What goes into a major acute coronary syndrome trial and what will future trials look like?
Acute coronary syndromes (ACS) are common and carry a high risk of death and serious complications. Over the past three decades, the international cardiology community has collaborated in numerous large, well-designed randomized trials evaluating promising new treatments leading to important improvements in care for patients with ACS. Industry has funded most of the ACS trials of new pharmacologic treatments, but there are many independently funded trials evaluating treatment strategies such as percutaneous coronary intervention. Improvements in ACS care have led to challenges in demonstrating the efficacy of new treatments and many current trials are comparing one active treatment against another, although new paradigms including anti-inflammatory treatments and stem cell infusions are being tested against placebo. Developing new drugs for ACS is a very expensive process with many trials not showing any benefit, and much of this expense is related to the cost of large multicenter phase 3 trials. Reducing the administrative burden and associated costs of ACS trials is an important immediate goal if the strong tradition of large collaborative trials is to continue, as well as the need for health care providers to engage more actively in the clinical research process and support large multinational independently funded trials. We discuss methodologic issues of ACS trials with recent examples and provide some perspectives for the future.
Erdem
Guliz
G
Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK.
Geisler
Tobias
T
Flather
Marcus D
MD
D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000241:Adenosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002986:Clinical Trials as Topic / Q000191:economics* / Q000639:trends; D000077144:Clopidogrel; D003497:Cyclic N-Oxides / Q000627:therapeutic use; D000077542:Eptifibatide; D006331:Heart Diseases / Q000188:drug therapy; D006801:Humans; D010455:Peptides / Q000627:therapeutic use; D010879:Piperazines / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D000068799:Prasugrel Hydrochloride; D011725:Pyridines / Q000627:therapeutic use; D012107:Research Design; D012109:Research Support as Topic / Q000191:economics* / Q000639:trends; D012307:Risk Factors; D018401:Sample Size; D013876:Thiophenes / Q000627:therapeutic use; D000077486:Ticagrelor; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006113:United Kingdom
D003497:Cyclic N-Oxides; D010455:Peptides; D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; D013876:Thiophenes; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine; D000077542:Eptifibatide; D013988:Ticlopidine; D001241:Aspirin; C435830:otamixaban