Outcome measures in clinical trials of traditional Chinese medicine for stable angina pectoris
Dongmei Xing, Mingjun Zhu, Chunxiang Liu, Hui Wang
Outcome measures in clinical trials of traditional Chinese medicine for stable angina pectoris
Objective: This work aimed to present a descriptive analysis of the outcome measures used in clinical trials of traditional Chinese medicine (TCM) for patients with stable angina pectoris, and to provide baseline data for the development of core outcome sets (COSs) for relevant clinical trials. Methods: Medical databases were searched to identify randomized trials of the effects of TCM for the treatment of stable angina pectoris. Outcome measures of each trial were extracted. Descriptive statistics were used to analyze the baseline characteristics of outcomes in clinical trials of TCM. Results: 94 randomized trials (with 9,111 participants) involving 79 different outcomes were identified. The mean number of outcomes was 5 (1-21 per trial). The 5 most commonly reported outcomes were efficacy rate of electrocardiogram, efficacy rate of angina pectoris, efficacy rate of TCM syndrome, fasting lipid indices, and withdrawal rate of nitroglycerin. Several challenges were identified: (1) significant heterogeneity of outcomes and differences in the technique and timing of the measurement of the same outcome; (2) transformation of continuous data into categorical data and presented as such in >90% of trials; (3) few trials on the outcomes associated with the advantages and characteristics of TCM; and (4) selective reporting of outcomes. Conclusions: The outcomes used are excessively heterogenous, and the choice of some outcomes (timing and techniques) for measurement is confusing or inappropriate. Hence, developing and implementing a COS is necessary for greater consistency.
Core outcome set / Outcome measures / Randomized trial / Traditional Chinese medicine
[[1]] |
Ohman EM. CLINICAL PRACTICE. Chronic stable angina. N Engl J Med 2016;374(12):1167-1176.
|
[[2]] |
Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation 2020;141(9):e139-e596.
|
[[3]] |
Fox K, Garcia MA, Ardissino D, et al. Guidelines on the management of stable angina pectoris. Eur Heart J 2006;27:1341-1381.
|
[[4]] |
Knuuti J, Wijns W, Saraste A, et al. 2019 ESC guidelines on the diagnosis and management of chronic coronary syndromes: the task force for diagnosis and management of chronic coronary syndromes of the European society of cardiology (ESC). Eur Heart J 2020;41:407-477.
|
[[5]] |
McKenna C, Hawkins N, Claxton K, et al. Cost-effectiveness of enhanced external counterpulsation (EECP) for the treatment of stable angina in the United Kingdom. Int J Technol Assess Health Care 2010;26(2):175-182.
|
[[6]] |
Zhao L, Li D, Zheng H, Chang X, et al. Acupuncture as adjunctive therapy for chronic stable angina: a randomized clinical trial. JAMA Intern Med 2019;179(10):1388-1397.
|
[[7]] |
Sun MY, Miao Y, Jin M, et al. Effect and safety of Guanxinning Tablet for stable angina pectoris patients with Xin (Heart)-blood stagnation syndrome: a randomized, multicenter, placebo-controlled trial. Chin J Integr Med 2019;25(9):684-690.
|
[[8]] |
Yang G, He H, Li H, et al. Effects of Danlou tablet for the treatment of stable angina pectoris: a study protocol of a randomized, double-blind, and placebo-controlled clinical trial. Medicine (Baltimore) 2020;99(49):e23416.
|
[[9]] |
Zhang L, Zhang J, Chen J, et al. Clinical research of traditional Chinese medicine needs to develop its own system of core outcome sets. Evid Based Complement Alternat Med 2013;2013:202703.
|
[[10]] |
Li Y, Zhang L, Lyu S, et al. Efficacy and safety of oral Guanxinshutong capsules in patients with stable angina pectoris in China: a prospective, multicenter, double-blind, placebo-controlled, randomized clinical trial. BMC Complement Altern Med 2019;19(1):1-9.
|
[[11]] |
Williamson PR, Altman DG, Bagley H, et al. The COMET handbook: version 1.0. Trials 2017;18(3):1-50.
|
[[12]] |
Kirkham JJ, Gargon E, Clarke M, et al. Can a core outcome set improve the quality of systematic reviews?—a survey of the Co-ordinating Editors of Cochrane Review Groups. Trials 2013;14(1):1-5.
|
[[13]] |
COMET initiative.
|
[[14]] |
Valgimigli M, Biscaglia S. Stable angina pectoris. Curr Atheroscler Rep 2014;16(7):422.
|
[[15]] |
Duan SY. The Combination of Traditional Chinese Medicine and West Medicine in Treatment of Chronic Stable Angina Pectoris. Beijing: Beijing University of Chinese Medicine; 2010.
|
[[16]] |
Tovey D. The impact of Cochrane Reviews. Cochrane Database Syst Rev. 2010 (7): ED000007.
|
[[17]] |
D'Amico G, Abraldes JG, Rebora P, et al. Ordinal outcomes are superior to binary outcomes for designing and evaluating clinical trials in compensated cirrhosis. Hepatology 2020;72(3):1029-1042.
|
[[18]] |
Thornley B, Adams C. Content and quality of 2000 controlled trials in schizophrenia over 50 years. BMJ 1998;317:1181-1184.
|
[[19]] |
World Health Organization. WHO traditional medicine strategy: 2014-2023.
|
[[20]] |
World Health Organization. The use of herbal medicines in primary health care.
|
[[21]] |
Cai M, Zhao HS, Sun JY. Survey of TCM application status on secondary prevention of coronary heart disease. Beijing J Tradit Chin Med 2013;32(5):343-345.
|
[[22]] |
World Health Organization. Legal status of traditional medicine and complementary.
|
[[23]] |
Kirkham J, Gorst S, Altman DG, et al. COS-STAR: a reporting guideline for studies developing core outcome sets (protocol). Trials 2015;16(1):1-6.
|
[[24]] |
World Health Organization. WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region. Geneva, Switzerland: World Health Organization; 2007.
|
[[25]] |
Chan AW, Altman DG. Identifying outcome reporting bias in randomised trials on PubMed: review of publications and survey of authors. BMJ 2005;330(7494):753.
|
[[26]] |
Saini P, Loke YK, Gamble C, et al. Selective reporting bias of harm outcomes within studies: findings from a cohort of systematic reviews. BMJ 2014;349:g6501.
|
[[27]] |
Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2012;60(24):e44-e164.
|
[[28]] |
Williamson P, Clarke M. The COMET (Core Outcome Measures in Effectiveness Trials) Initiative: its role in improving Cochrane Reviews. Cochrane Database Syst Rev 2012;(5):ED000041.
|
[[29]] |
Gargon E. The COMET (Core Outcome Measures in Effectiveness Trials) Initiative. Maturitas 2016;91:91-92.
|
[[30]] |
Chalmers I, Glasziou P. Avoidable waste in the production and reporting of research evidence. Lancet 2009;374:86-89.
|
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