Department of Dermatology University Hospital of Zurich Zurich Switzerland
- Christine‐Kühne Center for Allergy Research and Education CK‐CARE Davos Davos Switzerland
| | - Mohamed Shamji
- Allergy & Clinical Immunology, Inflammation, Repair and Development, Imperial College, National Heart and Lung Institute Immunomodulation and Tolerance Group London UK
- Asthma UK Centre in Allergic Mechanisms of Asthma London UK
| | - Isabel Skypala
- Royal Brompton & Harefield NHS Foundation Trust London UK
- Imperial College London UK
| | | | - Otto Spranger
- Global Allergy and Asthma Patient Platform Vienna Austria
| | - Maria Torres
- Allergy Unit IBIMA, Regional University Hospital of Malaga, UMA Malaga Spain
- ARADyAL Network RD16/0006/0001, Carlos III Health Institute Madrid Spain
| | | | - Sergio Bonini
- Institute of Translational Pharmacology Italian National Research Council Rome Italy
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Mayo-Wilson E, Fusco N, Hong H, Li T, Canner JK, Dickersin K. Opportunities for selective reporting of harms in randomized clinical trials: Selection criteria for non-systematic adverse events. Trials 2019; 20:553. [PMID: 31488200 PMCID: PMC6728982 DOI: 10.1186/s13063-019-3581-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 07/16/2019] [Indexed: 12/19/2022] Open
Abstract
Background Adverse events (AEs) in clinical trials may be reported in multiple sources. Different methods for reporting adverse events across trials or across sources for a single trial may produce inconsistent information about the adverse events associated with interventions. Methods We compared the methods authors use to decide which AEs to include in a particular source (i.e., “selection criteria”), including the number of different types of AEs reported (i.e., rather than the number of events). We compared sources (e.g., journal articles, clinical study reports (CSRs)) of trials for two drug-indications—gabapentin for neuropathic pain and quetiapine for bipolar depression. Electronic searches were completed in 2015. We identified selection criteria and assessed how criteria affected AE reporting. Results We identified 21 gabapentin and 7 quetiapine trials. We found 6 gabapentin CSRs and 2 quetiapine CSRs, all written by drug manufacturers. All CSRs reported all AEs without applying selection criteria; by comparison, no other source reported all AEs, and 15/68 (22%) gabapentin sources and 19/48 (40%) quetiapine sources reported using selection criteria. Selection criteria greatly affected the number of AEs reported. For example, 67/316 (21%) AEs in one quetiapine trial met the criterion “occurring in ≥2% of participants in any treatment group,” while only 5/316 (2%) AEs met the criterion “occurring in ≥10% of quetiapine-treated patients and twice as frequent in the quetiapine group as the placebo group.” Conclusions Selection criteria for reporting AEs vary across trials and across sources for individual trials. If investigators do not pre-specify selection criteria, they might “cherry-pick” AEs based on results. Even if investigators pre-specify selection criteria, selective reporting will produce biased meta-analyses and clinical practice guidelines. Data about all AEs identified in clinical trials should be publicly available; however, sharing data will not solve all the problems identified in this study. Electronic supplementary material The online version of this article (10.1186/s13063-019-3581-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Evan Mayo-Wilson
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, 1025 E 7th St, #179D, Bloomington, IN, 47405, USA.
| | - Nicole Fusco
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, 1025 E 7th St, #179D, Bloomington, IN, 47405, USA
| | - Hwanhee Hong
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Hampton House, Baltimore, MD, 21205, USA
| | - Tianjing Li
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, 1025 E 7th St, #179D, Bloomington, IN, 47405, USA
| | - Joseph K Canner
- Department of Surgery, Johns Hopkins School of Medicine, 600 North Wolfe Street, Blalock 1202, Baltimore, MD, 21287, USA
| | - Kay Dickersin
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, 1025 E 7th St, #179D, Bloomington, IN, 47405, USA
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Kuntz RE, Antman EM, Califf RM, Ingelfinger JR, Krumholz HM, Ommaya A, Peterson ED, Ross JS, Waldstreicher J, Wang SV, Zarin DA, Whicher DM, Siddiqi SM, Lopez MH. Individual Patient-Level Data Sharing for Continuous Learning: A Strategy for Trial Data Sharing. NAM Perspect 2019; 2019:201906b. [PMID: 34532668 DOI: 10.31478/201906b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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22
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Demotes-Mainard J, Cornu C, Guérin A, Bertoye PH, Boidin R, Bureau S, Chrétien JM, Delval C, Deplanque D, Dubray C, Duchossoy L, Edel V, Fouret C, Galaup A, Lesaulnier F, Matei M, Naudet F, Plattner V, Rubio M, Ruiz F, Sénéchal-Cohen S, Simon T, Vidal A, Viola A, Violleau M. Quel impact du nouveau règlement européen sur la protection des données sur la recherche clinique et recommandations. Therapie 2019; 74:17-29. [DOI: 10.1016/j.therap.2018.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/13/2018] [Indexed: 11/26/2022]
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23
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Demotes-Mainard J, Cornu C, Guérin A, Bertoye PH, Boidin R, Bureau S, Chrétien JM, Delval C, Deplanque D, Dubray C, Duchossoy L, Edel V, Fouret C, Galaup A, Lesaulnier F, Matei M, Naudet F, Plattner V, Rubio M, Ruiz F, Sénéchal-Cohen S, Simon T, Vidal A, Viola A, Violleau M. How the new European data protection regulation affects clinical research and recommendations? Therapie 2019; 74:31-42. [DOI: 10.1016/j.therap.2018.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 11/05/2018] [Indexed: 11/27/2022]
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Morgan MR, Roberts OG, Edwards AM. Ideation and implementation of an open science drug discovery business model - M4K Pharma. Wellcome Open Res 2018; 3:154. [PMID: 30705971 PMCID: PMC6346698 DOI: 10.12688/wellcomeopenres.14947.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2018] [Indexed: 12/04/2022] Open
Abstract
M4K Pharma was incorporated to launch an open science drug discovery program that relies on regulatory exclusivity as its primary intellectual property and commercial asset, in lieu of patents.In many cases and in key markets, using regulatory exclusivity can provide equivalent commercial protection to patents, while also being compatible with open science. The model is proving attractive to government, foundation and individual funders, who collectively have different expectations for returns on investment compared with biotech, pharmaceutical companies, or venture capital investors.In the absence of these investor-driven requirements for returns, it should be possible to commercialize therapeutics at affordable prices.M4K is piloting this open science business model in a rare paediatric brain tumour, but there is no reason it should not be more widely applicable.
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Affiliation(s)
- Maxwell Robert Morgan
- University of Toronto, Toronto, ON, M5G 1L7, Canada.,M4K Pharma, Toronto, ON, M5G 1L7, Canada.,Structural Genomics Consortium, London, UK
| | | | - Aled Morgan Edwards
- University of Toronto, Toronto, ON, M5G 1L7, Canada.,M4K Pharma, Toronto, ON, M5G 1L7, Canada.,Structural Genomics Consortium, London, UK
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Data sharing from pharmaceutical industry sponsored clinical studies: audit of data availability. BMC Med 2018; 16:165. [PMID: 30261889 PMCID: PMC6161442 DOI: 10.1186/s12916-018-1154-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 08/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical trial transparency is important to participants, trialists, publishers, and regulators, and there have been recent major policy changes by the pharmaceutical industry regarding clinical study data sharing. However, it is unknown if these changes are enabling independent researchers to access participant-level data from prominent contemporary clinical trials sponsored by the pharmaceutical industry 2 years after publication of the primary results. MAIN TEXT PubMed and ClinicalTrials.gov were searched to identify clinical trials of medicines sponsored by the pharmaceutical industry and first published between 1 July 2015 and 31 December 2015 in the top 10 general and internal medical journals by impact factor. For each clinical trial, the eligibility of independent researchers to request participant-level data was identified via the sponsor having a data sharing policy/process and a positive response to an enquiry. Fifty-six publications reporting on 61 industry-sponsored clinical trials were identified, of which 32 (52%) had a public data sharing policy/process and 9 (15%) were confirmed eligible for data sharing. Industry sponsors within the top 25 by global sales were more likely to have a data sharing policy (93% vs 10%), and there was a trend towards increased data sharing eligibility (23% vs 4%). Twenty-six studies were explicitly confirmed as ineligible for data sharing. The two most common data sharing policy conditions that prevented sharing of data for published results were the exclusion of studies that had ongoing follow-up of the published results and the exclusion of studies of medicines that have not yet achieved regulatory approval in the USA and the European Union. CONCLUSIONS Fifteen percent of the sampled clinical trials were available for data sharing 2 years after publication of primary results of the trial. Key issues limiting data sharing include a large proportion of industry sponsors who do not have a data sharing policy/process, and data sharing policy conditions that exclude access on the basis of ongoing follow-up and regulatory activity.
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Dickersin K, Mayo-Wilson E. Standards for design and measurement would make clinical research reproducible and usable. Proc Natl Acad Sci U S A 2018; 115:2590-2594. [PMID: 29531086 PMCID: PMC5856499 DOI: 10.1073/pnas.1708273114] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We find standards useful in everyday life and in science, although we do not always follow them. Adopting new standards can be expensive, so there may be a strong incentive to maintain the status quo rather than adopt new standards. The scientific community has many standards encompassing both doing clinical research and reporting it, including standards for design and measurement. Although existing research standards have improved both research and its reporting, we need to unify existing standards and to fill the gaps between steps throughout the research process. Existing gaps include implementation of standards and links between standards for study registration (to know about all studies undertaken), study protocols (to identify the preplanned study design and methods), data collection (to assess outcomes that are important and comparable across studies), dissemination of findings (to know the results of previous studies), data sharing (to make best use of existing data), and evidence synthesis (to draw appropriate conclusions from the body of evidence). The scientific community must work together to harmonize existing standards, to ensure that standards are kept up to date, to check that standards are followed, and to develop standards where they are still needed. A unified system of standards will make our work more reproducible.
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Affiliation(s)
- Kay Dickersin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205
| | - Evan Mayo-Wilson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205
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Meta-analysis of randomized clinical trials in the era of individual patient data sharing. Int J Clin Oncol 2018; 23:403-409. [PMID: 29330642 PMCID: PMC5951901 DOI: 10.1007/s10147-018-1237-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 01/01/2018] [Indexed: 12/31/2022]
Abstract
Background Individual patient data (IPD) meta-analysis is considered to be a gold standard when the results of several randomized trials are combined. Recent initiatives on sharing IPD from clinical trials offer unprecedented opportunities for using such data in IPD meta-analyses. Methods First, we discuss the evidence generated and the benefits obtained by a long-established prospective IPD meta-analysis in early breast cancer. Next, we discuss a data-sharing system that has been adopted by several pharmaceutical sponsors. We review a number of retrospective IPD meta-analyses that have already been proposed using this data-sharing system. Finally, we discuss the role of data sharing in IPD meta-analysis in the future. Results Treatment effects can be more reliably estimated in both types of IPD meta-analyses than with summary statistics extracted from published papers. Specifically, with rich covariate information available on each patient, prognostic and predictive factors can be identified or confirmed. Also, when several endpoints are available, surrogate endpoints can be assessed statistically. Conclusions Although there are difficulties in conducting, analyzing, and interpreting retrospective IPD meta-analysis utilizing the currently available data-sharing systems, data sharing will play an important role in IPD meta-analysis in the future.
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Rohner E, Grabik M, Tonia T, Jüni P, Pétavy F, Pignatti F, Bohlius J. Does access to clinical study reports from the European Medicines Agency reduce reporting biases? A systematic review and meta-analysis of randomized controlled trials on the effect of erythropoiesis-stimulating agents in cancer patients. PLoS One 2017; 12:e0189309. [PMID: 29228059 PMCID: PMC5724886 DOI: 10.1371/journal.pone.0189309] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/22/2017] [Indexed: 12/05/2022] Open
Abstract
Since 2010, the European Medicines Agency (EMA) has provided access to clinical study reports (CSRs). We requested CSRs for randomized controlled trials (RCTs) of erythropoiesis-stimulating agents (ESAs) in cancer patients from EMA and identified RCT publications with literature searches. We assessed CSR availability and completeness, the impact of unreported and unpublished data obtained from CSRs on the effects of ESAs on quality of life (QoL) of cancer patients, and discrepancies between data reported in the public domain and in CSRs. We used random-effects meta-analyses to evaluate the effect of ESAs on QoL measured with Functional Assessment of Cancer Therapy-Anemia (FACT-An), FACT-Fatigue (FACT-F) and FACT-Anemia Total (FACT-An Total) stratified by data source and the impact of discrepancies on QoL, mortality, adverse events, and clinical effectiveness outcomes. We identified 94 eligible RCTs; CSRs or other study documentation were available for 17 (18%) RCTs at EMA. Median report length was 1,825 pages (range 72-14,569). Of 180 outcomes of interest reported in the EMA documentation, 127 (71%) were publicly available. For 80 of those (63%) we noted discrepancies, but these had little impact on the pooled effect estimates. Of 27 QoL outcomes reported in the CSRs, 17 (63%) were unpublished. Including six unpublished comparisons (pooled mean difference [MD] 0.20; 95% confidence interval [CI] -1.93, 2.33) reduced the pooled effect of ESAs for FACT-An from MD 5.51 (95% CI 4.20, 6.82) in published data to MD 3.21 (95% CI 1.38, 5.03), which is below a clinically important difference (defined as MD ≥4). Effects were similar for FACT-F and FACT-An Total. Access to CSRs from EMA reduced reporting biases for QoL outcomes. However, EMA received documentation for a fraction of all RCTs on effects of ESAs in cancer patients. Additional efforts by other agencies and institutions are needed to make CSRs universally available for all RCTs.
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Affiliation(s)
- Eliane Rohner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Michael Grabik
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Peter Jüni
- University of Toronto, Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Frank Pétavy
- European Medicines Agency, London, United Kingdom
| | | | - Julia Bohlius
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Miller JE, Wilenzick M, Ritcey N, Ross JS, Mello MM. Measuring clinical trial transparency: an empirical analysis of newly approved drugs and large pharmaceutical companies. BMJ Open 2017; 7:e017917. [PMID: 29208616 PMCID: PMC5728266 DOI: 10.1136/bmjopen-2017-017917] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES To define a series of clinical trial transparency measures and apply them to large pharmaceutical and biotechnology companies and their 2014 FDA-approved drugs. DESIGN Cross-sectional descriptive analysis of all clinical trials supporting 2014 Food and Drugs Administration (FDA)-approved new drug applications (NDAs) for novel drugs sponsored by large companies. DATA SOURCES Data from over 45 sources, including Drugs@FDA.gov, ClinicalTrials.gov, corporate and international registries; PubMed, Google Scholar, EMBASE, corporate press releases, Securities and Exchange Commission (SEC) filings and personal communications with drug manufacturers. OUTCOME MEASURES Trial registration, results reporting, clinical study report (CSR) synopsis sharing, biomedical journal publication, and FDA Amendments Acts (FDAAA) compliance, analysed on the drug level. RESULTS The FDA approved 19 novel new drugs, sponsored by 11 large companies, involving 553 trials, in 2014. We analysed 505 relevant trials. Per drug, a median of 100% (IQR 86%-100%) of trials in patients were registered, 71% (IQR 57%-100%) reported results or shared a CSR synopsis, 80% (70%-100%) were published and 96% (80%-100%) were publicly available in some form by 13 months after FDA approval. Disclosure rates were lower at FDA approval (65%) and improved significantly by 6 months post FDA approval. Per drug, a median of 100% (IQR 75%-100%) of FDAAA-applicable trials were compliant. Half of reviewed drugs had publicly disclosed results for all trials in patients in our sample. One trial was uniquely registered in a corporate registry, and not ClinicalTrials.gov; 0 trials were uniquely registered in international registries. CONCLUSIONS Among large pharmaceutical companies and new drugs, clinical trial transparency is high based on several standards, although opportunities for improvement remain. Transparency is markedly higher for trials in patients than among all trials supporting drug approval, including trials in healthy volunteers. Ongoing efforts to publicly track companies' transparency records and recognise exemplary companies may encourage further progress.
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Affiliation(s)
- Jennifer E Miller
- Division of Medical Ethics, Department of Population Health, NYU School of Medicine, New York, USA
- Bioethics International, New York, USA
| | | | | | - Joseph S Ross
- Section of General Internal Medicine and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Health, New Haven, Connecticut, USA
| | - Michelle M Mello
- Stanford Law School and the Department of Health Research and Policy, Stanford University Stanford Law School, Stanford, California, USA
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Vaduganathan M, Nagarur A, Qamar A, Patel RB, Navar AM, Peterson ED, Bhatt DL, Fonarow GC, Yancy CW, Butler J. Availability and Use of Shared Data From Cardiometabolic Clinical Trials. Circulation 2017; 137:938-947. [PMID: 29133600 DOI: 10.1161/circulationaha.117.031883] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 10/16/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sharing of patient-level clinical trial data has been widely endorsed. Little is known about how extensively these data have been used for cardiometabolic diseases. We sought to evaluate the availability and use of shared data from cardiometabolic clinical trials. METHODS We extracted data from ClinicalStudyDataRequest.com, a large, multisponsor data-sharing platform hosting individual patient-level data from completed studies sponsored by 13 pharmaceutical companies. RESULTS From January 2013 to May 2017, the platform had data from 3374 clinical trials, of which 537 (16%) evaluated cardiometabolic therapeutics (phase 1, 36%; phase 2, 17%; phase 2/3, 1%; phase 3, 42%; phase 4, 4%). They covered 74 therapies and 398 925 patients. Diabetes mellitus (60%) and hypertension (15%) were the most common study topics. Median time from study completion to data availability was 79 months. As of May 2017, ClinicalStudyDataRequest.com had received 318 submitted proposals, of which 163 had signed data-sharing agreements. Thirty of these proposals were related to cardiometabolic therapies and requested data from 79 unique studies (15% of all trials, 29% of phase 3/4 trials). Most (96%) data requesters of cardiometabolic clinical trial data were from academic centers in North America and Western Europe, and half the proposals were unfunded. Most proposals were for secondary hypothesis-generating questions, with only 1 proposed reanalysis of the original study primary hypothesis. To date, 3 peer-reviewed articles have been published after a median of 19 months (9-32 months) from the data-sharing agreement. CONCLUSIONS Despite availability of data from >500 cardiometabolic trials in a multisponsor data-sharing platform, only 15% of these trials and 29% of phase 3/4 trials have been accessed by investigators thus far, and a negligible minority of analyses have reached publication.
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Affiliation(s)
- Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (M.V., A.Q., D.L.B.).
| | - Amulya Nagarur
- Department of Medicine, Massachusetts General Hospital, Boston (A.N.)
| | - Arman Qamar
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (M.V., A.Q., D.L.B.)
| | - Ravi B Patel
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (R.B.P., C.W.Y.)
| | - Ann Marie Navar
- Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, NC (A.M.N., E.D.P.)
| | - Eric D Peterson
- Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, NC (A.M.N., E.D.P.)
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (M.V., A.Q., D.L.B.)
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles (G.C.F.)
| | - Clyde W Yancy
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (R.B.P., C.W.Y.)
| | - Javed Butler
- Division of Cardiology, Stony Brook University, NY (J.B.)
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Soprovich A, El Kurdi S, Eurich DT. An analysis of redactions in Canada's Common Drug Review Clinical Review Reports and how they relate to the patients' voice. BMJ Open 2017; 7:e015497. [PMID: 28893743 PMCID: PMC5595205 DOI: 10.1136/bmjopen-2016-015497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IMPORTANCE Canada's Common Drug Review (CDR) evaluates drug data from published and unpublished research, as well as input from patient groups, to recommend provincial coverage. Currently, the CDR process gives manufacturers the opportunity to redact information in the final publicly available report. Patients often have strong feelings regarding the efficacy, harms, health-related quality of life (HRQL), and cost associated with the drugs under review and their redacted data. Highlighting Canada's approach will hopefully build on the growing international concern regarding transparency of clinical study data. OBJECTIVE The purpose was to objectively examine and classify completed, publicly available CDR-Clinical Review Reports (CRR) for redactions, and compare them to the patients' reported interests as patient-centred outcomes. METHODS Two independent reviewers searched for and examined publicly available CDR-CRR from November 2013-September 2016 through the Canadian Agency for Drugs and Technologies in Health (CADTH) on-line database. Both reviewers separately classified the redactions and patient-reported interests into the following categories: efficacy, harms, HRQL and costs. All discrepancies were rectified by consensus involving a third reviewer. RESULTS Fifty-two completed CDR-CRR were reviewed. 48 (92%) included patient-reported interests and 40 (77%) had redactions classified in the following categories: efficacy (75%), costs (48%), harms (38%), HRQL (23%). 89% of redactions were outcomes identified as patient-reported interests (69% efficacy, 42% harms, 36% cost, 33% HRQL). When examining drug characteristics, biological agents were statistically associated with increased odds of redactions with respect to either efficacy (OR 3.4, 95% CI 1.0 to 11.6) or harms (OR 3.5, 95% CI 1.02 to 12.4) compared with non-biological agents. CONCLUSIONS Whether data from the CDR-CRR used in the decision-making should be fully disclosed to the public is controversial. Our findings suggest clinical data (efficacy, harms, HRQL) matters to patients and should be publicly available within the CDR-CRR. Canada trails Europe and the USA regarding the transparency of clinical study data. This lack of transparency relates to the patient voice, and limits movement towards patient-centred care and patient-engaged research, restricting real-world value measurement.
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Affiliation(s)
- Allison Soprovich
- Alliance for Canadian Health Outcomes Research in Diabetes, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Sylvia El Kurdi
- Alliance for Canadian Health Outcomes Research in Diabetes, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
| | - Dean T Eurich
- Alliance for Canadian Health Outcomes Research in Diabetes, Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Broes S, Lacombe D, Verlinden M, Huys I. Sharing human samples and patient data: Opening Pandora’s box. J Cancer Policy 2017. [DOI: 10.1016/j.jcpo.2017.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Catalá-López F, Hutton B, Núñez-Beltrán A, Page MJ, Ridao M, Macías Saint-Gerons D, Catalá MA, Tabarés-Seisdedos R, Moher D. The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomised trials. PLoS One 2017; 12:e0180355. [PMID: 28700715 PMCID: PMC5507500 DOI: 10.1371/journal.pone.0180355] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 06/14/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed psychiatric disorders in childhood. A wide variety of treatments have been used for the management of ADHD. We aimed to compare the efficacy and safety of pharmacological, psychological and complementary and alternative medicine interventions for the treatment of ADHD in children and adolescents. METHODS AND FINDINGS We performed a systematic review with network meta-analyses. Randomised controlled trials (≥ 3 weeks follow-up) were identified from published and unpublished sources through searches in PubMed and the Cochrane Library (up to April 7, 2016). Interventions of interest were pharmacological (stimulants, non-stimulants, antidepressants, antipsychotics, and other unlicensed drugs), psychological (behavioural, cognitive training and neurofeedback) and complementary and alternative medicine (dietary therapy, fatty acids, amino acids, minerals, herbal therapy, homeopathy, and physical activity). The primary outcomes were efficacy (treatment response) and acceptability (all-cause discontinuation). Secondary outcomes included discontinuation due to adverse events (tolerability), as well as serious adverse events and specific adverse events. Random-effects Bayesian network meta-analyses were conducted to obtain estimates as odds ratios (ORs) with 95% credibility intervals. We analysed interventions by class and individually. 190 randomised trials (52 different interventions grouped in 32 therapeutic classes) that enrolled 26114 participants with ADHD were included in complex networks. At the class level, behavioural therapy (alone or in combination with stimulants), stimulants, and non-stimulant seemed significantly more efficacious than placebo. Behavioural therapy in combination with stimulants seemed superior to stimulants or non-stimulants. Stimulants seemed superior to behavioural therapy, cognitive training and non-stimulants. Behavioural therapy, stimulants and their combination showed the best profile of acceptability. Stimulants and non-stimulants seemed well tolerated. Among medications, methylphenidate, amphetamine, atomoxetine, guanfacine and clonidine seemed significantly more efficacious than placebo. Methylphenidate and amphetamine seemed more efficacious than atomoxetine and guanfacine. Methylphenidate and clonidine seemed better accepted than placebo and atomoxetine. Most of the efficacious pharmacological treatments were associated with harms (anorexia, weight loss and insomnia), but an increased risk of serious adverse events was not observed. There is lack of evidence for cognitive training, neurofeedback, antidepressants, antipsychotics, dietary therapy, fatty acids, and other complementary and alternative medicine. Overall findings were limited by the clinical and methodological heterogeneity, small sample sizes of trials, short-term follow-up, and the absence of high-quality evidence; consequently, results should be interpreted with caution. CONCLUSIONS Clinical differences may exist between the pharmacological and non-pharmacological treatment used for the management of ADHD. Uncertainties about therapies and the balance between benefits, costs and potential harms should be considered before starting treatment. There is an urgent need for high-quality randomised trials of the multiple treatments for ADHD in children and adolescents. PROSPERO, number CRD42014015008.
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Affiliation(s)
- Ferrán Catalá-López
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Fundación Instituto de Investigación en Servicios de Salud, Valencia, Spain
- Department of Medicine, University of Valencia/INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain
- * E-mail:
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amparo Núñez-Beltrán
- Centro de Atención Integral a Drogodependientes (CAID) Norte, Regional Health Council, Madrid, Spain
| | - Matthew J. Page
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Manuel Ridao
- Fundación Instituto de Investigación en Servicios de Salud, Valencia, Spain
- Instituto Aragonés de Ciencias de la Salud (IACS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Zaragoza, Spain
| | - Diego Macías Saint-Gerons
- Division of Pharmacoepidemiology and Pharmacovigilance, Spanish Medicines and Healthcare Products Agency (AEMPS), Madrid, Spain
| | | | - Rafael Tabarés-Seisdedos
- Department of Medicine, University of Valencia/INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain
| | - David Moher
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Kalager M. Del data. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2017; 137:679. [DOI: 10.4045/tidsskr.17.0446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Smith MY, Hammad TA, Metcalf M, Levitan B, Noel R, Wolka AM, Michaels DL, Johnson FR. Patient Engagement at a Tipping Point-The Need for Cultural Change Across Patient, Sponsor, and Regulator Stakeholders: Insights From the DIA Conference, "Patient Engagement in Benefit Risk Assessment Throughout the Life Cycle of Medical Products". Ther Innov Regul Sci 2016; 50:546-553. [PMID: 30231755 DOI: 10.1177/2168479016662902] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Benefit-risk assessment is the foundation for decision making throughout the life cycle of medical products. Because patients are the beneficiaries of the efficacy of medical treatments and also bear their possible risks, their perspectives and judgments about value and the relative importance of benefits and risks should be at the heart of the medical decision-making process. Patient engagement is now at a tipping point; there have been a growing number of patient engagement initiatives over the past several years, but there remains the need for a common language, alignment on engagement approaches and best practices, and a shared vision regarding a desired future state. This article discusses insights gleaned from the DIA conference, "Patient Engagement in Benefit-Risk Assessment throughout the Life Cycle of Medical Products" (September 2015). It highlights the changes that will need to occur within the patient, medical-product sponsor, and regulatory cultures in order for patient engagement to become integrated into the medical-product development process and life cycle maintenance. Furthermore, it emphasizes that reaching the desired future state will require a conscious commitment from all stakeholders to work collaboratively to develop shared solutions and to map a common path forward.
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Lueza B, Lacas B, Pignon JP, Paoletti X. [New applications for individual participant data meta-analyses of randomized trials]. Bull Cancer 2016; 104:139-146. [PMID: 27908441 DOI: 10.1016/j.bulcan.2016.10.024] [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: 10/28/2016] [Accepted: 10/31/2016] [Indexed: 10/20/2022]
Abstract
Meta-analyses of randomized trials using individual-participant data, which represent the highest level of evidence for the evaluation of a treatment effect, are now used in different contexts in clinical research. This article aims at reviewing some of these new applications. Meta-analyses are increasingly used in economic evaluation, which implies new measure outcomes of the treatment effect, as well as in biomarkers evaluations thanks to their higher statistical power and the possibility to validate findings on independent data. This article also considers the perspectives opened up by new data sources, such as randomized trials registers, and data sharing policies.
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Affiliation(s)
- Béranger Lueza
- Gustave-Roussy, université Paris-Saclay, service de biostatistique et d'épidémiologie, 94805 Villejuif, France; Oncostat CESP, INSERM, université Paris-Saclay, university Paris-Sud, UVSQ, 94085 Villejuif, France; Gustave-Roussy, plateforme Ligue nationale contre le cancer de méta-analyse en oncologie, 94085 Villejuif, France
| | - Benjamin Lacas
- Gustave-Roussy, université Paris-Saclay, service de biostatistique et d'épidémiologie, 94805 Villejuif, France; Oncostat CESP, INSERM, université Paris-Saclay, university Paris-Sud, UVSQ, 94085 Villejuif, France; Gustave-Roussy, plateforme Ligue nationale contre le cancer de méta-analyse en oncologie, 94085 Villejuif, France
| | - Jean-Pierre Pignon
- Gustave-Roussy, université Paris-Saclay, service de biostatistique et d'épidémiologie, 94805 Villejuif, France; Oncostat CESP, INSERM, université Paris-Saclay, university Paris-Sud, UVSQ, 94085 Villejuif, France; Gustave-Roussy, plateforme Ligue nationale contre le cancer de méta-analyse en oncologie, 94085 Villejuif, France
| | - Xavier Paoletti
- Gustave-Roussy, université Paris-Saclay, service de biostatistique et d'épidémiologie, 94805 Villejuif, France; Oncostat CESP, INSERM, université Paris-Saclay, university Paris-Sud, UVSQ, 94085 Villejuif, France; Gustave-Roussy, plateforme Ligue nationale contre le cancer de méta-analyse en oncologie, 94085 Villejuif, France.
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Affiliation(s)
- Sergio Bonini
- From the European Medicines Agency, London (S.B., G.R.); and the Second University of Naples, Naples (S.B.), and Istituto di Farmacologia Traslazionale del Consiglio Nazionale delle Ricerche (S.B.) and the University of Rome Tor Vergata (G.R.), Rome - all in Italy
| | - Guido Rasi
- From the European Medicines Agency, London (S.B., G.R.); and the Second University of Naples, Naples (S.B.), and Istituto di Farmacologia Traslazionale del Consiglio Nazionale delle Ricerche (S.B.) and the University of Rome Tor Vergata (G.R.), Rome - all in Italy
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Transparency in drug regulation: public assessment reports in Europe and Australia. Drug Discov Today 2016; 21:1806-1813. [DOI: 10.1016/j.drudis.2016.06.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/07/2016] [Accepted: 06/27/2016] [Indexed: 11/20/2022]
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Fitzgerald N, Angus K, Elders A, de Andrade M, Raistrick D, Heather N, McCambridge J. Weak evidence on nalmefene creates dilemmas for clinicians and poses questions for regulators and researchers. Addiction 2016; 111:1477-87. [PMID: 27262594 PMCID: PMC5089629 DOI: 10.1111/add.13438] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/15/2015] [Accepted: 04/21/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS Nalmefene has been approved in Europe for the treatment of alcohol dependence and subsequently recommended by the UK National Institute for Health and Care Excellence (NICE). This study examines critically the evidence base underpinning both decisions and the issues arising. METHODS Published studies of nalmefene were identified through a systematic search, with documents from the European Medicines Agency, the NICE appraisal and public clinical trial registries also examined to identify methodological issues. RESULTS Efficacy data used to support the licensing of nalmefene suffer from risk of bias due to lack of specification of a priori outcome measures and sensitivity analyses, use of post-hoc sample refinement and the use of inappropriate comparators. Despite this, evidence for the efficacy of nalmefene in reducing alcohol consumption in those with alcohol dependence is, at best, modest, and of uncertain significance to individual patients. The relevance of existing trial data to routine primary care practice is doubtful. CONCLUSIONS Problems with the registration, design, analysis and reporting of clinical trials of nalmefene did not prevent it being licensed and recommended for treating alcohol dependence. This creates dilemmas for primary care clinicians and commissioning organisations where nalmefene has been heavily promoted, and poses wider questions about the effectiveness of the medicines regulation system and how to develop the alcohol treatment evidence base.
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Affiliation(s)
- Niamh Fitzgerald
- Institute for Social Marketing, UK Centre for Tobacco Alcohol StudiesUniversity of StirlingScotlandUK
| | - Kathryn Angus
- Institute for Social Marketing, UK Centre for Tobacco Alcohol StudiesUniversity of StirlingScotlandUK
| | | | - Marisa de Andrade
- School of Health in Social ScienceUniversity of EdinburghEdinburghScotlandUK
| | | | - Nick Heather
- Department of Psychology, Faculty of Health and Life SciencesNorthumbria UniversityNewcastle upon TyneUK
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Abstract
INTRODUCTION More rapid drug premarketing procedures pose a challenge for regulatory agencies in terms of innovation and improving real-world safety and effectiveness Areas covered: This review considers the blockbuster drugs used over the previous fifteen years with adverse reactions after marketing, the elements and time span of risk identification and the measures implemented or considered, based on the existing literature and reports from the agencies Expert opinion: Risk prediction is founded on several factors: randomization, sample size, a well-established endpoint for safety, use of a comparator rather than placebo and a longer Phase-III period, in which a serious illness may be identified by early signs of alteration in the primary parenchyma with the latest biochemical, instrumental and imaging techniques. In comparative non-inferiority evaluations, increased safety should be preferred, with the exception of drugs that may be useful in serious or life-threatening diseases for which there are few or no effective existing therapies. A period of restricted use may be required to test and dispense new drugs, as well as to implement specific methods for the early detection of adverse events. It is important not to regard a new medicine axiomatically as the best treatment before it comes into wide use.
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Affiliation(s)
- Paolo Preziosi
- a Institute of Pharmacology , Catholic University School of Medicine , Roma , Italy
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Sacristán JA, Aguarón A, Avendaño-Solá C, Garrido P, Carrión J, Gutiérrez A, Kroes R, Flores A. Patient involvement in clinical research: why, when, and how. Patient Prefer Adherence 2016; 10:631-40. [PMID: 27175063 PMCID: PMC4854260 DOI: 10.2147/ppa.s104259] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The development of a patient-centered approach to medicine is gradually allowing more patients to be involved in their own medical decisions. However, this change is not happening at the same rate in clinical research, where research generally continues to be carried out on patients, but not with patients. This work describes the why, when, and how of more active patient participation in the research process. Specific measures are proposed to improve patient involvement in 1) setting priorities, 2) study leadership and design, 3) improved access to clinical trials, 4) preparation and oversight of the information provided to participants, 5) post-study evaluation of the patient experience, and 6) the dissemination and application of results. In order to achieve these aims, the relative emphases on the ethical principles underlying research need to be changed. The current model based on the principle of beneficence must be left behind, and one that upholds the ethical principles of autonomy and non maleficence should be embraced. There is a need to improve the level of information that patients and society as a whole have on research objectives and processes; the goal is to promote the gradual emergence of the expert patient.
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Affiliation(s)
| | | | | | - Pilar Garrido
- Oncology Department, Hospital Ramón y Cajal, Madrid, Spain
| | - Juan Carrión
- FEDER (Spanish Federation for Rare Diseases), Madrid, Spain
| | | | - Robert Kroes
- Clinical Open Innovation, Lilly Europe, Amsterdam, the Netherlands
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Barnes PJ, Bonini S, Seeger W, Belvisi MG, Ward B, Holmes A. Barriers to new drug development in respiratory disease. Eur Respir J 2016; 45:1197-207. [PMID: 25931481 DOI: 10.1183/09031936.00007915] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Peter J Barnes
- Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Sergio Bonini
- Second University of Naples, Caserta, Italy Institute of Translational Pharmacology-CNR, Rome, Italy European Medicines Agency, London, UK
| | - Werner Seeger
- University of Giessen and Marburg Lung Centre, Member of the German Centre for Lung Research (DZL), Giessen, Germany
| | - Maria G Belvisi
- Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Brian Ward
- European Affairs Dept, European Respiratory Society, Brussels, Belgium
| | - Anthony Holmes
- National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs), London, UK
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Viergever RF, Li K. Trends in global clinical trial registration: an analysis of numbers of registered clinical trials in different parts of the world from 2004 to 2013. BMJ Open 2015; 5:e008932. [PMID: 26408831 PMCID: PMC4593134 DOI: 10.1136/bmjopen-2015-008932] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To analyse developments (and their causes) in the number and proportion of clinical trials that were registered in different parts of the world after the International Committee of Medical Journal Editors (ICMJE) announced in 2004 that it would require registration of clinical trials as a condition for publication. SETTING The International Clinical Trials Registry Platform (ICTRP). DESIGN The ICTRP database was searched for all clinical trials that were registered up to 31 December 2013. RESULTS The ICTRP database contained data on 186,523 interventional clinical trials. The annual number of registered clinical trials increased from 3294 in 2004 to 23,384 in 2013. Relative to the number of clinical trial research publications, the global number of registered clinical trials increased fivefold between 2004 and 2013, rising particularly strongly between 2004 and 2005. In certain regions, especially Asia, the annual number of registered trials increased more gradually and continued to increase up to 2013. In India and Japan, two countries with marked but more gradual increases, these increases only happened after several local measures were implemented that encouraged and enforced registration. In most regions, there was a trend toward trials being registered at local registries. CONCLUSIONS Clinical trial registration has greatly improved transparency in clinical trial research. However, these improvements have not taken place equally in all parts of the world. Achieving compliance with registration requires a coalescence of global and local measures, and remains a key challenge in many countries. Poor quality of registered trial data and the inaccessibility of trial protocols, results and participant-level data further undermine the potential benefits of clinical trial registration. National and regional registries and the ICTRP have played a leading role in achieving the successes of trial registration to date and should be supported in addressing these challenges in the future.
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Affiliation(s)
- Roderik F Viergever
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Keyang Li
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Rasi G, Bonini S. Innovative medicines: new regulatory procedures for the third millennium. Expert Opin Biol Ther 2015; 15 Suppl 1:S5-8. [DOI: 10.1517/14712598.2015.1026322] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Rosenblatt M, Jain SH, Cahill M. Sharing of clinical trial data: benefits, risks, and uniform principles. Ann Intern Med 2015; 162:306-7. [PMID: 25622304 DOI: 10.7326/m14-1299] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Mintzes B, Lexchin J, Quintano AS. Clinical trial transparency: many gains but access to evidence for new medicines remains imperfect. Br Med Bull 2015; 116:43-53. [PMID: 26493102 DOI: 10.1093/bmb/ldv042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although selective and incomplete publication is widely acknowledged to be a problem, full access to clinical trial data remains illusive. SOURCES OF DATA Authors' personal files, key documents from Food and Drug Administration and European Medicines Agency and focussed searches of PubMed. AREAS OF AGREEMENT Existing sources of information provide an incomplete overview of scientific research. AREAS OF CONTROVERSY Persistent arguments about commercial confidentiality and the potential difficulties in de-identifying raw data can block important progress. Current industry efforts are voluntary and only partially satisfy the need for complete data. GROWING POINTS Requirements for trial registration are increasing. Important regulatory changes in particular in Europe have the potential to result in the release of more information. AREAS TIMELY FOR DEVELOPING RESEARCH Documenting the effects of prospective trial registration and requirements for proactive clinical trial publication on healthcare decisions, public health and rational resource allocation.
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Affiliation(s)
- Barbara Mintzes
- Charles Perkins Centre and Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - Joel Lexchin
- School of Health Policy and Management, York University, York, UK University Health Network, Toronto, Canada Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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