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2型糖尿病近期3期试验中使用的患者报告结局(PROs):对这些PROs评估的概念以及未来试验选择PRO时需考虑的因素的综述

Patient Reported Outcomes (PROs) used in recent Phase 3 trials for Type 2 Diabetes: A review of concepts assessed by these PROs and factors to consider when choosing a PRO for future trials.

作者信息

Reaney Matthew, Elash Celeste A, Litcher-Kelly Leighann

机构信息

ERT, Peterborough, UK; University of Chichester, UK.

ERT, Pittsburgh, USA.

出版信息

Diabetes Res Clin Pract. 2016 Jun;116:54-67. doi: 10.1016/j.diabres.2016.04.009. Epub 2016 Apr 23.

Abstract

AIMS

Many treatment options are available for people with Type 2 Diabetes (T2D). While the goal of treatment is to reach target HbA1c levels, the psychological experience may be more tangible and meaningful for the patient. Together with biomarkers, Patient-Reported Outcome (PRO) data provide a holistic understanding of the clinical and psychosocial impact of T2D and its treatment.

METHODS

A literature review was conducted in multiple databases to identify PRO endpoints used in Phase 3 trials of newer classes of drugs for the treatment of T2D.

RESULTS

This review identified five PRO concepts which were evaluated as endpoints in Phase 3 trials of GLP-1 receptor agonists, novel insulins, SGLT-2 inhibitors, and DPP-4 inhibitors; symptoms, health-related quality of life, psychological well-being, satisfaction with treatment/health and impact of weight. Twenty PRO questionnaires were used to measure these concepts/endpoints directly from patients. The relevance of, and scientific basis for, these concepts as endpoints are discussed, the similarities and differences between questionnaires targeting the same concepts/endpoints are explored, and the sensitivity of the questionnaires to the experimental intervention is summarized. In addition, factors that should be considered when choosing PROs for future T2D trials are discussed.

CONCLUSIONS

The information gained from PROs in clinical trial research is important in defining treatment benefit within the context of the trial, and the potential benefit (i.e. better adherence) in clinical practice. However, variable results have been observed in recent trials and careful and systematic consideration should be given to PRO selection for future studies of T2D.

摘要

目的

2型糖尿病(T2D)患者有多种治疗选择。虽然治疗目标是达到糖化血红蛋白(HbA1c)目标水平,但心理体验对患者而言可能更切实且有意义。患者报告结局(PRO)数据与生物标志物一起,能全面了解T2D及其治疗的临床和社会心理影响。

方法

在多个数据库中进行文献综述,以确定用于新型T2D治疗药物3期试验的PRO终点。

结果

本综述确定了五个PRO概念,这些概念在胰高血糖素样肽-1(GLP-1)受体激动剂、新型胰岛素、钠-葡萄糖协同转运蛋白2(SGLT-2)抑制剂和二肽基肽酶-4(DPP-4)抑制剂的3期试验中被评估为终点;症状、健康相关生活质量、心理健康、对治疗/健康的满意度以及体重影响。使用了20份PRO问卷直接从患者那里测量这些概念/终点。讨论了这些概念作为终点的相关性和科学依据,探讨了针对相同概念/终点的问卷之间的异同,并总结了问卷对实验干预的敏感性。此外,还讨论了在未来T2D试验中选择PRO时应考虑的因素。

结论

从临床试验研究中的PRO获得的信息对于在试验背景下定义治疗益处以及临床实践中的潜在益处(即更好的依从性)很重要。然而,最近的试验中观察到了不同的结果,未来T2D研究的PRO选择应进行仔细和系统的考虑。

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