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Locher C, Laporte S, Derambure P, Chassany O, Girault C, Avakiantz A, Bahans C, Deplanque D, Fustier P, Germe AF, Kassaï B, Lacoste L, Petitpain N, Roustit M, Simon T, Train C, Cucherat M. Data Monitoring Committees and clinical trials: From scientific justification to organisation. Therapie 2024; 79:111-121. [PMID: 38103949 DOI: 10.1016/j.therap.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
Clinical trials often last several months or even several years. As the trial progresses, it can be tempting to find out whether the data obtained already answers the question posed at the start of the trial in order to stop inclusions or monitoring earlier. However, knowing and taking into account interim results can sometimes compromise the integrity of the results, which is counterproductive. To minimise this risk and ensure that the treatments are assessed reliably, safety and/or efficacy criteria are monitored during the study by a Data Monitoring Committee. After receiving the results confidentially, the Data Monitoring Committee assesses the benefit/risk ratio of the study treatment and recommends that the trial be continued, modified or terminated. Data Monitoring Committee members issuing these recommendations have an important responsibility: a hasty decision to end the trial may lead to inconclusive results unable to answer the initial question and, inversely, delaying the decision to end the trial may expose the subjects to potentially ineffective or even harmful interventions. The Data Monitoring Committee's task is therefore particularly complex. With this in mind, the round table discussion at the Giens workshops was a chance to review the scientific justification for creating Data Monitoring Committees and to recall the need for their members to receive comprehensive training on the complexities of multiple analyses, confidentiality requirements applying to the results and the need for them to be aware that recommendations to end a trial must be based on data that is robust enough to assess the benefit/risk ratio of the treatment studied.
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Affiliation(s)
- Clara Locher
- Inserm, UMR S 1085, service de pharmacologie clinique, Centre d'investigation clinique de Rennes (CIC1414), Institut de recherche en santé, environnement et travail (Irset), CHU de Rennes, 35000 Rennes, France.
| | - Silvy Laporte
- UMR 1059 Inserm, URC/pharmacologie clinique, université Jean-Monnet Saint-Étienne, CHU de Saint-Étienne, 42055 Saint-Étienne, France
| | | | - Olivier Chassany
- Unité de recherche clinique en économie de la santé (URC-ECO), hôpital Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - Cécile Girault
- Fédération francophone de cancérologie digestive (FFCD), 21000 Dijon, France
| | | | - Claire Bahans
- Département de pédiatrie, CHU de Limoges, 87000 Limoges, France
| | - Dominique Deplanque
- Inserm, CIC 1403, Centre d'investigation clinique, University of Lille, CHU de Lille, 59000 Lille, France
| | - Pierre Fustier
- Département de recherche et développement clinique - hématologie - BeiGene, Switzerland GmbH, 4051 Basel, Switzerland
| | | | - Behrouz Kassaï
- Inserm, UMR 5558 CNRS, service de pharmacotoxicologie, Centre d'investigation clinique 1407, hospices civils de Lyon, université de Lyon, 69000 Lyon, France
| | - Louis Lacoste
- Pôle USSAR, anesthésie réanimation, CHU de Poitiers, 86021 Poitiers, France
| | - Nadine Petitpain
- Unité de vigilance des essais cliniques, DRCI CHRU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - Matthieu Roustit
- Inserm, CIC1406, University Grenoble Alpes, CHU de Grenoble, 38000 Grenoble, France
| | - Tabassome Simon
- Service de pharmacologie clinique, plateforme de recherche de l'est parisien (URCEST-CRCEST-CRB), hôpital Saint-Antoine, Sorbonne université, Assistance publique-Hôpitaux de Paris (AP-HP), 75000 Paris, France
| | | | - Michel Cucherat
- metaEvidence.org, service de pharmacotoxicologie, hospices civils de Lyon, 69000 Lyon, France
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El Miedany Y, El Gaafary M, Toth M, Palmer D, Ali A, Bahlas S, Mahran S, Hassan W, Abu-Zaid MH, Saber S, Elwakil W. Beyond the symptoms: Personalizing giant cell arteritis care through multidimensional patient reported outcome measure. Semin Arthritis Rheum 2023; 63:152285. [PMID: 37944298 DOI: 10.1016/j.semarthrit.2023.152285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Giant Cell Arteritis (GCA) is the commonest form of systemic vasculitis in people over the age of 50. Published research highlighted the lack of a disease-specific patient reported outcomes (PROMs) for GCA. OBJECTIVES To assess the validity, reliability and responsiveness to change of a devised disease specific patient self-reported outcome measures questionnaire for Giant Cell Arteritis (GCA). METHODS The GCA-PROMs was conceptualized based on frameworks outlined in the OMERACT developed core set of Outcome Measures for Large-Vessel Vasculitis and the guiding principles of the FDA guidance. Initially, cognitive interviews were conducted to identify item pool of questions. Item selection and reduction was achieved based on patients as well as an interdisciplinary group of specialists. Rasch and internal consistency reliability analyses were implemented. RESULTS A total of 54 GCA patients completed the questionnaire. The GCA-PROMs questionnaire was reliable as demonstrated by a high standardized alpha (0.878-0.983). Content construct assessment of the GCA-PROMs functional disability and QoL revealed significant correlation (p< 0.01) with both HAQ and EQ-5D. Changes in functional disability, QoL showed significant (p< 0.01) variation with diseases activity status in response to therapy. CONCLUSIONS The developed GCA-PROMs questionnaire is a reliable and valid instrument for assessment of GCA patients. A stratified treatment regimen depending on the individual patient's risk factors as well as preferences and associated comorbidities is the best approach to tailored patient management.
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Affiliation(s)
- Y El Miedany
- Professor Canterbury Christ Church University, England; H. Senior Clinical Lecturer, King's College London, England.
| | - M El Gaafary
- Professor Community and Public Health, Ain Shams University, Cairo, Egypt
| | - M Toth
- H. Senior Clinical Lecturer, King's College London, England; Darent Valley Hospital, Kent, England
| | - D Palmer
- North Middlesex University Hospital, London, England
| | - Ayman Ali
- Darent Valley Hospital, Kent, England
| | - S Bahlas
- Professor of Internal Medicine/Rheumatology, College of Medicine, King Abdulaziz University, Saudi Arabia
| | - S Mahran
- Professor Rheumatology, Physical Medicine and Rehabilitation, Assiut University, Egypt
| | - W Hassan
- Professor Rheumatology and Rehabilitation, Benha University, Benha, Egypt
| | - M H Abu-Zaid
- Assistant Professor Rheumatology and Rehabilitation, Tanta University, Tanta, Egypt
| | - S Saber
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
| | - W Elwakil
- Lectuer Rheumatology and Rehabilitation, Alexandria University, Alexanrdia, Egypt
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Kosker AR. Metal and fatty acid levels of some commercially important marine species from the northeastern Mediterranean: benefits and health risk estimation. Environ Monit Assess 2020; 192:358. [PMID: 32394291 DOI: 10.1007/s10661-020-08287-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
Metal and fatty acid levels of some commercially important fish and crustacean species of economic value in the northeastern Mediterranean (Mersin Bay) were investigated. In addition, to predict possible risks regarding consumer health that may arise from the consumption of these species, risk estimates were calculated for adults and children considering consumption frequencies of one, three and seven times a week. The estimated weekly intake (EWI), target hazard quotient (THQ), lifetime cancer risk (CR) and benefit/risk ratio associated with their consumption were calculated. EWI values were found to be lower than the provisional tolerable weekly intake (PTWI) values determined by the European Food Safety Authority and FAO/WHO. For most samples examined, THQ was < 1. The benefit/risk ratios for all samples were calculated to be less than threshold. For the fish species examined, CR for consumers was identified to be low, except for heavy consumption cases.
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Affiliation(s)
- Ali Rıza Kosker
- Faculty of Fisheries, Cukurova University, 01330, Adana, Turkey.
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Abstract
Neuropathic pain is caused by a lesion or disease affecting the somatosensory system and is difficult to manage, often proving refractory to existing treatments. In more than half of cases, it is localized and affects a specific, clearly circumscribed area of the body (localized neuropathic pain, or LNP). A recently developed screening tool enables patients with probable neuropathic pain/LNP to be identified quickly and easily. In view of the conflicting current treatment recommendations, an advisory board of pain specialists met in June 2015 to develop a complementary treatment guidance algorithm, for use in the primary care setting and by non-pain specialists. The starting point of the algorithm is a diagnosis of LNP and there was consensus that first-line treatment should be a topical analgesic agent, because the benefit/risk ratios are far better than for systemic agents. Topical application offers site-specific delivery, a lower total systemic dose and avoidance of first-pass metabolism, reducing the risk of adverse events and drug/drug interactions. The 5% lidocaine medicated plaster has most evidence supporting its use in LNP, producing effective analgesia and reducing the associated area of allodynia, but other topical agents include capsaicin, clonidine and botulinum toxin type A. Treatment should be commenced with the topical agent of choice, and the patient re-assessed after an appropriate period. Where the response is good the topical agent is continued, with a re-evaluation after 3-6 months. A systemic agent (e.g. gabapentin, pregabalin, duloxetine, venlafaxine) is added if there is only a partial response, or substituted if there is no response, and the patient re-assessed after a month. If there is poor or no response to the systemic agent the patient should be switched to an alternative one and, if this also proves ineffective, referred to a pain specialist.
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Affiliation(s)
- Massimo Allegri
- a a Pain Therapy Service, Azienda Ospedaliera Universitaria Parma Hospital , Parma , Italy
| | - Ralf Baron
- b b Division of Neurological Pain Research and Therapy, Department of Neurology , Christian-Albrechts-Universität zu Kiel , Kiel , Germany
| | - Guy Hans
- c c Multidisciplinary Pain Centre, Antwerp University Hospital , Edegum , Belgium
| | - Gerardo Correa-Illanes
- d d Rehabilitation Department , Hospital del Trabajador de Asociación Chilena de Seguridad , Santiago , Chile
| | - Victor Mayoral Rojals
- e e Anaesthesiology Department , Hospital Universitario de Bellvitge, 08907 El Hospitalet de Llobregat , Barcelona , Spain
| | - Gerard Mick
- f f Centre for Pain Evaluation and Treatment, University Neurological Hospital , Lyons , France
| | - Michael Serpell
- g g University Department of Anaesthesia , Pain Research Office, Gartnavel General Hospital , Glasgow , Scotland , UK
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