Systematic reviews in paediatric multiple sclerosis and Creutzfeldt-Jakob disease exemplify shortcomings in methods used to evaluate therapies in rare conditions - Université Paris Cité Accéder directement au contenu
Article Dans Une Revue Orphanet Journal of Rare Diseases Année : 2016

Systematic reviews in paediatric multiple sclerosis and Creutzfeldt-Jakob disease exemplify shortcomings in methods used to evaluate therapies in rare conditions

Résumé

Background: Randomized controlled trials (RCTs) are the gold standard design of clinical research to assess interventions. However, RCTs cannot always be applied for practical or ethical reasons. To investigate the current practices in rare diseases, we review evaluations of therapeutic interventions in paediatric multiple sclerosis (MS) and Creutzfeldt-Jakob disease (CJD). In particular, we shed light on the endpoints used, the study designs implemented and the statistical methodologies applied. Methods: We conducted literature searches to identify relevant primary studies. Data on study design, objectives, endpoints, patient characteristics, randomization and masking, type of intervention, control, withdrawals and statistical methodology were extracted from the selected studies. The risk of bias and the quality of the studies were assessed. Results: Twelve (seven) primary studies on paediatric MS (CJD) were included in the qualitative synthesis. No double-blind, randomized placebo-controlled trial for evaluating interventions in paediatric MS has been published yet. Evidence from one open-label RCT is available. The observational studies are before-after studies or controlled studies. Three of the seven selected studies on CJD are RCTs, of which two received the maximum mark on the Oxford Quality Scale. Four trials are controlled observational studies. Conclusions: Evidence from double-blind RCTs on the efficacy of treatments appears to be variable between rare diseases. With regard to paediatric conditions it remains to be seen what impact regulators will have through e.g., paediatric investigation plans. Overall, there is space for improvement by using innovative trial designs and data analysis techniques.
Fichier principal
Vignette du fichier
art_10.1186_s13023-016-0402-6.pdf (999.41 Ko) Télécharger le fichier
Origine : Publication financée par une institution
Loading...

Dates et versions

hal-01286678 , version 1 (11-03-2016)

Licence

Paternité

Identifiants

Citer

Steffen Unkel, Christian Röver, Nigel Stallard, Norbert Benda, Martin Posch, et al.. Systematic reviews in paediatric multiple sclerosis and Creutzfeldt-Jakob disease exemplify shortcomings in methods used to evaluate therapies in rare conditions. Orphanet Journal of Rare Diseases, 2016, 11, pp.16. ⟨10.1186/s13023-016-0402-6⟩. ⟨hal-01286678⟩
564 Consultations
346 Téléchargements

Altmetric

Partager

Gmail Facebook X LinkedIn More