Despite recent advance in methods for handling multiple endpoints in clinical trials, some challenges remain. This paper discusses some of these challenges, including confusion surrounding the terminology used to describe the multiple endpoints, the justification for simultaneously testing for non-inferiority and superiority in a non-inferiority trial, lack of agreement on the situations under which multiple objectives do or do not lead to the need for a multiplicity correction, and choice of the most appropriate multiple comparisons procedure. In addition, this paper will discuss the position of the recent FDA draft guidance, Multiple Endpoints in Clinical Trials, on these issues. Copyright © 2017 John Wiley & Sons, Ltd.
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http://dx.doi.org/10.1002/sim.7390 | DOI Listing |
Int J Stroke
January 2025
Medical University of South Carolina, Charleston, SC, USA.
Background: The usual antithrombotic treatment for symptomatic intracranial atherosclerotic stenosis (ICAS) consists of dual treatment with clopidogrel and aspirin for 90 days followed by aspirin alone but the risk of recurrent stroke remains high up to 12 months. The Comparison of Anticoagulation and anti-Platelet Therapies for Intracranial Vascular Atherostenosis (CAPTIVA) trial was designed to determine whether other combinations of dual antithrombotic therapy are superior to clopidogrel and aspirin.
Methods: CAPTIVA is an ongoing, prospective, double-blinded, three-arm clinical trial at over 100 sites in the United States and Canada that will randomize 1683 high-risk subjects with a symptomatic infarct attributed to 70-99% stenosis of a major intracranial artery to 12 months of treatment with (1) ticagrelor (180 mg loading dose, then 90 mg twice daily), (2) low-dose rivaroxaban (2.
J Clin Med
January 2025
Department of Anesthesiology, University Hospital of Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
: Enhanced recovery after surgery (ERAS) protocols aim to improve clinical outcomes, shorten hospital length of stay (LOS), and reduce costs through a multidisciplinary perioperative approach. Although introduced in colorectal surgery, they are less established in cardiac surgery, especially in combination with on-table extubation (OTE). This study evaluates the impact of a novel ERAS concept with OTE (RERACS) in elective aortic-valve-replacement and coronary bypass surgery.
View Article and Find Full Text PDFDiagnostics (Basel)
January 2025
Department of Medical Oncology, Sivas Cumhuriyet University School of Medicine, Sivas 58140, Turkey.
: This study evaluated the prognostic impact of Trop-2, CD47, and CD163 expression on clinical outcomes in triple-negative breast cancer (TNBC) and investigated their interactions with tumor progression. : A retrospective cohort of 92 patients with TNBC was analyzed. The expression scores for Trop-2, CD47, and CD163 were categorized as negative/low (0-3 points) or high (4-6 points).
View Article and Find Full Text PDFStat Med
February 2025
Villanova University, Villanova, Pennsylvania, USA.
We study the problem of testing multiple secondary endpoints conditional on a primary endpoint being significant in a two-stage group sequential procedure, focusing on two secondary endpoints. This extends our previous work with one secondary endpoint. The test for the secondary null hypotheses is a closed procedure.
View Article and Find Full Text PDFClin Orthop Relat Res
January 2025
Department of Rehabilitation, Radboud University Medical Center, Nijmegen, the Netherlands.
Background: Many patients with a lower limb socket-suspended prothesis experience socket-related problems, such as pain, chronic skin conditions, and mechanical problems, and as a result, health-related quality of life (HRQoL) is often negatively affected. A bone-anchored prosthesis can overcome these problems and improve HRQoL, but these prostheses have potential downsides as well. A valid and reliable tool to assess potential candidates for surgery concerning a favorable risk-benefit ratio between potential complications related to bone-anchored prostheses and improvements in HRQoL is not available yet.
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