Decision architecture randomisation: extremely efficient clinical trials that preserve clinician and patient choice?

Flory, James; Ancker, Jessica S.; Kim, Scott Y. H.; Kuperman, Gilad J.; Vickers, Andrew J.

doi:10.1136/bmjebm-2023-112386

Cited by 2 publications

(1 citation statement)

References 20 publications

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“…At the end of the combined treatment with leuprorelin and anastrozole, the 20 girls in Group A of the GAIL study ( 1 ) were further randomized into two subgroups using their electronic health record numbers only ( 6 ). A total of 10 girls forming subgroup A1 continued anastrozole as monotherapy until BA 14 years, while the 10 girls forming subgroup A2 did not receive any therapy.…”

Section: Methodsmentioning

confidence: 99%

Anastrozole monotherapy further improves near-adult height after the initial combined treatment with leuprorelin and anastrozole in early-maturing girls with compromised growth prediction: results from the second phase of the GAIL study

Papadimitriou,

Dermitzaki,

Christopoulos

et al. 2024

Front. Endocrinol.

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BackgroundThe first phase of the GAIL study (“Girls treated with an Aromatase Inhibitor and Leuprorelin,” ISRCTN11469487) has shown that the combination of anastrozole and leuprorelin for 24 months is safe and effective in improving the predicted adult height (PAH) in girls with early puberty and compromised growth prediction by +1.21 standard deviation score (SDS; +7.51 cm) compared to inhibition of puberty alone, +0.31 SDS (+1.92 cm).Objectives and hypothesesIn the second phase of the GAIL study, we assessed the adult height (AH)/near-adult height (NAH) at the end of the first phase and, in addition, the efficacy of anastrozole monotherapy thereafter in further improving NAH.MethodsWe measured the AH (age 16.5 years)/NAH [bone age (BA), 15 years] of the 40 girls included, divided into two matched groups: group A (20 girls on anastrozole + leuprorelin) and group B (20 girls on leuprorelin alone). Group A was further randomized into two subgroups: A1 and A2. Group A1 (n = 10), after completion of the combined therapy, received anastrozole 1 mg/day as monotherapy until BA 14 years, with a 6-month follow-up. Group A2 (n = 10) and group B (n = 20), who received only the combined treatment and leuprorelin alone, respectively, were recalled for evaluation of AH/NAH.ResultsAH or NAH exceeded the PAH at the completion of the 2-year initial phase of the GAIL study in all groups, but the results were statistically significant only in group A1: NAH–PAH group A1, +3.85 cm (+0.62 SDS, p = 0.01); group A2, +1.6 cm (+0.26 SDS, p = 0.26); and group B, +1.7 cm (+0.3 SDS, p = 0.08). The gain in group A1 was significantly greater than that in group A2 (p = 0.04) and in group B (p = 0.03). Anastrozole was determined to be safe even as monotherapy in Group A1.ConclusionsIn early-maturing girls with compromised growth potential, the combined treatment with leuprorelin and anastrozole for 2 years or until the age of 11 years resulted in a total gain in height of +9.7 cm when continuing anastrozole monotherapy until the attainment of NAH, as opposed to +7.4 cm if they do not continue with the anastrozole monotherapy and +3.6 cm when treated with leuprorelin alone. Thus, the combined intervention ends at the shortest distance from the target height if continued with anastrozole monotherapy until BA 14 years.

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Section: Methodsmentioning

confidence: 99%

Anastrozole monotherapy further improves near-adult height after the initial combined treatment with leuprorelin and anastrozole in early-maturing girls with compromised growth prediction: results from the second phase of the GAIL study

Papadimitriou,

Dermitzaki,

Christopoulos

et al. 2024

Front. Endocrinol.

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Individualized clinical decisions within standard-of-care pragmatic clinical trials: Implications for consent

Astrachan,

Flory,

Kim

2024

Clinical Trials

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Pragmatic clinical trials of standard-of-care interventions compare the relative merits of medical treatments already in use. Traditional research informed consent processes pose significant obstacles to these trials, raising the question of whether they may be conducted with alteration or waiver of informed consent. However, to even be eligible, such a trial in the United States must have no more than minimal research risk. We argue that standard-of-care pragmatic clinical trials can be designed to ensure that they are minimal research risk if the random assignment of an intervention in a pragmatic clinical trial can accommodate individualized, clinically motivated decision-making for each participant. Such a design will ensure that the patient-participants are not exposed to any risks beyond the clinical risks of the interventions, and thus, the trial will have minimal research risk. We explain the logic of this view by comparing three scenarios of standard-of-care pragmatic clinical trials: one with informed consent, one without informed consent, and one recently proposed design called Decision Architecture Randomization Trial. We then conclude by briefly showing that our proposal suggests a natural way to determine when to use an alteration versus a waiver of informed consent.

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Decision architecture randomisation: extremely efficient clinical trials that preserve clinician and patient choice?

Cited by 2 publications

References 20 publications

Anastrozole monotherapy further improves near-adult height after the initial combined treatment with leuprorelin and anastrozole in early-maturing girls with compromised growth prediction: results from the second phase of the GAIL study

Anastrozole monotherapy further improves near-adult height after the initial combined treatment with leuprorelin and anastrozole in early-maturing girls with compromised growth prediction: results from the second phase of the GAIL study

Individualized clinical decisions within standard-of-care pragmatic clinical trials: Implications for consent

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