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Methodological issues associated with clinical trials in epilepsy

Edoardo Ferlazzo1,2, Chiara Sueri1, Sara Gasparini1,2

  • 1a Regional Epilepsy Centre , Bianchi-Melacrino-Morelli Hospital , Reggio Calabria , Italy.

Expert Review of Clinical Pharmacology
|July 19, 2017
PubMed
Abstract

Insights

Epilepsy clinical trial success rates remain stagnant despite advances. Optimizing trial methodology is crucial for meeting regulatory requirements and patient needs in epilepsy research.

Area of Science:

  • Clinical trial methodology
  • Epilepsy research
  • Regulatory science

Background:

  • Epilepsy clinical trials have seen methodological advances, yet patient seizure-freedom rates have not significantly improved.
  • Current add-on trials often include refractory epilepsy patients, potentially limiting drug response.
  • Monotherapy trials face methodological, economic, and ethical challenges, with differing regulatory standards between the EU and US.

Purpose of the Study:

  • To review methodological limitations in current epilepsy clinical trials.
  • To explore strategies for overcoming these limitations and identify future research needs.
  • To enhance the reliability of epilepsy clinical trial outcomes.

Main Methods:

  • Literature search of PubMed up to March 2017 and ClinicalTrials.gov for unpublished studies.
  • Analysis of add-on and monotherapy trial designs and their inherent limitations.
  • Review of newer trial designs like futility and time-to-event studies.

Main Results:

  • Add-on trials may be limited by patient selection (refractory epilepsy) and variability from diverse populations.
  • Monotherapy trials present complex regulatory and ethical considerations.
  • Patient-reported outcomes and seizure occurrence randomness can impact trial results.

Conclusions:

  • Clinical trial methodology requires optimization to better align with regulatory demands and the needs of patients and clinicians.
  • Addressing limitations in patient selection, outcome assessment, and trial design is essential for advancing epilepsy treatment.
  • Improved trial designs and strategies are necessary to achieve more robust and reliable outcomes in epilepsy research.
Keywords:
Seizuresdesigndrugsefficacyendpointsrandomizedstudies

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