학술논문
Optimizing the Design and Analysis of Clinical Trials for Antibacterials Against Multidrug-resistant Organisms : A White Paper From COMBACTE’s STAT-Net
Document Type
research-article
Author
COMBACTE-NET Consortium; de Kraker, Marlieke E. A.; Sommer, Harriet; de Velde, Femke; Gravestock, Isaac; Weiss, Emmanuel; McAleenan, Alexandra; Nikolakopoulos, Stavros; Amit, Ohad; Ashton, Teri; Beyersmann, Jan; Held, Leonhard; Lovering, Andrew M.; MacGowan, Alasdair P.; Mouton, Johan W.; Timsit, Jean-François; Wilson, David; Wolkewitz, Martin; Bettiol, Esther; Dane, Aaron; Harbarth, Stephan
Source
Clinical Infectious Diseases, 2018 Dec . 67(12), 1922-1931.
Subject
Language
English
ISSN
10584838
15376591
15376591
Abstract
Innovations are urgently required for clinical development of antibacterials against multidrug-resistant organisms. Therefore, a European, public-private working group (STAT-Net; part of Combatting Bacterial Resistance in Europe [COMBACTE]), has reviewed and tested several innovative trials designs and analytical methods for randomized clinical trials, which has resulted in 8 recommendations. The first 3 focus on pharmacokinetic and pharmacodynamic modeling, emphasizing the pertinence of population-based pharmacokinetic models, regulatory procedures for the reassessment of old antibiotics, and rigorous quality improvement. Recommendations 4 and 5 address the need for more sensitive primary end points through the use of rank-based or time-dependent composite end points. Recommendation 6 relates to the applicability of hierarchical nested-trial designs, and the last 2 recommendations propose the incorporation of historical or concomitant trial data through Bayesian methods and/or platform trials. Although not all of these recommendations are directly applicable, they provide a solid, evidence-based approach to develop new, and established, antibacterials and address this public health challenge.