Reporting of informed consent, standard of care and post-trial obligations in global randomized intervention trials: a systematic survey of registered trials.
OBJECTIVE
Ethical guidelines are designed to ensure benefits, protection and respect of participants in clinical research. Clinical trials must now be registered on open-access databases and provide details on ethical considerations. This systematic survey aimed to determine the extent to which recently registered clinical trials report the use of standard of care and post-trial obligations in trial registries, and whether trial characteristics vary according to setting.


METHODS
We selected global randomized trials registered on http://www.clinicaltrials.gov and http://www.controlled-trials.com. We searched for intervention trials of HIV/AIDS, malaria, and tuberculosis from 9 October 2004, the date of the most recent version of the Helsinki Declaration, to 10 April 2007.


RESULTS
We collected data from 312 trials. Fifty-eight percent (58%, 95% CI = 53 to 64) of trial protocols report informed consent. Fifty-eight percent (58%, 95% CI = 53 to 64) of trials report active controls. Almost no trials (1%, 95% CI = 0.5 to 3) mention post-trial provisions. Most trials measure surrogate outcomes. Twenty percent (20%, 95% CI = 16 to 25) of trials measure patient-important outcomes, such as death; and the odds that these outcomes are in a low income country are five times greater than for a developed country (odds ratio (OR) 5.03, 95% CI = 2.70 to 9.35, p = < 0.001). Pharmaceutical companies are involved in 28% (CI = 23 to 33) of trials and measure surrogate outcomes more often than nonpharmaceutical companies (OR 2.45, 95% CI = 1.18 to 5.09, p = 0.31).


CONCLUSIONS
We found a large discrepancy in the quality of reporting and approaches used in trials in developing settings compared to wealthier settings.
Cohen
Emma R M
ER
Simon Fraser University, Burnaby, British Columbia, Canada.
O'Neill
Jennifer M
JM
Joffres
Michel
M
Upshur
Ross E G
RE
Mills
Edward
E
D019049:Developed Countries; D003906:Developing Countries; D032984:Ethics, Research; D006381:Helsinki Declaration; D006801:Humans; D007258:Informed Consent / Q000592:standards*; D028681:Moral Obligations; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D016032:Randomized Controlled Trials as Topic / Q000592:standards*; D012107:Research Design / Q000592:standards*; D012109:Research Support as Topic; D012935:Social Justice