EPI 205: Clinical Trials (Winter 2021)
Section outline
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Roster with section leader assignments (as of 1/9/2021) File
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Protocol Assignment 1 File
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Protocol Assignment 2 File
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Protocol Assignment 3 File
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Protocol Assignment 4 File
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Lecture: Design, Subjects and Randomization
Definition and importance of randomized controlled trials (RCT); examples of RCTs; disadvantages; alternatives; reasons for doing RCTs; randomization; inclusion/exclusion criteria; study designs including classical RCT, factorial designs, cross-over designs, matched pairs, cluster or grouped randomization.
Faculty: Dennis Black
Location (Access restricted to registered students): Zoom URL
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Epi205 Course Logistics Media Resource
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Lecture 1A Media Resource
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Lecture 1A File
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Lecture 1B Media Resource
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Lecture 1b File
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Live Session: January 7, 2021 Media Resource
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Workshop 1 for Lecture 1 File
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Abstract & Video: Schwalm, Jon-David, et al. "A community-based comprehensive intervention to reduce cardiovascular risk in hypertension (HOPE 4): a cluster-randomised controlled trial." The Lancet 394.10205 (2019): 1231-1242. URL
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MODERNA Protocol File
MODERNA Protocol: Scan the Moderna trial protocol summary and read the following sections within the summary:
- Randomization
- Inclusion & Exclusion
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Baden et al. "Efficacy and Safety of the mRNA-1273 SARS-CoV-2 Vaccine" N Engl J Med (2020) File
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Research Summary: Efficacy and Safety of mRNA-1273 SARS-CoV-2 Vaccine File
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Li, Bai, et al. "The CHIRPY DRAGON intervention in preventing obesity in Chinese primary-school--aged children: A cluster-randomised controlled trial." PLoS medicine 16.11 (2019). File
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Manson et al., "Vitamin D supplements and prevention of cancer and cardiovascular disease" NEJM 380.1 (2019): 33-44 File
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Homework Assignment #1 File
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Biegel et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med 2020 File
This article will be referred to in the homework.
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Answer Key for Assignment #1 File
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Lecture 2: Blinding, Intervention and Controls
Definition and importance of blinding; strategies if the study can’t be blinded; strategies to evaluate blinding; considerations when choosing the intervention; multiple interventions; importance of the control or placebo; advantages and disadvantages of equivalence trials.
Please watch Dr. Grady's lecture from 2020.
Faculty: Deborah Grady
Location (Access restricted to registered students): Zoom URL
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Blinding & Interventions File
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Q&A Session for Lecture 2 File
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1/14/2021 Live Session Media Resource
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Noseworthy H, et al. The impact of blinding on the results of a randomized, placebo-controlled multiple sclerosis clinical trial. Neurology 1994 44: 16-20. File
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Kirkley A, et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2008 Sep 11;359(11):1097-107. File
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Homework Assignment for lecture #2 File
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Homework Assignment #2 - Answer Key File
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Lecture 3: Measuring Outcomes and Adverse Effects
Clinical outcomes and alternatives. Defining adverse events; elicited vs. volunteered; nuisance adverse events; pitfalls of attribution of cause; FDA adverse events classifications.
Faculty: Dennis Black
Location (Access restricted to registered students): Zoom URL
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Lecture 3 File
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Lecture 3A Media Resource
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Lecture 3B Media Resource
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Workshop Slides_01.21.2021 File
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Workshop 3 Video_01.21.2021 Media Resource
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Psaty BM, Lumley T. Surrogate end points and FDA approval: a tale of 2 lipid-altering drugs. JAMA. 2008 Mar 26;299(12):1474-6. File
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Bent S, et al. Brief communication: Better ways to question patients about adverse medical events: a randomized, controlled trial. Ann Intern Med. 2006 Feb 21;144(4):257-61. File
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Knoll MD, Wonodi C. Oxford-AstraZeneca COVID-19 vaccine efficacy. Lancet. 2021 Jan 9;397(10269):72-74. doi: 10.1016/S0140-6736(20)32623-4. Epub 2020 Dec 8. PMID: 33306990. File
Please read this article prior to Thursday's workshop
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Voysey M, et al. Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK. Lancet. 2021 Jan 9;397(10269):99-111. File
Please read this article prior to Thursday's workshop
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Homework Assignment for Lecture 3 File
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Homework Assignment for Lecture 3 - Answer Key File
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Small Group Discussion (see Roster for your section assignment)
Faculty:
Location (Access restricted to registered students): Zoom URL
Avins: Meeting ID: 867 1257 3247; Passcode: 707889
Brenowitz: Meeting ID: 972 2251 5513; Password: 251253
Gadgil: Meeting ID: 973 2893 4925; Password: 811427
Hue: Meeting ID: 981 5229 9256; Password: 048118
Phillips: Meeting ID: 912 1127 1821; Password: 984928
Pressman:
Yank: Meeting ID: 946 3354 1410; Password: 744119 -
Lecture 4: Statistical Issues in Randomized Trials, Review of data analysis for RCTs; Factorial RCT designs and analysis approaches; Subgroups and multiple comparisons: implications for inference from RCTs. Also most informative statistical graphic techniques for RCTs.
Pervasiveness of multiple comparisons in randomized trials; the general problem of multiple comparisons and statistical adjustments; multiple endpoints; statistical concerns about subgroup analyses; what to do with an unexpected subgroup finding; adverse experience categorization; multivariate adjustment.
Faculty: Dennis Black
Location (Access restricted to registered students): Zoom URL
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Lecture 4A Media Resource
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Lecture 4B Media Resource
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Lecture 4A File
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Lecture 4B File
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Wang R, Lagakos SW, Ware JH, Hunter DJ, Drazen JM. Statistics in medicine--reporting of subgroup analyses in clinical trials. N Engl J Med. 2007 Nov 22;357(21):2189-94. FileNote: this paper sets the standard for evaluating RCT subgroup analyses.
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Polack, Fernando P., et al. "Safety and efficacy of the BNT162b2 mRNA Covid-19 vaccine." N Engl J Med (2020) File
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Lippman S, et al. Effect of selenium and vitamin E of risk on prostate cancer and other cancers. JAMA. 2009;301(1):(doi:10.1001/jama.2008.864) File
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Gaziano J, et al. Vitamins E and C in the prevention of prostate and total cancer in men: The Physicians' Health Study II randomized controlled trial. JAMA 2009;301(1):(doi:10.1001/jama.2008.862 File
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Manson et al. Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease. NEJM 2019 File
Read and review the abstract
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Manson et al. Marine n−3 Fatty Acids and Prevention of Cardiovascular Disease and Cancer NEJM 2019 File
Read and review the abstract
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Homework Assignment #4 File
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Lecture 4 Homework Assignment Answer Key File
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Lecture 5: Follow-up, Adherence to the Protocol, and Post-Randomization and Introduction to Sample Size Planning
Follow-up in RCTs; what happens after randomization; patient compliance or adherence; effect of incomplete follow-up; strategies to enhance compliance; intention-to- treat and per-protocol analyses; analysis based on post-randomization; subgroup analysis.
Faculty: Dennis Black
Location (Access restricted to registered students): Zoom URL-
Lecture 5 Media Resource
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Lecture 5 File
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Lecture 5B: Sample Size Media Resource
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Lecture 5B: Sample Size File
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Workshop 4 - February 4, 2021 Media Resource
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Hollis and Campbell. What is meant by intention to treat analysis? Survey of published randomized controlled trials. BMJ 1999:319;670-4. File
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Homework Assignment for Lecture 5 File
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Lecture 5 Homework Assignment Answer Key File
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Small Group Discussion (see Roster for your section assignment)
Review of prior lecture and problem set
Faculty:
Location (Access restricted to registered students): Zoom URL
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Lecture 6: Non-Inferiority Trials
Faculty: Vinay PrasadNon inferiority trials are studies that seek to show a new treatment, compared to an established treatment, is no worse than by some amount. That amount is called the margin or delta. Equivalence trials are subset of the non-inferiority design
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Lecture 6 - Non-Inferiority Trials Media Resource
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Lecture 6 - No-Inferiority Trials File
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Kudo M et al. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised phase 3 non-inferiority trial. Lancet 2018 Mar 24;391(10126):1163-1173. File
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Prasad V. Non-Inferiority Trials in Medicine: Practice Changing or a Self-Fulfilling Prophecy? J Gen Intern Med 2018 Jan;33(1):3-5. doi: 10.1007/s11606-017-4191-y. File
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Lecture 7: Nuts and Bolts - Conducting a Trial
Should one do a trial; pilot studies; funding sources; contracts; budgets; the study team; team management; space; recruitment of study subjects; starting the protocol; forms; compliance and follow-up; final visit and post-trial.
Faculty: Deborah Grady & Steven Cummings
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Pilot Studies and Nuts&Bolts File
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NY Times Article: Clinical Trials Are Moving Out of the Lab and Into People’s Homes File
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Workshop: Dr. Cummings - Remote Trials Media Resource
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Small Group Discussion (see Roster for your section assignment)
Review of prior lecture and problem set
Faculty:
Location (Access restricted to registered students): Zoom URL
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Lecture 8: Ethics in Clinical Trials and Interim Monitoring & Statistical Aspects of Interim Monitoring
Ethical issues in clinical trials, including choice of interventions in control and intervention groups, randomization, selection of subjects, and interim analyses
Why alter/stop a clinical trial early; who should decide to stop the trial; what parameters should be monitored and how often; what statistical methods should be used; statistical approaches
Faculty: Alison Huang & Joan Hilton
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Trial Ethics & Interim Monitoring File
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Biostatistical Methods for Monitoring RCTs File
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Trial Ethics & Interim Monitoring Media Resource
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Biostatistical Methods for Monitoring RCT Media Resource
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Live Session: Interim Monitoring (Huang) Media Resource
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Live Session: Interim Monitoring (Huang) File
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Lo B. Ethical issues in clinical trials, pages 1-7. File
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Lecture 8 Homework File
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Lecture 8 Homework Assignment - Answer Key File
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Lecture 9: Adaptive and Cluster Randomization Trials
Faculty: Joan Hilton
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Lecture 9 - Cluster RCT File
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Lecture 9 - Cluster RCT Media Resource
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Q&A Session - Cluster RCT (Hilton) Media Resource
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Brown AW, Li P, Bohan Brown MM, Kaiser KA, Keith SW, Oakes JM, Allison DB. Best (but oft-forgotten) practices: designing, analyzing, and reporting cluster randomized controlled trials. Am J Clin Nutr. 2015 Aug;102(2):241-8. File
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Coronado GD, Petrik AF, Vollmer WM, et al. Effectiveness of a Mailed Colorectal Cancer Screening Outreach Program in Community Health Clinics: The STOP CRC Cluster Randomized Clinical Trial. JAMA Intern Med. 2018;178(9):1174–1181. File
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Covariate Balancing Strategies URL
Optional video for viewing
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Small Group Discussion (see Roster for your section assignment)
Review of prior lecture and problem set
Faculty:
Location (Access restricted to registered students): Zoom URL
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Lecture 10:
- Trials of COVID Interventions
- Global Health Trials
Faculty: David Glidden & Patrick Phillips
Dr. Glidden will discuss the issues that have presented themselves in COVID-19 therapeutic trials.
Dr. Phillips will discuss global health trials.
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COVID Therapeutics File
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Global Health Trials File
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Glidden: COVID Therapeutics Media Resource
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Phillips - Global Health Trials Media Resource
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Lecture 11: Multicenter Studies and Industry-sponsored trials
The anatomy and physiology of multicenter trials. How to work effectively and make use of data from such trials. How industry trials operate. Pros and cons of participation in industry sponsored trials and principles that may minimize bias.Faculty: Dennis Black
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Multicenter Studies Pt1 File
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Multicenter Studies Pt2 File
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Multicenter Studies PT1 Media Resource
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Multicenter Studies Pt2 Media Resource
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Final Exam 2021 File

