title: More ethical and more efficient clinical research: multiplex trial design.
abstract: BACKGROUND
  Today's clinical research faces challenges such as a lack of clinical equipoise between treatment arms, reluctance in randomizing for multiple treatments simultaneously, inability to address interactions and increasingly restricted resources. Furthermore, many trials are biased by extensive exclusion criteria, relatively small sample size and less appropriate outcome measures.
  
  
  RESULTS
  We propose a 'Multiplex' trial design that preserves clinical equipoise with a continuous and factorial trial design that will also result in more efficient use of resources. This multiplex design accommodates subtrials with appropriate choice of treatment arms within each subtrial. Clinical equipoise should increase consent rates while the factorial design is the best way to identify interactions.
  
  
  CONCLUSIONS
  The multiplex design may evolve naturally from today's research limitations and challenges, while principal objections seem absent. However this new design poses important infrastructural, organisational and psychological challenges that need in depth consideration.
authors.affiliation: Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. f.keus@umcg.nl.
authors.forename: Frederik
authors.initials: F
authors.lastname: Keus
authors.forename: Iwan C C
authors.initials: IC
authors.lastname: van der Horst
authors.forename: Maarten W
authors.initials: MW
authors.lastname: Nijsten
mesh_terms: D035843:Biomedical Research / Q000941:ethics*; D002986:Clinical Trials as Topic / Q000941:ethics*; D058015:Health Communication; D006801:Humans; D012107:Research Design