title: Trial design: how must we move ahead?
abstract: Scleroderma is clinically heterogeneous and a variety of plausible mechanisms of disease have been hypothesized. Recent years have witnessed a significant improvement in overall survival although all of the gains in management have been therapies for specific organ involvement, e.g. renal crisis and pulmonary arterial hypertension. Future studies will rely on improved clinical science, which involves structured validation of proposed measures of outcome; development of a combined response index; and further refinement of specific subsets of disease expression. Immunoablation with stem cell reconstitution is an example of aggressive therapy chosen as appropriate for a particularly severe disease subset and in whom the pilot data are encouraging. Good science and clinical ethics force continued consideration of equipoise between risk and benefit.
authors.affiliation: University of Michigan Scleroderma Program, Ann Arbor, Michigan 48106, USA. jseibold@umich.edu
authors.forename: J R
authors.initials: JR
authors.lastname: Seibold
authors.forename: A
authors.initials: A
authors.lastname: Tyndall
authors.forename: D E
authors.initials: DE
authors.lastname: Furst
mesh_terms: D002986:Clinical Trials as Topic / Q000592:standards*; D006801:Humans; D012107:Research Design; D018570:Risk Assessment; D012595:Scleroderma, Systemic / Q000628:therapy*; D016896:Treatment Outcome
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