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      Reporting of data monitoring committees and adverse events in paediatric trials: a descriptive analysis

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          Abstract

          Objectives

          For 300 paediatric trials, we evaluated the reporting of: a data monitoring committee (DMC); interim analyses, stopping rules and early stopping; and adverse events and harm-related endpoints.

          Methods

          For this cross-sectional evaluation, we randomly selected 300 paediatric trials published in 2012 from the Cochrane Central Register of Controlled Trials. We collected data on the reporting of a DMC; interim analyses, stopping rules and early stopping; and adverse events and harm-related endpoints. We reported the findings descriptively and stratified by trial characteristics.

          Results

          Eighty-five (28%) of the trials investigated drugs, and 18% (n=55/300) reported a DMC. The reporting of a DMC was more common among multicentre than single centre trials (n=41/132, 31% vs n=14/139, 10%, p<0.001) and industry-sponsored trials compared with those sponsored by other sources (n=16/50, 32% vs n=39/250, 16%, p=0.009). Trials that reported a DMC enrolled more participants than those that did not (median [range]): 224 (10–60480) vs 91 (10–9528) (p<0.001). Only 25% of these trials reported interim analyses, and 42% reported stopping rules. Less than half (n=143/300, 48%) of trials reported on adverse events, and 72% (n=215/300) reported on harm-related endpoints. Trials that reported a DMC compared with those that did not were more likely to report adverse events (n=43/55, 78% vs 100/245, 41%, p<0.001) and harm-related endpoints (n=52/55, 95% vs. 163/245, 67%, p<0.001). Only 32% of drug trials reported a DMC; 18% and 19% did not report on adverse events or harm-related endpoints, respectively.

          Conclusions

          The reporting of a DMC was infrequent, even among drug trials. Few trials reported stopping rules or interim analyses. Reporting of adverse events and harm-related endpoints was suboptimal.

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          Most cited references19

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          Reporting of Adverse Events in Published and Unpublished Studies of Health Care Interventions: A Systematic Review

          Background We performed a systematic review to assess whether we can quantify the underreporting of adverse events (AEs) in the published medical literature documenting the results of clinical trials as compared with other nonpublished sources, and whether we can measure the impact this underreporting has on systematic reviews of adverse events. Methods and Findings Studies were identified from 15 databases (including MEDLINE and Embase) and by handsearching, reference checking, internet searches, and contacting experts. The last database searches were conducted in July 2016. There were 28 methodological evaluations that met the inclusion criteria. Of these, 9 studies compared the proportion of trials reporting adverse events by publication status. The median percentage of published documents with adverse events information was 46% compared to 95% in the corresponding unpublished documents. There was a similar pattern with unmatched studies, for which 43% of published studies contained adverse events information compared to 83% of unpublished studies. A total of 11 studies compared the numbers of adverse events in matched published and unpublished documents. The percentage of adverse events that would have been missed had each analysis relied only on the published versions varied between 43% and 100%, with a median of 64%. Within these 11 studies, 24 comparisons of named adverse events such as death, suicide, or respiratory adverse events were undertaken. In 18 of the 24 comparisons, the number of named adverse events was higher in unpublished than published documents. Additionally, 2 other studies demonstrated that there are substantially more types of adverse events reported in matched unpublished than published documents. There were 20 meta-analyses that reported the odds ratios (ORs) and/or risk ratios (RRs) for adverse events with and without unpublished data. Inclusion of unpublished data increased the precision of the pooled estimates (narrower 95% confidence intervals) in 15 of the 20 pooled analyses, but did not markedly change the direction or statistical significance of the risk in most cases. The main limitations of this review are that the included case examples represent only a small number amongst thousands of meta-analyses of harms and that the included studies may suffer from publication bias, whereby substantial differences between published and unpublished data are more likely to be published. Conclusions There is strong evidence that much of the information on adverse events remains unpublished and that the number and range of adverse events is higher in unpublished than in published versions of the same study. The inclusion of unpublished data can also reduce the imprecision of pooled effect estimates during meta-analysis of adverse events.
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            Standard 5: selection, measurement, and reporting of outcomes in clinical trials in children.

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              A descriptive analysis of a representative sample of pediatric randomized controlled trials published in 2007

              Background Randomized controlled trials (RCTs) are the gold standard for trials assessing the effects of therapeutic interventions; therefore it is important to understand how they are conducted. Our objectives were to provide an overview of a representative sample of pediatric RCTs published in 2007 and assess the validity of their results. Methods We searched Cochrane Central Register of Controlled Trials using a pediatric filter and randomly selected 300 RCTs published in 2007. We extracted data on trial characteristics; outcomes; methodological quality; reporting; and registration and protocol characteristics. Trial registration and protocol availability were determined for each study based on the publication, an Internet search and an author survey. Results Most studies (83%) were efficacy trials, 40% evaluated drugs, and 30% were placebo-controlled. Primary outcomes were specified in 41%; 43% reported on adverse events. At least one statistically significant outcome was reported in 77% of trials; 63% favored the treatment group. Trial registration was declared in 12% of publications and 23% were found through an Internet search. Risk of bias (ROB) was high in 59% of trials, unclear in 33%, and low in 8%. Registered trials were more likely to have low ROB than non-registered trials (16% vs. 5%; p = 0.008). Effect sizes tended to be larger for trials at high vs. low ROB (0.28, 95% CI 0.21,0.35 vs. 0.16, 95% CI 0.07,0.25). Among survey respondents (50% response rate), the most common reason for trial registration was a publication requirement and for non-registration, a lack of familiarity with the process. Conclusions More than half of this random sample of pediatric RCTs published in 2007 was at high ROB and three quarters of trials were not registered. There is an urgent need to improve the design, conduct, and reporting of child health research.
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                Author and article information

                Journal
                BMJ Paediatr Open
                BMJ Paediatr Open
                bmjpo
                bmjpo
                BMJ Paediatrics Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2399-9772
                2019
                20 March 2019
                : 3
                : 1
                : e000426
                Affiliations
                [1 ] departmentAlberta Research Centre for Health Evidence , University of Alberta , Edmonton, Alberta, Canada
                [2 ] departmentDiscipline of Child and Adolescent Health and Centre for Kidney Research , University of Sydney , Sydney, New South Wales, Australia
                [3 ] departmentCentre for Kidney Research , The Children’s Hospital at Westmead , Sydney, New South Wales, Australia
                [4 ] departmentDepartment of Pediatrics , University of Alberta , Edmonton, Alberta, Canada
                [5 ] departmentDepartment of Medicine , University of the Philippines , Manila, Philippines
                [6 ] departmentFaculdade de Medicina , Universidade de Lisboa , Lisboa, Portugal
                [7 ] departmentDepartment of Pediatrics and Child Health , University of Manitoba , Winnipeg, Manitoba, Canada
                [8 ] departmentClinical Trials Platform , George and Fay Yee Centre for Healthcare Innovation , Winnipeg, Manitoba, Canada
                [9 ] departmentDevelopmental Medicine , Royal Children’s Hospital Melbourne , Parkville, Victoria, Australia
                [10 ] departmentDepartment of Psychological Sciences , University of Liverpool , Liverpool, UK
                Author notes
                [Correspondence to ] Dr Michele P Dyson; mdyson@ 123456ualberta.ca
                Author information
                http://orcid.org/0000-0002-0845-9786
                Article
                bmjpo-2018-000426
                10.1136/bmjpo-2018-000426
                6542427
                31206076
                021ff50a-8787-4ce5-8c21-672dc16d8a39
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 21 December 2018
                : 13 February 2019
                : 18 February 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;
                Categories
                Evidence Based Medicine
                1506
                Original article
                Custom metadata
                unlocked

                data collection,ethics,general paediatrics
                data collection, ethics, general paediatrics

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