Discrepancies in serious adverse event reporting may distort the medical evidence base

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The worst thing that can happen to a person participating in a clinical trial is what’s known as a ‘serious adverse event’, which can describe anything from permanent kidney damage or liver failure to hospitalization or even death. Federal law in the US mandates that researchers conducting trials of drugs or other products regulated by the country’s Food and Drug Administration (FDA) report adverse events on ClinicalTrials.gov, a data repository open to the public. But a new study shows that many of these serious adverse events don’t appear in medical journals, making some interventions seem more favorable than they may actually be.

Reporting online today in the Archives of Internal Medicine, a group of researchers led by Daniel Hartung, a drug safety and policy analyst at Oregon Health & Science University in Portland, looked at how the data reported on ClincialTrials.gov stack up against the results published in the medical literature. The team limited their focus to phase 3 or 4 trials with results reported on ClinicalTrials.gov and completed prior to 2009, to allow sufficient time for the trials’ results to be published in medical journals. Hartung’s group then randomly selected 10% of those trials that had matching publications, yielding a total of 110 trials.

Hartung’s team found that 33 of the trials reported a greater number of serious adverse events on ClinicalTrials.gov than in the medical literature. For example, a 13,608-person study comparing the blood-thinning drugs Effient (prasugrel) and Plavix (clopidogrel) reported in the online database a total of 3,406 serious adverse events among all participants in the trial, and 3,082 in a related publication. (The patients in the trial were at high risk of heart attack, and were undergoing angioplasty, so it’s important to note that these adverse events were not necessarily linked to the drugs.)

Of the 84 trials that reported the occurrence of serious adverse events in the public database, 16 of the matching publications either failed to mention them or incorrectly reported that they did not occur. (Notably, 5 trials actually reported more serious adverse events in related medical papers than they did in the public database.)

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Researchers less willing to share study details, according to journal’s survey

Researchers are increasingly reluctant to share the background details of their studies with other scientists according to new results from a survey of authors who published papers in the Annals of Internal Medicine in the last five years. This downward trend in researchers’ willingness to disclose such information is, unfortunately, at odds with the current surge in efforts to facilitate access to the types of study specifics that are vital to reproducing results.

Increasing transparency in research—by sharing the nitty-gritty details of studies that don’t make it into the published accounts, such as preliminary qualifying test results for clinical trial participants—is a hot topic. A report released on 29 March by the Institute of Medicine (IOM) based in Washington, DC, entitled “Sharing Clinical Research Data: A Workshop,” concluded that giving other scientists access to information from studies was increasingly important for the research community. But the report did acknowledge that researchers sometimes have fears that the data they share, for example clinical results, might be misused or misinterpreted if not enough attention is given to how the data were originally collected.

“The biomedical industry lags behind the rest of the world in how we share information,” says Sharon Terry, chair of the IOM workshop committee and president of the Genetic Alliance, a Washington, DC-based health advocacy group that focuses on issues related to gene testing. “We need to catch up with the other industries that have figured out ways to share data and still protect it.”

In the new survey, a majority of researchers said that they would be willing to share study materials with their colleagues, according to the results presented by Christine Laine, the editor-in-chief of the Annals of Internal Medicine, at the International Congress on Peer Review and Biomedical Publication held in Chicago today.

The findings came from theoretical questions answered by 389 respondents who published papers in the Annals of Internal Medicine between 2008 and 2012. During that period, 71% said they would share their study protocols beyond what was in the methods, and 72% were willing to share the full statistical methods used to analyze the data, including the computer algorithms employed. However, only 54% were willing to share all the data collected during the study, including information that didn’t end up being in the final report. Most of the researchers who answered the survey questions also added extra provisos under which they would share these types of information; for example some would only do so in response to a personal request from an interested party (rather than depositing the information in, for example, an online data bank).

Downward trend

What concerns the surveyors most is that over the five-year survey period the responses showed a noticeable decline in scientists’ willingness to share details about their study protocols. Based on the replies to the theoretical questions, around 80% of the survey respondents in 2008 said they would share additional details about their study protocols, beyond what is described in the methods section of the paper, but by 2012 only 60% were willing to provide colleagues with that information, a significant difference. There was a similar—but not statistically significant—slip in researchers’ willingness to share data. When the survey started, about 60% of researchers said they’d share raw data, but five years later that number had dropped to 45%.

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Immunologist effort aims to improve hyperlinking of research papers to raw data

TrialShareA study published today in the New England Journal of Medicine reports that people suffering from ANCA-associated vasculitis, a disease in which the body attacks its own defense system, can now be effectively treated with one month of weekly infusions of rituximab, instead of the standard 18-month regimen with daily pills of cyclophosphamide, which has strong side effects. But that is not the only thing that makes the report noteworthy. According to its authors, the study is the first to contain hyperlinked charts or graphs that redirect users to an information-sharing system called TrialShare, where they can instantly access data amassed during this clinical trial and others.

The interactive platform was developed by the Immune Tolerance Network (ITN), a consortium of clinical researchers who study everything from allergies to organ transplants. The ITN is headquartered in Seattle, Washington, and funded by the US National Institute of Allergy and Infectious Disease, in Bethesda, Maryland.

Even without an online version of the article, anyone can sign on to the website, at www.itnTrialShare.org. However, the site is geared toward researchers who want access to information acquired during a study—for example, the twice daily blood pressure readings of patients that a researcher might have reported as an average instead of logging every measurement—which may not have made it into the published paper or supplementary material. Creators of the website emphasize that the information about the patients is anonymized.

This isn’t the first effort to put more information about clinical trials in the hands—and minds—of more people, with the hope of improving the design of future studies and avoiding redundant work. There are some groups, such as the Biomarkers Consortium, based in Bethesda, Maryland, and founded by a combination of private and public agencies that include the US National Institutes of Health (NIH), focused on specific collaborations that only share research data only among their partnership members. TrialShare, by comparison, is now open-access.

Other databases, such as the Gene Expression Omnibus (GEO) run by the NIH’s National Center for Biotechnology Information, act as repositories for data, but they lack the clinical data seen in the TrialShare site.

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UPDATED: GSK inquiry reports signs of possible data fabrication in multiple sclerosis paper

An inquiry by the British pharmaceutical company GlaxoSmithKline (GSK) into allegations of possible data fabrication in a 2010 Nature Medicine paper regarding the role of specialized T cells in autoimmune disease has found what it sees as evidence of misconduct. Concerns regarding the paper surfaced last week, when news sources reported that the company had begun investigating the research conducted for the study at a GSK lab in Shanghai.

The paper, led by Jingwu Zhang at the GlaxoSmithKline Research and Development Center’s department of neuroimmunology in Shanghai, originally claimed to have found data suggesting that the signaling molecule interleukin-7 caused a subset of T cells known as T helper 17 (TH17) cells taken from people with multiple sclerosis to multiply. The finding complemented other research in the field suggesting that genetic differences in the cell receptor for interleukin-7 might put some individuals at risk for developing multiple sclerosis—an autoimmune disease thought to involve helper T cells.

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Yale immunologist wins new €4 million award

Ruslan Medzhitov

{credit}Brian Ach/HHMI{/credit}

Most scientists will say that they go to the lab every day out of a pure love of science, not to make buckets of money. But for researchers at the pinnacle of their fields, science can be a lucrative trade. Win a Nobel Prize, and you could take home more than $1.2 million. Bag a Templeton Prize, and you could be depositing a $1.7 million check. Net a Breakthrough Prize in Life Sciences, first awarded earlier this year, and you’d walk away with a cool $3 million.

But that’s nothing compared to the €4 million ($5.1 million) purse attached to the Else Kröner-Fresenius Award, a new prize handed out today by the German non-profit Else Kröner-Fresenius-Stiftung (EKFS). Although €3.5 million of the prize money is intended for future research (leaving only €500,000 for the recipient to use as he or she pleases) the total value of new award makes it the most valuable single accolade in all of science, monetarily at least.

That accolade was given to immunologist Ruslan Medzhitov, a Russian-born scientist at Yale University in New Haven, Connecticut, who co-discovered and characterized mammalian Toll-like receptors (TLRs) in the 1990s. These pattern recognition molecules are now recognized as integral parts of the innate immune system that fight off microbial infections and detect associated damage. Many drug companies are actively targeting these receptors in the hopes of treating cancer, sepsis and inflammatory disease.

Two years ago, Medzhitov (pictured) was controversially overlooked for the 2011 Nobel Prize in Physiology or Medicine, which went to the discoverer of dendritic cells (Ralph Steinman) and two other immunologists who elucidated key aspects of innate immunity (Bruce Beutler and Jules Hoffmann, with whom Medzhitov shared the 2011 Shaw Prize in Life Science and Medicine, the $1 million ‘Nobel Prize of the East’). At the time, 24 scientists wrote an open letter in Nature arguing that Medzhitov and his mentor Charles Janeway, who died in 2003, should have been recognized by the Nobel Committee for their seminal contribution of cloning a human TLR and showing that it activated signaling pathways that induce adaptive immunity.

However, according to Stefan Kaufmann, director at the Max Planck Institute for Infection Biology in Berlin, the Nobel snub had no effect on Medzhitov’s selection for the new award. Medzhitov “was clearly one of more innovative researchers,” says Kaufmann, who, as president of the International Union of Immunological Societies, served as chair of the award’s executive committee. Plus, he notes, the Else Kröner-Fresenius Award recognizes both past achievements and ongoing research activity, and Medzhitov has an active research program that could aid in the development of new vaccines and anti-inflammatory medicines. (See this commentary that Kaufmann cowrote last year in Nature Immunology for more background on the award.)

The inaugural immunology-themed award was timed to commemorate the 25th anniversary of the death of EKFS founder Else Kröner. Going forward, the foundation expects to grant the award every four years to a different discipline of medical research.

Centenarian genetics study retracted

Researchers from Boston University today issued a retraction notice for a controversial paper published last year that purportedly described a predictive test for living to and beyond 100 years. The July 2010 study identified 150 single nucleotide polymorphisms that clustered into three subgroups. On the basis of these genetic factors, the study authors claimed that they could predict an individual’s likelihood of exceedingly long life with 77% accuracy.

Shortly after being published in Science, the study’s methods drew fire from genomicists and biostatisticians, which prompted the journal’s editors to issue an expression of concern in November. Critics argued that the sample size, at 1,055 centenarians and 1,267 controls, was not large enough to draw robust conclusions, Nature reported at the time. In addition, the researchers analyzed the two experimental groups using slightly different SNP chips and in different labs, which could bias the data, Newsweek quoted Duke genomicist David Goldstein as saying.

The authors responded that they would reanalyze the data immediately in response to the criticisms, many of which were communicated over social media (see Nature’s January 2011 news feature: ‘Peer review: Trial by Twitter’).

In today’s retraction notice, the authors wrote that the analysis still found disease-related genetic factors associated with long life that clustered into subgroups — but they differed enough “from those originally published online to the point of becoming a new report.”

The original paper has been cited 25 times according to Google Scholar.

New dimensions in molecular modeling

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This week PLoS Biology, in collaboration with the Structural Genomics Consortium, rolled out “enhanced versions” of two of its articles. Once a browser plug-in is installed, readers see a 3-D molecular model alongside the article. As they progress through the text, the structure spins and zooms in or out to focus on the relevant molecular feature.

One of the enhanced PLoS Biology articles details the structure of CaMKIIδ, which senses and transmits calcium signals to aid in cellular signaling. The other is a structural and functional analysis of the human peptidyl-prolyl isomerase family of proteins, which are targeted by the immunosuppressive drug cyclosporin, which helps counteract organ rejection in transplant recipients.

We can foresee this becoming the tool of choice at conferences and meetings in the near future. And, who knows? Perhaps an all 3-D issue of Nature Medicine is in order &mdash but we wouldn’t be the first publication to jump on that train.

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Canadian biomedical research gets central repository

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Two years ago, the Canadian Institutes of Health Research (CIHR) mandated that all studies funded by taxpayer-backed grants be made freely accessible within six months of publication. The problem was there was no central repository to store all these papers, so manuscripts tended to be kept on a hodgepodge of publishers’ websites, institutional repositories and elsewhere.

Now there’s a solution. As of today, researchers can submit their final peer-reviewed manuscripts to PubMed Central (PMC) Canada, the north-of-the-border spin-off of the US National Institutes of Health’s PMC, a free digital archive of biomedical journal paper.

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