The Proportion of Randomized Controlled Trials That Inform Clinical Practice: A Longitudinal Cohort Study of Trials Registered on ClinicalTrials.gov

Abstract

BackgroundPrior studies suggest that clinical trials are often hampered by problems in design, conduct and reporting that limit their uptake in clinical practice. We have described “informativeness” as the ability of a trial to guide clinical, policy or research decisions. Little is known about the proportion of initiated trials that inform clinical practice.MethodsWe created a cohort of randomized interventional clinical trials in three disease areas (ischemic heart disease, diabetes mellitus and lung cancer), that were initiated between 1 January 2009 and 31 December 2010 using ClinicalTrials.gov. We restricted inclusion to trials aimed at answering a clinical question related to the treatment or prevention of disease. Our primary outcome was the proportion of clinical trials fulfilling four conditions of informativeness: importance of the clinical question, trial design, feasibility, and reporting of results.ResultsOur study included 125 clinical trials. The proportion meeting four conditions for informativeness was 26.4% (95% CI 18.9 – 35.0). Sixty-seven percent of participants were enrolled in informative trials. The proportion of informative trials did not differ significantly between our three disease areas.ConclusionsOur results suggest that the majority of clinical trials designed to guide clinical practice possess features that may compromise their ability to do so. This highlights opportunities to improve the scientific vetting of clinical research.FundingThis study was funded by the Fonds de recherche Santé Québec postdoctoral research grant (NH). This funding body was not involved in study design, conduct or reporting.

Tracing the path of 37,050 studies into practice across 18 specialties of the 2.4 million published between 2011 and 2020

“…In the best-performing specialty (general and internal medicine), this citation reached a peak of 36%; that is, at least, 64% of trials are never cited. This was in line with a recent manual review of 125 randomized interventional clinical trials published in 2009–2010 in three disease areas (ischemic heart disease, diabetes mellitus, and lung cancer), which demonstrated only 26.4% of trials fulfilled four conditions of informativeness: importance of the clinical question, trial design, feasibility, and reporting of results ( Hutchinson et al, 2022 ).…”