Journal Article

Streamlining the institutional review board process in pragmatic randomized clinical trials: challenges and lessons learned from the Aspirin Dosing: A Patient-centric Trial Assessing Benefits and Long-Term Effectiveness (ADAPTABLE) trial

Hernandez, Adrian F., Crenshaw, David, Ford, Daniel E., Hess, Rachel, Rudov, Lindsey, Marquis-Gravel, Guillaume, Robertson, Holly, Jones, W. Schuyler, Joosten, Yvonne A., Riley, Danielle

2021

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Aspirin / Aspirin - administration & dosage / Aspirin - adverse effects / Atherosclerosis - prevention & control / Biomedicine / Cardiology / Cardiovascular diseases / Clinical medicine / Clinical trials / Commentary / Dosage and administration / Drug therapy / Electronic health records / Electronic Health Records - statistics & numerical data / Ethics / Ethics Committees, Research - standards / Female / Health Sciences / Humans / Informed consent / Informed Consent - standards / Institutional review boards / Male / Medicine / Medicine & Public Health / Middle Aged / Multicenter Studies as Topic - ethics / Multicenter Studies as Topic - standards / Patient Participation / Pragmatic Clinical Trials as Topic - ethics / Pragmatic Clinical Trials as Topic - standards / Pragmatic trials / Randomized Controlled Trials as Topic - ethics / Randomized Controlled Trials as Topic - standards / Research Design - standards / Risk Assessment - standards / Secondary Prevention - methods / Statistics for Life Sciences / Testing / The future of pragmatic trials / Treatment Outcome