Division of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Clin Ther. 2011 Dec;33(12):2072-81. doi: 10.1016/j.clinthera.2011.10.026. Epub 2011 Dec 2.
There is a need to explore feasible means of accruing an appropriate study cohort to help fill the knowledge gap between pharmacogenetic contributions to drug response and clinical application in the pediatric population.
The aim of this study was to identify factors affecting recruitment of eligible subjects in pharmacogenetic studies at a large Midwestern pediatric academic medical center. The objectives were to evaluate recruitment success of ongoing trials and ascertain contributors to differential recruitment rates. We hypothesized that studies with good recruitment of eligible subjects would share characteristics not present in studies with lower than anticipated recruitment. The goal was to better understand barriers to good recruitment in pharmacogenetic studies to help inform future trial and infrastructure design.
Investigators designed a survey with proposed elements of success, which was then completed by lead and/or site investigators of all pharmacogenetics studies at the institution. Results were evaluated using an investigator-developed likelihood of success scoring system.
Two studies recruited >95% of the approached eligible patients; 4 studies were consistent with investigator-anticipated recruitment (>50%), and 1 study did not meet expected recruitment. A study's total score on the investigator-devised scoring tool correlated well with the proportion of approached patients recruited (Pearson's correlation, r = 0.82; P < 0.001). Multiple factors impacted successful recruitment into these pharmacogenetic studies. Features of studies with successful recruitment included standardized clinical care, an ongoing team-patient relationship, severe and/or life-threatening outcome measures, study coordinator with experience in clinical research, a study medication with few or no alternative treatment options, and active involvement of the research team in clinical care.
A scoring system for study characteristics may be useful to calculate the risk of failure for successful recruitment, allow discrimination among characteristics contributing to the risk, and permit study design alterations to improve likelihood of successful recruitment in pediatric pharmacogenetic studies.
需要探索可行的方法来积累适当的研究队列,以帮助填补药物反应的遗传药理学贡献与儿科人群临床应用之间的知识空白。
本研究旨在确定在中西部一家大型儿科学术医疗中心进行遗传药理学研究时影响合格受试者招募的因素。目的是评估正在进行的试验的招募成功率,并确定导致招募率差异的因素。我们假设,招募合格受试者成功率高的研究具有研究设计中没有的特点。目标是更好地了解遗传药理学研究中招募工作的障碍,为未来的试验和基础设施设计提供信息。
研究人员设计了一份带有成功要素的调查问卷,然后由机构内所有遗传药理学研究的首席和/或现场调查员完成。使用研究人员开发的成功可能性评分系统对结果进行评估。
两项研究招募了超过 95%的合格患者;四项研究与研究人员预期的招募率一致(>50%),一项研究未达到预期的招募率。研究人员设计的评分工具上的研究总得分与所招募患者的比例密切相关(Pearson 相关系数,r=0.82;P<0.001)。许多因素影响了这些遗传药理学研究的成功招募。成功招募研究的特点包括标准化的临床护理、持续的团队-患者关系、严重和/或危及生命的结果测量、具有临床研究经验的研究协调员、研究药物几乎没有或没有替代治疗方案,以及研究团队积极参与临床护理。
研究特征的评分系统可能有助于计算成功招募的失败风险,区分导致风险的特征,并允许研究设计改变,以提高儿科遗传药理学研究中成功招募的可能性。