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Briguori C, Quintavalle C, Mariano E, D'Agostino A, Scarpelli M, Focaccio A, Zoccai GB, Evola S, Esposito G, Sangiorgi GM, Condorelli G. Kidney Injury After Minimal Radiographic Contrast Administration in Patients With Acute Coronary Syndromes. J Am Coll Cardiol 2024; 83:1059-1069. [PMID: 38479953 DOI: 10.1016/j.jacc.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/09/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Acute kidney injury (AKI) is common in patients with acute coronary syndromes (ACS) treated by percutaneous coronary intervention. OBJECTIVES Contrast media (CM) volume minimization has been advocated for prevention of AKI. The DyeVert CM diversion system (Osprey Medical, Inc) is designed to reduce CM volume during coronary procedures. METHODS In this randomized, single-blind, investigator-driven clinical trial conducted in 4 Italian centers from February 4, 2020 to September 13, 2022, 550 participants with ACS were randomly assigned in a 1:1 ratio to the following: 1) the contrast volume reduction (CVR) group (n = 276), in which CM injection was handled by the CM diversion system; and 2) the control group (n = 274), in which a conventional manual or automatic injection syringe was used. The primary endpoint was the rate of AKI, defined as a serum creatinine (sCr) increase ≥0.3 mg/dL within 48 hours after CM exposure. RESULTS There were 412 of 550 (74.5%) participants with ST-segment elevation myocardial infarction (211 of 276 [76.4%] in the CVR group and 201 of 274 [73.3%] in the control group). The CM volume was lower in the CVR group (95 ± 30 mL vs 160 ± 23 mL; P < 0.001). Seven participants (1 in the CVR group and 6 in the control group) did not have postprocedural sCr values. AKI occurred in 44 of 275 (16%) participants in the CVR group and in 65 of 268 (24.3%) participants in the control group (relative risk: 0.66; 95% CI: 0.47-0.93; P = 0.018). CONCLUSIONS CM volume reduction obtained using the CM diversion system is effective for prevention of AKI in patients with ACS undergoing invasive procedures. (REnal Insufficiency Following Contrast MEDIA Administration TriaL IV [REMEDIALIV]: NCT04714736).
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Affiliation(s)
- Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentre, Naples, Italy.
| | - Cristina Quintavalle
- Center for Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Naples, Italy
| | - Enrica Mariano
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | | | - Mario Scarpelli
- Interventional Cardiology Unit, Mediterranea Cardiocentre, Naples, Italy
| | - Amelia Focaccio
- Interventional Cardiology Unit, Mediterranea Cardiocentre, Naples, Italy
| | - Giuseppe Biondi Zoccai
- Interventional Cardiology Unit, Mediterranea Cardiocentre, Naples, Italy; Center for Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), Naples, Italy; Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy; Division of Cardiology, Paolo Giaccone University Hospital, Palermo, Italy; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Salvatore Evola
- Division of Cardiology, Paolo Giaccone University Hospital, Palermo, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Science, Division of Cardiology, Federico II University of Naples, Naples, Italy
| | | | - Gerolama Condorelli
- Department of Molecular Medicine and Medical Biotechnology, Federico II University, Naples, Italy; Scientific Institute for Research, Hospitalization, and Health Care-Mediterranean Neurological Institute (IRCCS Neuromed), Pozzilli, Italy
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Briguori C, D'Amore C, De Micco F, Signore N, Esposito G, Visconti G, Airoldi F, Signoriello G, Focaccio A. Left Ventricular End-Diastolic Pressure Versus Urine Flow Rate-Guided Hydration in Preventing Contrast-Associated Acute Kidney Injury. JACC Cardiovasc Interv 2021; 13:2065-2074. [PMID: 32912462 DOI: 10.1016/j.jcin.2020.04.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/19/2020] [Accepted: 04/07/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study compared left ventricular end-diastolic pressure (LVEDP)-guided and urine flow rate (UFR)-guided hydration. BACKGROUND Tailored hydration regimens improve the prevention of contrast-associated acute kidney injury (CA-AKI). METHODS Between July 15, 2015, and June 6, 2019, patients at high risk for CA-AKI scheduled for coronary and peripheral procedures were randomized to 2 groups: 1) normal saline infusion rate adjusted according to the LVEDP (LVEDP-guided group); and 2) hydration controlled by the RenalGuard System in order to reach UFR ≥300 ml/h (UFR-guided group). The primary endpoint was the composite of CA-AKI (i.e., serum creatinine increase ≥25% or ≥0.5 mg/dl at 48 h) and acute pulmonary edema (PE). Major adverse events (all-cause death, renal failure requiring dialysis, PE, and sustained kidney injury) at 1 month were assessed. RESULTS The primary endpoint occurred in 20 of 351 (5.7%) patients in the UFR-guided group and in 36 of 351 (10.3%) patients in the LVEDP-guided group (relative risk [RR]: 0.560; 95% confidence interval [CI]: 0.390 to 0.790; p = 0.036). CA-AKI and PE rates in the UFR-guided group and LVEDP-guided group were 5.7% and 10.0% (RR: 0.570; 95% CI: 0.300 to 0.960; p = 0.048), and, respectively, 0.3% and 2.0% (RR: 0.070; 95% CI: 0.020 to 1.160; p = 0.069). Three patients in the UFR-guided group experienced complications related to the Foley catheter. Hypokalemia rate was 6.2% in the UFR-guided group and 2.3% in the LVEDP-guided group (p = 0.013). The 1-month major adverse events rate was 7.1% in the UFR-guided group and 12.0% in the LVEDP-guided group (p = 0.030). CONCLUSIONS The study demonstrates that UFR-guided hydration is superior to LVEDP-guided hydration to prevent the composite of CA-AKI and PE.
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Affiliation(s)
- Carlo Briguori
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy.
| | - Carmen D'Amore
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Francesca De Micco
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Nicola Signore
- Interventional Cardiology Unit, Policlinico di Bari, Bari, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Science, Division of Cardiology, "Federico II" University of Naples, Naples, Italy
| | - Gabriella Visconti
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
| | - Flavio Airoldi
- Interventional Cardiology Unit, Istituto di Ricerca a Carattere Scientifico Multimedica MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Giuseppe Signoriello
- Department of Mental Health and Preventive Medicine, Second University of Naples, Naples, Italy
| | - Amelia Focaccio
- Interventional Cardiology Unit, Mediterranea Cardiocentro, Naples, Italy
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Waleed M, Kazmi I, Farooq M, Hamid A, Karam F, Allgar V, Wong KY. Clustering by Health Professionals in Individually Randomised Controlled Trials. EUROPEAN MEDICAL JOURNAL 2019. [DOI: 10.33590/emj/10312509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: The aim of this study was to investigate the prevalence of clustering by health professionals in individually randomised controlled trials (iRCT), and its adjustment in both the sample size calculation estimates and the analysis of the data collected in iRCT (that is, trials that randomise individuals only). As a result, cluster randomised controlled trials will not be the part of this review study. Additionally, the authors aimed to discover the prevalence of the various forms of clustering in iRCT.
Methods: iRCT, in which the intervention was delivered by a health professional, were electronically searched in three medical journals. The dates searched were from 1st January 2000–31st August 2009. The retrieved trials were then screened to exclude those with complex designs and trials with more than two parallel arms. The selected trials were then fully reviewed for the presence of clustering effects and any corresponding adjustment. Data about the sample size calculation in the selected trials were also included. A basic form was generated for the purpose of data extraction from each of the selected trials.
Results: Of the 130 iRCT reviewed, clustering of outcomes was present in 127 (98%) trials. Only 61 trials (47%) had adjusted for the clustering effects in their design and analysis, while 53% of the trials had ignored the clustering effect, and hence no adjustment had been made in the trial design or analysis.
Regarding the various forms of clustering, clustering by centre in multicentre trials was found in 79 trials (60%), followed by natural clustering in 26 trials (20%), and clustering imposed by the design of the study in 23 trials (18%).
Conclusion: Potential clustering of outcomes exists in almost all iRCT; however, this review found that <50% of iRCT took clustering into account and adjusted the sample size calculation and statistical analysis of this data for clustering. Almost half of the reviewed iRCT ignored the clustering effect. As a result, inaccurate and nongeneralisable results could have been generated.
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Affiliation(s)
- Mohammad Waleed
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Isma Kazmi
- Department of Renal medicine, St James’ University Hospital, Leeds, UK
| | | | - Abdul Hamid
- Department of Anaesthesia, Northern General Hospital, Sheffield, UK
| | - Fazal Karam
- Department of Orthopedics, Saidu Group of Teaching Hospital, Saidu Sharif, Pakistan
| | | | - Kenneth Y.K. Wong
- Department of Cardiology, Blackpool Teaching Hospitals NHS Foundation Trust (Blackpool Victoria Hospital), Blackpool, UK
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Briguori C, D'Amore C, De Micco F, Signore N, Esposito G, Napolitano G, Focaccio A. Renal insufficiency following contrast media administration trial III: Urine flow rate‐guided versus left‐ventricular end‐diastolic pressure‐guided hydration in high‐risk patients for contrast‐induced acute kidney injury. Rationale and design. Catheter Cardiovasc Interv 2019; 95:895-903. [DOI: 10.1002/ccd.28386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/12/2019] [Accepted: 06/22/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Carlo Briguori
- Interventional Cardiology UnitMediterranea Cardiocentro Naples Italy
| | - Carmen D'Amore
- Interventional Cardiology UnitMediterranea Cardiocentro Naples Italy
| | | | - Nicola Signore
- Interventional Cardiology UnitPoliclinico di Bari Bari Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Science, Division of Cardiology“Federico II” University of Naples Naples Italy
| | | | - Amelia Focaccio
- Interventional Cardiology UnitMediterranea Cardiocentro Naples Italy
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Wiseman SJ, Meijboom R, Valdés Hernández MDC, Pernet C, Sakka E, Job D, Waldman AD, Wardlaw JM. Longitudinal multi-centre brain imaging studies: guidelines and practical tips for accurate and reproducible imaging endpoints and data sharing. Trials 2019; 20:21. [PMID: 30616680 PMCID: PMC6323670 DOI: 10.1186/s13063-018-3113-6] [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: 05/17/2018] [Accepted: 12/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background Research involving brain imaging is important for understanding common brain diseases. Study endpoints can include features and measures derived from imaging modalities, providing a benchmark against which other phenotypical data can be assessed. In trials, imaging data provide objective evidence of beneficial and adverse outcomes. Multi-centre studies increase generalisability and statistical power. However, there is a lack of practical guidelines for the set-up and conduct of large neuroimaging studies. Methods We address this deficit by describing aspects of study design and other essential practical considerations that will help researchers avoid common pitfalls and data loss. Results The recommendations are grouped into seven categories: (1) planning, (2) defining the imaging endpoints, developing an imaging manual and managing the workflow, (3) performing a dummy run and testing the analysis methods, (4) acquiring the scans, (5) anonymising and transferring the data, (6) monitoring quality, and (7) using structured data and sharing data. Conclusions Implementing these steps will lead to valuable and usable data and help to avoid imaging data wastage.
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Affiliation(s)
- Stewart J Wiseman
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK. .,UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK. .,CCBS, Chancellor's Building, Royal Infirmary of Edinburgh, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
| | - Rozanna Meijboom
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
| | - Maria Del C Valdés Hernández
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
| | - Cyril Pernet
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Eleni Sakka
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Dominic Job
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Adam D Waldman
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna M Wardlaw
- Edinburgh Imaging and Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,UK Dementia Research Institute Edinburgh, University of Edinburgh, Edinburgh, UK
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Briguori C, Visconti G, Focaccio A, Donahue M, Golia B, Selvetella L, Ricciarelli B. Novel Approaches for Preventing or Limiting Events (NAPLES III) Trial: Randomised Comparison of Bivalirudin Versus Unfractionated Heparin in Patients at High Risk of Bleeding Undergoing Elective Coronary Stenting Throught The Femoral Approach. Rationale and Design. Cardiovasc Drugs Ther 2014; 28:273-9. [DOI: 10.1007/s10557-014-6518-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Shu L, Sulaiman AH, Huang YS, Fones Soon Leng C, Crutel VS, Kim YS. Comparable efficacy and safety of 8 weeks treatment with agomelatine 25-50mg or fluoxetine 20-40mg in Asian out-patients with major depressive disorder. Asian J Psychiatr 2014; 8:26-32. [PMID: 24655622 DOI: 10.1016/j.ajp.2013.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 09/13/2013] [Accepted: 09/22/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This randomized, double-blind study evaluates the efficacy and tolerability of agomelatine, using fluoxetine as an active comparator, in Asian patients suffering from moderate to severe major depressive disorder (MDD). METHOD Patients were randomly assigned to receive either agomelatine (25-50mg/day, n=314) or fluoxetine (20-40mg/day, n=314) during an 8-week treatment period. The main outcome measure was the change in Hamilton Depression Rating Scale 17 items (HAM-D17) scores. Secondary efficacy criteria included scores on Clinical Global Impression Severity of illness (CGI-S) and Improvement of illness (CGI-I), patient sleeping improvement using the self-rating Leeds Sleep Evaluation Questionnaire (LSEQ) and anxiety using the Hamilton Anxiety Rating Scale (HAM-A) scores. Tolerability and safety evaluations were based on emergent adverse events. RESULTS Agomelatine and fluoxetine exert a comparable antidepressant efficacy in the Asian population. Mean changes over 8 weeks were clinically relevant and similar in both groups (-14.8±7.3 and -15.0±8.1 on HAM-D17 scale in agomelatine and fluoxetine groups, respectively). The between-group difference reached statistical significance on non-inferiority test (p=0.015). Clinically relevant decreases in CGI-S and CGI-I scores were observed over the treatment period in both groups. The two treatments were equally effective on the symptoms of both anxiety and sleep. The good tolerability profile and safety of both doses of agomelatine was confirmed in the Asian population. CONCLUSIONS Agomelatine and fluoxetine are equally effective in the treatment of MDD-associated symptoms in Asian depressed patients.
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Affiliation(s)
- L Shu
- The Sixth Hospital of Peking, Institute of Mental Health, Peking University, No. 51 Hua Yuan Bei Road, Haidian District, Beijing 100083, China.
| | - A H Sulaiman
- University Malaya Medical Centre, Department of Psychological Medicine, Jalan University, 50603 Kuala Lumpur, Malaysia
| | - Y S Huang
- Department of Psychiatry, Chang Gung Memorial Hospital, 199, Tung-Hwa North Road, 105 Tapei, Taiwan
| | - C Fones Soon Leng
- Gleneagles Medical Centre, Department of Psychiatry, #4-11, 6 Napier Road, 258499, Singapore
| | - V Strijckmans Crutel
- Institut de Recherches Internationales Servier (IRIS), 50 Rue Carnot, 92284 Suresnes Cedex, France
| | - Y S Kim
- Seoul National University, Department of Psychiatry, 28 Yongon-Dong, Chongno-Gu, Seoul 110-744, Republic of Korea
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Regulatory and Scientific Issues Regarding Use of Foreign Data in Support of New Drug Applications in the United States: An FDA Perspective. Clin Pharmacol Ther 2013; 94:230-42. [DOI: 10.1038/clpt.2013.70] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 03/28/2013] [Indexed: 11/09/2022]
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Ohishi M. Potential Factors Influencing Regional Differences and Similarities in Multiregional Clinical Trials. ACTA ACUST UNITED AC 2012. [DOI: 10.1177/0092861512443747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kanhere MH, Kanhere HA, Cameron A, Maddern GJ. Does patient volume affect clinical outcomes in adult intensive care units? Intensive Care Med 2012; 38:741-51. [DOI: 10.1007/s00134-012-2519-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 02/21/2012] [Indexed: 11/29/2022]
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Rashid MM, McKean JW, Kloke JD. R Estimates and Associated Inferences for Mixed Models With Covariates in a Multicenter Clinical Trial. Stat Biopharm Res 2012. [DOI: 10.1080/19466315.2011.636293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Chen J, Quan H, Gallo P, Menjoge S, Luo X, Tanaka Y, Li G, Ouyang SP, Binkowitz B, Ibia E, Talerico S, Ikeda K. Consistency of Treatment Effect across Regions in Multiregional Clinical Trials, Part 1: Design Considerations. ACTA ACUST UNITED AC 2011. [DOI: 10.1177/009286151104500609] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Briguori C, Visconti G, Focaccio A, Airoldi F, Valgimigli M, Sangiorgi GM, Golia B, Ricciardelli B, Condorelli G. Renal Insufficiency After Contrast Media Administration Trial II (REMEDIAL II): RenalGuard System in high-risk patients for contrast-induced acute kidney injury. Circulation 2011; 124:1260-9. [PMID: 21844075 DOI: 10.1161/circulationaha.111.030759] [Citation(s) in RCA: 182] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The RenalGuard System, which creates high urine output and fluid balancing, may be beneficial in preventing contrast-induced acute kidney injury. METHODS AND RESULTS The Renal Insufficiency After Contrast Media Administration Trial II (REMEDIAL II) trial is a randomized, multicenter, investigator-driven trial addressing the prevention of contrast-induced acute kidney injury in high-risk patients. Patients with an estimated glomerular filtration rate ≤30 mL · min(-1) · 1.73 m(-2) and/or a risk score ≥11 were randomly assigned to sodium bicarbonate solution and N-acetylcysteine (control group) or hydration with saline and N-acetylcysteine controlled by the RenalGuard System and furosemide (RenalGuard group). The primary end point was an increase of ≥0.3 mg/dL in the serum creatinine concentration at 48 hours after the procedure. The secondary end points included serum cystatin C kinetics and rate of in-hospital dialysis. Contrast-induced acute kidney injury occurred in 16 of 146 patients in the RenalGuard group (11%) and in 30 of 146 patients in the control group (20.5%; odds ratio, 0.47; 95% confidence interval, 0.24 to 0.92). There were 142 patients (48.5%) with an estimated glomerular filtration rate ≤30 mL · min(-1) · 1.73 and 149 patients (51.5%) with only a risk score ≥11. Subgroup analysis according to inclusion criteria showed a similarly lower risk of adverse events (estimated glomerular filtration rate ≤30 mL · min(-1) · 1.73 m(-2): odds ratio, 0.44; risk score ≥11: odds ratio, 0.45; P for interaction=0.97). Changes in cystatin C at 24 hours (0.02±0.32 versus -0.08±0.26; P=0.002) and 48 hours (0.12±0.42 versus 0.03±0.31; P=0.001) and the rate of in-hospital dialysis (4.1% versus 0.7%; P=0.056) were higher in the control group. CONCLUSION RenalGuard therapy is superior to sodium bicarbonate and N-acetylcysteine in preventing contrast-induced acute kidney injury in high-risk patients. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrial.gov. Unique identifier: NCT01098032.
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Affiliation(s)
- Carlo Briguori
- Laboratory of Interventional Cardiology, Department of Cardiology, Clinica Mediterranea, Naples, Italy.
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Ho K, Tan J. Use of L’Abbé and pooled calibration plots to assess the relationship between severity of illness and effectiveness in studies of corticosteroids for severe sepsis. Br J Anaesth 2011; 106:528-536. [DOI: 10.1093/bja/aeq417] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Briguori C, Visconti G, Ricciardelli B, Condorelli G. Renal insufficiency following contrast media administration trial II (REMEDIAL II): RenalGuard system in high-risk patients for contrast-induced acute kidney injury: rationale and design. EUROINTERVENTION 2011; 6:1117-22, 7. [DOI: 10.4244/eijv6i9a194] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
We consider a Gaussian copula model for multivariate survival times. Estimation of the copula association parameter is easily implemented with existing software using a two-stage estimation procedure. Using the Gaussian copula, we are able to test whether the association parameter is equal to zero. When the association term is positive, the model can be extended to incorporate cluster-level frailty terms. Asymptotic properties are derived under the two-stage estimation scheme. Simulation studies verify finite sample utility. We apply the method to a Children's Oncology Group multi-center study of acute lymphoblastic leukemia. The analysis estimates marginal treatment effects and examines potential clustering within treatment institution.
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Affiliation(s)
- Megan Othus
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109, Tel.: 206-667-5749
| | - Yi Li
- Harvard University and Dana Farber Cancer Institute, Boston, MA 02115
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Jensen K, Kieser M. Blinded sample size recalculation in multicentre trials with normally distributed outcome. Biom J 2010; 52:377-99. [PMID: 20394080 DOI: 10.1002/bimj.200900114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The internal pilot study design enables to estimate nuisance parameters required for sample size calculation on the basis of data accumulated in an ongoing trial. By this, misspecifications made when determining the sample size in the planning phase can be corrected employing updated knowledge. According to regulatory guidelines, blindness of all personnel involved in the trial has to be preserved and the specified type I error rate has to be controlled when the internal pilot study design is applied. Especially in the late phase of drug development, most clinical studies are run in more than one centre. In these multicentre trials, one may have to deal with an unequal distribution of the patient numbers among the centres. Depending on the type of the analysis (weighted or unweighted), unequal centre sample sizes may lead to a substantial loss of power. Like the variance, the magnitude of imbalance is difficult to predict in the planning phase. We propose a blinded sample size recalculation procedure for the internal pilot study design in multicentre trials with normally distributed outcome and two balanced treatment groups that are analysed applying the weighted or the unweighted approach. The method addresses both uncertainty with respect to the variance of the endpoint and the extent of disparity of the centre sample sizes. The actual type I error rate as well as the expected power and sample size of the procedure is investigated in simulation studies. For the weighted analysis as well as for the unweighted analysis, the maximal type I error rate was not or only minimally exceeded. Furthermore, application of the proposed procedure led to an expected power that achieves the specified value in many cases and is throughout very close to it.
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Affiliation(s)
- Katrin Jensen
- Institute of Medical Biometry and Informatics, Ruprecht-Karls University Heidelberg, Germany
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Ikeda K, Bretz F. Sample size and proportion of Japanese patients in multi-regional trials. Pharm Stat 2010; 9:207-16. [PMID: 20872621 DOI: 10.1002/pst.455] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In recent years, multi-regional trials have received increasing attention by pharmaceutical companies carrying out global drug development programs. In Japan, new drugs are often approved several years after market release in other countries. The recently published guidance on 'Basic Principles on Global Clinical Trials' addresses specifically this time lag. A multi-regional trial has at least two main objectives. First, it is necessary to show a significant benefit in effect of a new drug in the entire population. Second, one needs to demonstrate that the results for a particular region are consistent with those from the entire population. In this paper, we discuss the methods proposed in the Japanese regulatory guidance document and derive closed form expressions for the resulting probabilities, which require the evaluation of multivariate normal or t probabilities. In addition, we propose an alternative method with better operating characteristics than the current approaches. Moreover, we examine the performance of our suggested method by simulating the probability of achieving the objectives and calculating the false-positive error rate.
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Reply to Hurley. Intensive Care Med 2010. [DOI: 10.1007/s00134-010-1817-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Affiliation(s)
- Hiroyuki Uesaka
- a The Center for Advanced Medical Engineering and Informatics , Osaka University , Osaka, Japan
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Hansen RA, Song L, Moore CG, Gilsenan AW, Kim MM, Calloway MO, Murray MD. Effect of ropinirole on sleep outcomes in patients with restless legs syndrome: meta-analysis of pooled individual patient data from randomized controlled trials. Pharmacotherapy 2009; 29:255-62. [PMID: 19249945 DOI: 10.1592/phco.29.3.255] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
STUDY OBJECTIVE To compare the effects of ropinirole with those of placebo on sleep, as evaluated by specific domains of the Medical Outcomes Study (MOS) sleep scale, as well as the Clinical Global Impression-Improvement (CGI-I) scale, in patients with restless legs syndrome (RLS). DESIGN Meta-analysis of six randomized, double-blind, placebo-controlled, parallel-group trials conducted in the United States and Europe. PATIENTS A total of 1679 patients aged 18-79 years with primary moderate-to-severe RLS who received ropinirole (835 patients) or placebo (844 patients). MEASUREMENTS AND MAIN RESULTS A systematic review of MEDLINE (January 1980-January 2007) and clinical trial registers was performed to identify placebo-controlled trials of ropinirole that used the 12-item MOS sleep scale to assess sleep in patients with RLS. Individual patient data from both published and nonpublished trials were pooled for meta-analysis. In the eligible studies, immediate-release ropinirole 0.25-6 mg or placebo had been given for at least 12 weeks. In addition, sleep scale summary scores for the domains of sleep quantity, adequacy, disturbance, and daytime somnolence had to have been assessed at baseline and at 12 weeks. Our meta-analysis found that at baseline study patients slept an average of 5.8 hours/night. At the end of 12 weeks, ropinirole-treated patients slept a mean of 2.5 hours/week more and had a 21% greater improvement from baseline in sleep adequacy scores compared with patients receiving placebo. Ropinirole-treated patients also had 14% less sleep disturbance and 8% less daytime somnolence than patients receiving placebo. Clinicians rated 63% of ropinirole-treated patients and 47% of patients receiving placebo as responders based on the CGI-I scale. Mixed effects analysis of covariance was used to estimate treatment effect adjusting for study center as a random effect, as well as the following fixed effects known to affect sleep: baseline sleep characteristics, age, sex, and chronic medical conditions. All differences were statistically significant (p<0.05), even after adjusting for multiple comparisons. CONCLUSION Pooled data from six similarly designed clinical trials provide evidence that ropinirole improves sleep quantity and adequacy, and lessens sleep disturbance and daytime somnolence in patients with primary RLS.
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Affiliation(s)
- Richard A Hansen
- Division of Pharmaceutical Outcomes and Policy, Center for Pharmaceutical Outcomes and Policy, School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina 27599-7360, USA
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23
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Abstract
It becomes the important issue for the medical supplies administration to solve the drug lag in our country. As means to overcome both the slow speed and high cost of clinical trial for new drug application in Japan, it seems useful to carry out clinical development simultaneously in East Asia countries such as China, Korea and Taiwan where it is thought that each country has similar ethnicity one another. When conducting simultaneous development with the same protocol in plural countries, it should be avoided that side effect develops abusively. In addition, both the effectiveness and safety expected after marketing should be secured in each country by a recommended amount of medicine for usage provided by simultaneous development between many countries. It is necessary for ethnic similarity to be shown so that development between the many countries in the same dosage is permitted at least. It is expected that the possibility of mutual utilization of clinical trial data of China, Korea and Japan will be shown by pharmacokinetics and pharmacodynamics examinations based on clinical test data of these countries by the Scientific Research funded by MHLW. On the other hand, it seems that it is meaningful and significant to examine the similarity at the gene level from various points of view. In order to give grounds for the validity of carrying out clinical trial in the same protocol in East Asia countries, it may be useful to examine genetic diversity of East Asia countries with plural heredity anthropological techniques such as heredity distance, and compare degree of the genetic diversity between the races of East Asia countries and that of other regions, for example, West Europe countries which have been recognized as one clinical trial field.
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Affiliation(s)
- Kazuhiko Nakajima
- Drug Evaluation Committee, Japan Pharmaceutical Manufactures Associations, Tokyo, Japan.
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24
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Kawai N, Chuang-Stein C, Komiyama O, Li Y. An Approach to Rationalize Partitioning Sample Size into Individual Regions in a Multiregional Trial. ACTA ACUST UNITED AC 2008. [DOI: 10.1177/009286150804200206] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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25
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Komárek A, Lesaffre E, Legrand C. Baseline and treatment effect heterogeneity for survival times between centers using a random effects accelerated failure time model with flexible error distribution. Stat Med 2008; 26:5457-72. [PMID: 17910009 DOI: 10.1002/sim.3083] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Nowadays, most clinical trials are conducted in different centers and even in different countries. In most multi-center studies, the primary analysis assumes that the treatment effect is constant over centers. However, it is also recommended to perform an exploratory analysis to highlight possible center by treatment interaction, especially when several countries are involved. We propose in this paper an exploratory Bayesian approach to quantify this interaction in the context of survival data. To this end we used and generalized a random effects accelerated failure time model. The generalization consists in using a penalized Gaussian mixture as an error distribution on top of multivariate random effects that are assumed to follow a normal distribution. For computational convenience, the computations are based on Markov chain Monte Carlo techniques. The proposed method is illustrated on the disease-free survival times of early breast cancer patients collected in the EORTC trial 10854.
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Affiliation(s)
- Arnost Komárek
- Biostatistical Centre, Katholieke Universiteit Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium
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26
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Corn BW, Wexler ID, Suntharalingam M, Inbar M, Curran WJ. Globalization of the Radiation Therapy Oncology Group: implementation of a model for service expansion and public health improvement. J Clin Oncol 2008; 26:1160-6. [PMID: 18309952 DOI: 10.1200/jco.2007.14.3891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Radiation Therapy Oncology Group (RTOG) is part of the cooperative group network that is overseen by the National Cancer Institute (NCI). Although the NCI is a US-based group, it has empowered the cooperative groups to recruit foreign institutions to participate in collaborative clinical trials. The RTOG undertook the challenge of globalizing its efforts in 2004. This article describes the rationale for this decision and the tactics adopted by the first hospital outside of North America to enroll patients onto RTOG trials. The challenges confronted by foreign institutions seeking admission to the RTOG and the mechanism by which Tel Aviv Medical Center (TAMC) met these challenges are described. Shortly after its acceptance, TAMC emerged as one of the leading accruers of patients to RTOG studies. The public health implications of this accomplishment are discussed.
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Affiliation(s)
- Benjamin W Corn
- Department of Radiation Oncology, Tel Aviv Medical Center, Tel Aviv, Israel.
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27
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Vierron E, Giraudeau B. Sample size calculation for multicenter randomized trial: Taking the center effect into account. Contemp Clin Trials 2007; 28:451-8. [PMID: 17188941 DOI: 10.1016/j.cct.2006.11.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2006] [Revised: 10/17/2006] [Accepted: 11/12/2006] [Indexed: 11/27/2022]
Abstract
In multicenter trials, data from the same center are more similar than those from different centers. These similarities induce a correlation between data, known as the center effect, which is assessed by the intraclass correlation coefficient (ICC). Here, we derive a sample size formula for continuous data that takes into account this center effect. Our analytical developments lead to an elementary formula different from the classical one by a (1-rho) factor, where rho is the ICC. This work allows for adjusting and reducing the sample size according to the magnitude of the center effect and leads to a better consistency in the conduct of multicenter randomized trials.
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Affiliation(s)
- Emilie Vierron
- INSERM CIC 202, Université François Rabelais, Tours, CHRU de Tours, France.
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28
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Sauerbrei W, Royston P. Modelling to extract more information from clinical trials data: On some roles for the bootstrap. Stat Med 2007; 26:4989-5001. [PMID: 17607706 DOI: 10.1002/sim.2954] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Despite its importance in the theoretical literature, the bootstrap appears to play a negligible role in pharmaceutical research, as will be demonstrated by a brief literature review. As will be shown by examples, the bootstrap is a useful tool in the planning and analysis of clinical trials. The first example shows that some important information required in the design of a study can best be gained by using the bootstrap. It is argued from two further examples that more information can be extracted from large clinical trials by data-dependent modelling. This is shown by identifying a prognostic factor that may play a role as an inclusion criterion of a new study and by an interaction of a continuous predictor with treatment. To protect against erroneous conclusions from data-dependent modelling in a multivariable context, detailed checks of the results and stability analyses should be performed by the bootstrap. To conclude, a discussion of the future of modelling and the future of the bootstrap is given.
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Affiliation(s)
- Willi Sauerbrei
- Institute of Medical Biometry and Medical Informatics, University Medical Center Freiburg, Stefan-Meier-Strasse 26, 79104 Freiburg, Germany.
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