Abstract
ABSTRACTBackground: Adverse event (AE) reporting in clinical trials does not fully capture the patient-level perspective and comparing tolerability across treatments or among studies is difficult.Objective: This study was designed to develop a treatment tolerability index algorithm that combines AE reporting with physician- and patient-level AE information into a global burden score to allow comparison of the overall tolerability of antipsychotic medications used in treating schizophrenia.Study design: Data from a 4-arm, placebo-controlled clinical trial were used in the proposed tolerability index algorithm. For each patient, AEs were adjusted by frequency, severity, duration, and patient-experienced importance, and average tolerability-related burden scores were calculated.Setting: Algorithm development analyses.Patients: This study analyzed data from a previously completed clinical trial that evaluated a potential antipsychotic medication; no patients were involved in the current study.Intervention: No interventions were administered in this study; the analyses described used data derived from a previously completed clinical trial in which patients received bifeprunox, risperidone, or placebo.Main outcome measure: Burden scores and tolerability index scores were compared for patients who did or did not discontinue treatment because of AEs.Results: The number of AEs varied widely among patients. Burden scores were significantly worse for patients who discontinued treatment because of AEs. Mean tolerability index scores, adjusted based on AE frequency, severity-adjusted duration, and patient-experienced impact, were poorer for active medications than placebo, and increased with dose.Conclusion: The treatment tolerability index will allow comparison of AE burden and tolerability between treatments using existing clinical trial information. This suggests that scoring is possible, is clinically relevant, and allows standardized comparison of antipsychotic tolerability.
Highlights
Reporting of adverse events (AEs) in randomized clinical trials is comprehensive, but the information reported is frequently limited to population-level summaries of Adverse event (AE) frequency and severity
The maximum frequency of 24 AEs was reported for a patient in the bifeprunox 30 mg treatment arm
The mean unadjusted treatment burden scores for bifeprunox 30 mg, bifeprunox 40 mg, risperidone 6 mg, and placebo were 2.91, 2.96, 3.05, and 2.01, respectively (Table 1)
Summary
Reporting of adverse events (AEs) in randomized clinical trials is comprehensive, but the information reported is frequently limited to population-level summaries of AE frequency and severity. Information about patient experiences as reported by clinicians and aggregated for each AE is most commonly presented, without documenting the cumulated impact experienced by a single patient or the patients who do not experience any such events This limitation of AE reporting in clinical trials is recognized by clinicians, whose perception of tolerability-related treatment burden often differs from the patient experience [1,2]. Objective: This study was designed to develop a treatment tolerability index algorithm that combines AE reporting with physician- and patient-level AE information into a global burden score to allow comparison of the overall tolerability of antipsychotic medications used in treating schizophrenia. Burden scores were significantly worse for patients who discontinued treatment because of AEs. Mean tolerability index scores, adjusted based on AE frequency, severity-adjusted duration, and patient-experienced impact, were poorer for active medications than placebo, and increased with dose. This suggests that scoring is possible, is clinically relevant, and allows standardized comparison of antipsychotic tolerability
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