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      A pre‐specified statistical analysis plan for the VERIFY study: Vildagliptin efficacy in combination with metformin for early treatment of T2DM

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          Abstract

          Aims

          To ensure the integrity of the planned analyses and maximize the clinical utility of the VERIFY study results by describing the detailed concepts behind its statistical analysis plan (SAP) before completion of data collection and study database lock. The SAP will be adhered to for the final primary data analysis of the VERIFY trial.

          Materials and Methods

          Vildagliptin efficacy in combination with metformin for early treatment of T2DM (VERIFY) is an ongoing, multicentre, randomized controlled trial aiming to demonstrate the clinical benefits of glycaemic durability and glucose control achieved with an early combination therapy in newly‐diagnosed type 2 diabetes (T2DM) patients.

          Results

          The SAP was initially designed at the study protocol conception phase and later modified, as reported here, in collaboration between the steering committee members, statisticians, and the VERIFY study leadership team. All authors were blinded to treatment allocation. An independent statistician has additionally retrieved and presented unblinded data to the independent data safety monitoring committee. An overview of the trial design with a focus on describing the fine‐tuning of the analysis plan for the primary efficacy endpoint, risk of initial treatment failure, and secondary, exploratory and pre‐specified subgroup analyses is provided here.

          Conclusion

          According to optimal trial practice, the details of the statistical analysis and data‐handling plan prior to locking the database are reported here. The SAP accords with high‐quality standards of internal validity to minimize analysis bias and will enhance the utility of the reported results for improved outcomes in the management of T2DM.

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          Most cited references13

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          The UK Prospective Diabetes Study (UKPDS): clinical and therapeutic implications for type 2 diabetes

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            Cardiovascular Outcomes Trials in Type 2 Diabetes: Where Do We Go From Here? Reflections From a Diabetes Care Editors’ Expert Forum

            In December 2008, the U.S. Food and Drug Administration issued guidance to the pharmaceutical industry setting new expectations for the development of antidiabetes drugs for type 2 diabetes. This guidance expanded the scope and cost of research necessary for approval of such drugs by mandating long-term cardiovascular outcomes trials (CVOTs) for safety. Since 2008, 9 CVOTs have been reported, 13 are under way, and 4 have been terminated. Reassuringly, each of the completed trials demonstrated the noninferiority of their respective drugs to placebo for their primary cardiovascular (CV) composite end point. Notably, four additionally provided evidence of CV benefit in the form of significant decreases in the primary CV composite end point, two suggested reductions in CV death, and three suggested reductions in all-cause mortality. Although these trials have yielded much valuable information, whether that information justifies the investment of time and resources is controversial. In June 2016, a Diabetes Care Editors’ Expert Forum convened to review the processes and challenges of CVOTs, discuss the benefits and limitations of their current designs, and weigh the merits of modifications that might improve the efficiency and clinical value of future trials. Discussion and analysis continued with the CVOT trial results released in June 2017 at the American Diabetes Association’s Scientific Sessions and in September 2017 at the European Association for the Study of Diabetes scientific meeting. This article summarizes the discussion and findings to date.
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              Estimating renal function in old people: an in-depth review

              Estimates of glomerular filtration rate (eGFR) should provide accurate measure of an individual’s kidney function because important clinical decisions such as timing of renal replacement therapy and drug dosing may be dependent on eGFR. Formulae from which eGFR is derived are generally based on serum creatinine measurement, such as Cockcroft–Gault, MDRD and CKD-EPI. More recently, calculation of eGFR using other laboratory biomarkers such as cystatin C has emerged with apparent greater accuracy. In old people, there is age-related physiological change in the kidney, which could lead to reduced GFR. Likewise, physiological changes in body composition that occur with the ageing process impede the use of a single creatinine-based calculation of eGFR across all adult age groups. Studies have shown differences in the prevalence of CKD based on the type of equation used to estimate GFR. This review discusses the evolution of eGFR calculations and the relative accuracy of such equations in older population.
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                Author and article information

                Contributors
                david.matthews@ocdem.ox.ac.uk
                Journal
                Diabetes Obes Metab
                Diabetes Obes Metab
                10.1111/(ISSN)1463-1326
                DOM
                Diabetes, Obesity & Metabolism
                Blackwell Publishing Ltd (Oxford, UK )
                1462-8902
                1463-1326
                30 June 2019
                October 2019
                : 21
                : 10 ( doiID: 10.1111/dom.v21.10 )
                : 2240-2247
                Affiliations
                [ 1 ] Oxford Centre for Diabetes Endocrinology and Metabolism, Radcliffe Department of Medicine Oxford UK
                [ 2 ] Harris Manchester College, University of Oxford Oxford UK
                [ 3 ] Department of Cardiovascular Metabolism, Novartis Pharma AG Basel Switzerland
                [ 4 ] Divisions of Endocrinology and Diabetes University Hospital Leipzig Leipzig Germany
                [ 5 ] Clinical Development and Analytics, Novartis Pharmaceutical Corporation East Hanover New Jersey
                [ 6 ] Department of Clinical and Experimental Medicine, Section of Metabolic Diseases and Diabetes University of Pisa Pisa Italy
                Author notes
                [*] [* ] Correspondence

                David R. Matthews, MD, Harris Manchester College, Mansfield Road, Oxford, OX1 2TD, UK.

                Email: david.matthews@ 123456ocdem.ox.ac.uk

                Author information
                https://orcid.org/0000-0001-6504-0036
                https://orcid.org/0000-0002-5388-0270
                Article
                DOM13800
                10.1111/dom.13800
                6771473
                31144427
                cc2a67f0-e22c-4ce0-a848-0983d66fbaae
                © 2019 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 12 April 2019
                : 16 May 2019
                : 28 May 2019
                Page count
                Figures: 1, Tables: 4, Pages: 8, Words: 6264
                Funding
                Funded by: Novartis Pharmaceutical Corporation
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                dom13800
                October 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.9 mode:remove_FC converted:01.10.2019

                Endocrinology & Diabetes
                glycaemic durability,randomized controlled trial,statistical analysis plan,type 2 diabetes mellitus,verify study,vildagliptin

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