Guillaume Marquis-Gravel1, Holly Robertson1, W Schuyler Jones1,2, Danielle Riley3, Daniel E Ford4, David Crenshaw5, Yvonne A Joosten5, Lindsey Rudov6, Adrian F Hernandez1,2, Rachel Hess7. 1. Duke Clinical Research Institute, 200 Morris St, Durham, NC, 27701, USA. 2. Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA. 3. University of Iowa College of Public Health, 145 N Riverside Dr, Iowa City, IA, 52242, USA. 4. Institute for Clinical and Translational Research, Johns Hopkins School of Medicine, 750 E. Pratt Street, Baltimore, MD, 21202, USA. 5. Institute for Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 1200, Nashville, TN, 37203, USA. 6. Louisiana Public Health Institute, 1515 Poydras St #1200, New Orleans, LA, 70112, USA. 7. Departments of Population Health Sciences and Internal Medicine, University of Utah School of Medicine, 295 Chipeta Way Williams Building Room 1N492, Salt Lake City, UT, 84108, USA. rachel.hess@hsc.utah.edu.
Abstract
BACKGROUND: New considerations during the ethical review processes may emerge from innovative, yet unfamiliar operational methods enabled in pragmatic randomized controlled trials (RCT), potentially making institutional review board (IRB) evaluation more complex. In this manuscript, key components of the pragmatic "Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-term Effectiveness (ADAPTABLE)" randomized trial that required a reappraisal of the IRB submission, review, and approval processes are discussed. MAIN TEXT: ADAPTABLE is a pragmatic, multicenter, open-label RCT evaluating the comparative effectiveness of two doses of aspirin widely used for secondary prevention (81 mg and 325 mg) in 15,000 patients with an established history of atherosclerotic cardiovascular disease. The electronic informed consent form is completed online by the participants at the time of enrollment, and endpoint ascertainment is conducted through queries of electronic health records. IRB challenges encountered regarding centralized IRB evaluation, electronic informed consent, patient engagement, and risk determination in ADAPTABLE are described in this manuscript. The experience of ADAPTABLE encapsulates how pragmatic protocol components intended to facilitate the study conduct have been tempered by unexpected, yet justified concerns raised by local IRBs. How the lessons learned can be applied to future similar pragmatic trials is delineated. CONCLUSION: Development of engaging communication channels between IRB and study personnel in pragmatic randomized trials as early as at the time of protocol design allows to reduce issues with IRB approval. Integrations of the lessons learned in ADAPTABLE regarding the IRB process for centralized IRBs, informed consent, patient engagement, and risk determination can be emulated and will be instrumental in future pragmatic studies.
BACKGROUND: New considerations during the ethical review processes may emerge from innovative, yet unfamiliar operational methods enabled in pragmatic randomized controlled trials (RCT), potentially making institutional review board (IRB) evaluation more complex. In this manuscript, key components of the pragmatic "Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-term Effectiveness (ADAPTABLE)" randomized trial that required a reappraisal of the IRB submission, review, and approval processes are discussed. MAIN TEXT: ADAPTABLE is a pragmatic, multicenter, open-label RCT evaluating the comparative effectiveness of two doses of aspirin widely used for secondary prevention (81 mg and 325 mg) in 15,000 patients with an established history of atherosclerotic cardiovascular disease. The electronic informed consent form is completed online by the participants at the time of enrollment, and endpoint ascertainment is conducted through queries of electronic health records. IRB challenges encountered regarding centralized IRB evaluation, electronic informed consent, patient engagement, and risk determination in ADAPTABLE are described in this manuscript. The experience of ADAPTABLE encapsulates how pragmatic protocol components intended to facilitate the study conduct have been tempered by unexpected, yet justified concerns raised by local IRBs. How the lessons learned can be applied to future similar pragmatic trials is delineated. CONCLUSION: Development of engaging communication channels between IRB and study personnel in pragmatic randomized trials as early as at the time of protocol design allows to reduce issues with IRB approval. Integrations of the lessons learned in ADAPTABLE regarding the IRB process for centralized IRBs, informed consent, patient engagement, and risk determination can be emulated and will be instrumental in future pragmatic studies.
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Authors: Consuelo H Wilkins; Terri L Edwards; Mary Stroud; Nan Kennedy; Rebecca N Jerome; Colleen E Lawrence; Sheila V Kusnoor; Sarah Nelson; Loretta M Byrne; Leslie R Boone; Julia Dunagan; Tiffany Israel; Casey Rodweller; Bethany Drury; Rhonda G Kost; Jill M Pulley; Gordon R Bernard; Paul A Harris Journal: J Clin Transl Sci Date: 2021-08-19