Reporting Clinical End Points and Safety Events in an Acute Coronary Syndrome Trial: Results With Integrated Collection
BackgroundEnd points and adverse events (AEs) are collected separately in clinical trials, yet regulatory requirements for serious AE reporting vary across regions, so classifying end points according to seriousness criteria can be useful in global trials. Methods and ResultsIn the Apixaban for Prev...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2017-04-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.117.005490 |
| _version_ | 1811331999686721536 |
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| author | Patrícia O. Guimarães Renato D. Lopes Susanna R. Stevens André Zimerman Lisa Wruck Stefan K. James Ghazala Haque Roberto Rocha C. V. Giraldez John H. Alexander Karen P. Alexander |
| author_facet | Patrícia O. Guimarães Renato D. Lopes Susanna R. Stevens André Zimerman Lisa Wruck Stefan K. James Ghazala Haque Roberto Rocha C. V. Giraldez John H. Alexander Karen P. Alexander |
| author_sort | Patrícia O. Guimarães |
| collection | DOAJ |
| description | BackgroundEnd points and adverse events (AEs) are collected separately in clinical trials, yet regulatory requirements for serious AE reporting vary across regions, so classifying end points according to seriousness criteria can be useful in global trials. Methods and ResultsIn the Apixaban for Prevention of Acute Ischemic Events 2 (APPRAISE‐2) trial, patients with a recent acute coronary syndrome were randomized to apixaban or placebo for the prevention of recurrent ischemic events. Suspected end points (myocardial infarction, stroke, or bleeding) were adjudicated by an independent clinical events classification committee. Safety criteria were collected for suspected end points and AEs. Patient‐level event rates per 100 patient‐days of follow‐up, modeled using Poisson regression, explored the influence of region and patient characteristics on event reporting. Overall, 13 909 events were reported by 858 sites in 39 countries; 8.4% (n=1166) were suspected end points, and 91.6% (n=12 743) were AEs. Overall, 66.0% of suspected end points were confirmed by the clinical events classification committee. Most clinical events classification committee‐confirmed end points met criteria to be classified as serious (94.0%); many clinical events classification committee‐negated end points also did (63.2%), but fewer AEs met seriousness criteria (17.9%). The most common seriousness criterion was hospitalization (79.9%, n=2594). Region explained 28.7% of end point‐ and 26.4% of serious AE‐reporting variation, and patient characteristics explained an additional 25.4% of end point and 13.4% of serious AE variation. Nonserious AE‐reporting variation was not explained by adjustment. ConclusionsAn integrated collection of end points and serious AEs is feasible in a multinational trial and illustrates the shared characteristics of events. Tailoring event collection to fit the phase and purpose of the trial is achievable and informative. Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00831441. |
| first_indexed | 2024-04-13T16:29:23Z |
| format | Article |
| id | doaj.art-073b0a760ff946ae86a63f4d218f41fd |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T16:29:23Z |
| publishDate | 2017-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-073b0a760ff946ae86a63f4d218f41fd2022-12-22T02:39:37ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802017-04-016410.1161/JAHA.117.005490Reporting Clinical End Points and Safety Events in an Acute Coronary Syndrome Trial: Results With Integrated CollectionPatrícia O. Guimarães0Renato D. Lopes1Susanna R. Stevens2André Zimerman3Lisa Wruck4Stefan K. James5Ghazala Haque6Roberto Rocha C. V. Giraldez7John H. Alexander8Karen P. Alexander9Duke Clinical Research Institute, Duke University School of Medicine, Durham, NCDuke Clinical Research Institute, Duke University School of Medicine, Durham, NCDuke Clinical Research Institute, Duke University School of Medicine, Durham, NCDuke Clinical Research Institute, Duke University School of Medicine, Durham, NCDuke Clinical Research Institute, Duke University School of Medicine, Durham, NCUppsala Clinical Research Center, Uppsala University, Uppsala, SwedenDuke Clinical Research Institute, Duke University School of Medicine, Durham, NCInstituto do Coração (InCor), Hospital das Clínicas Faculdade de Medicina da Universidade de São Paulo, São Paulo, BrazilDuke Clinical Research Institute, Duke University School of Medicine, Durham, NCDuke Clinical Research Institute, Duke University School of Medicine, Durham, NCBackgroundEnd points and adverse events (AEs) are collected separately in clinical trials, yet regulatory requirements for serious AE reporting vary across regions, so classifying end points according to seriousness criteria can be useful in global trials. Methods and ResultsIn the Apixaban for Prevention of Acute Ischemic Events 2 (APPRAISE‐2) trial, patients with a recent acute coronary syndrome were randomized to apixaban or placebo for the prevention of recurrent ischemic events. Suspected end points (myocardial infarction, stroke, or bleeding) were adjudicated by an independent clinical events classification committee. Safety criteria were collected for suspected end points and AEs. Patient‐level event rates per 100 patient‐days of follow‐up, modeled using Poisson regression, explored the influence of region and patient characteristics on event reporting. Overall, 13 909 events were reported by 858 sites in 39 countries; 8.4% (n=1166) were suspected end points, and 91.6% (n=12 743) were AEs. Overall, 66.0% of suspected end points were confirmed by the clinical events classification committee. Most clinical events classification committee‐confirmed end points met criteria to be classified as serious (94.0%); many clinical events classification committee‐negated end points also did (63.2%), but fewer AEs met seriousness criteria (17.9%). The most common seriousness criterion was hospitalization (79.9%, n=2594). Region explained 28.7% of end point‐ and 26.4% of serious AE‐reporting variation, and patient characteristics explained an additional 25.4% of end point and 13.4% of serious AE variation. Nonserious AE‐reporting variation was not explained by adjustment. ConclusionsAn integrated collection of end points and serious AEs is feasible in a multinational trial and illustrates the shared characteristics of events. Tailoring event collection to fit the phase and purpose of the trial is achievable and informative. Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00831441.https://www.ahajournals.org/doi/10.1161/JAHA.117.005490acute coronary syndromeclinical end pointsclinical events classificationsafetyserious adverse events |
| spellingShingle | Patrícia O. Guimarães Renato D. Lopes Susanna R. Stevens André Zimerman Lisa Wruck Stefan K. James Ghazala Haque Roberto Rocha C. V. Giraldez John H. Alexander Karen P. Alexander Reporting Clinical End Points and Safety Events in an Acute Coronary Syndrome Trial: Results With Integrated Collection Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease acute coronary syndrome clinical end points clinical events classification safety serious adverse events |
| title | Reporting Clinical End Points and Safety Events in an Acute Coronary Syndrome Trial: Results With Integrated Collection |
| title_full | Reporting Clinical End Points and Safety Events in an Acute Coronary Syndrome Trial: Results With Integrated Collection |
| title_fullStr | Reporting Clinical End Points and Safety Events in an Acute Coronary Syndrome Trial: Results With Integrated Collection |
| title_full_unstemmed | Reporting Clinical End Points and Safety Events in an Acute Coronary Syndrome Trial: Results With Integrated Collection |
| title_short | Reporting Clinical End Points and Safety Events in an Acute Coronary Syndrome Trial: Results With Integrated Collection |
| title_sort | reporting clinical end points and safety events in an acute coronary syndrome trial results with integrated collection |
| topic | acute coronary syndrome clinical end points clinical events classification safety serious adverse events |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.005490 |
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