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Kinamon T, Gopinath R, Waack U, Needles M, Rubin D, Collyar D, Doernberg SB, Evans S, Hamasaki T, Holland TL, Howard-Anderson J, Chambers H, Fowler VG, Nambiar S, Kim P, Boucher HW. Exploration of a Potential Desirability of Outcome Ranking Endpoint for Complicated Intra-Abdominal Infections Using 9 Registrational Trials for Antibacterial Drugs. Clin Infect Dis 2023; 77:649-656. [PMID: 37073571 PMCID: PMC10443999 DOI: 10.1093/cid/ciad239] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Desirability of outcome ranking (DOOR) is a novel approach to clinical trial design that incorporates safety and efficacy assessments into an ordinal ranking system to evaluate overall outcomes of clinical trial participants. Here, we derived and applied a disease-specific DOOR endpoint to registrational trials for complicated intra-abdominal infection (cIAI). METHODS Initially, we applied an a priori DOOR prototype to electronic patient-level data from 9 phase 3 noninferiority trials for cIAI submitted to the US Food and Drug Administration between 2005 and 2019. We derived a cIAI-specific DOOR endpoint based on clinically meaningful events that trial participants experienced. Next, we applied the cIAI-specific DOOR endpoint to the same datasets and, for each trial, estimated the probability that a participant assigned to the study treatment would have a more desirable DOOR or component outcome than if assigned to the comparator. RESULTS Three key findings informed the cIAI-specific DOOR endpoint: (1) a significant proportion of participants underwent additional surgical procedures related to their baseline infection; (2) infectious complications of cIAI were diverse; and (3) participants with worse outcomes experienced more infectious complications, more serious adverse events, and underwent more procedures. DOOR distributions between treatment arms were similar in all trials. DOOR probability estimates ranged from 47.4% to 50.3% and were not significantly different. Component analyses depicted risk-benefit assessments of study treatment versus comparator. CONCLUSIONS We designed and evaluated a potential DOOR endpoint for cIAI trials to further characterize overall clinical experiences of participants. Similar data-driven approaches can be utilized to create other infectious disease-specific DOOR endpoints.
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Affiliation(s)
- Tori Kinamon
- Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Oak Ridge Institute for Science and Education, United States Department of Energy, Oak Ridge, TN, USA
| | - Ramya Gopinath
- Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Ursula Waack
- Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Mark Needles
- Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Daniel Rubin
- Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | | | - Sarah B Doernberg
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, CA, USA
| | - Scott Evans
- Biostatistics Center and Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
- Antibiotic Resistance Leadership Group, Durham, NC, USA
| | - Toshimitsu Hamasaki
- Biostatistics Center and Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
- Antibiotic Resistance Leadership Group, Durham, NC, USA
| | - Thomas L Holland
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Duke Clinical Research Institute, Durham, NC, USA
| | - Jessica Howard-Anderson
- Antibiotic Resistance Leadership Group, Durham, NC, USA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Henry Chambers
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, CA, USA
- Antibiotic Resistance Leadership Group, Durham, NC, USA
| | - Vance G Fowler
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Antibiotic Resistance Leadership Group, Durham, NC, USA
| | - Sumati Nambiar
- Antibiotic Resistance Leadership Group, Durham, NC, USA
- Child Health Innovation and Leadership Department, Johnson & Johnson, Raritan, NJ, USA
| | - Peter Kim
- Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD, USA
| | - Helen W Boucher
- Antibiotic Resistance Leadership Group, Durham, NC, USA
- Tufts University School of Medicine and Tufts Medicine, Boston, MA, USA
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