On 2013 Dec 06, Lorraine Johnson commented:
It is not possible to keep up. Stepping back down the food chain a moment to RCTs. Consider the use of RCTs to solve combination regimen questions. Answer: cannot be done in our lifetime. We need better (and faster) tools. The summation of these efforts will necessarily incorporate the weaknesses of the underlying data to provide answers. See Saver re combination regimen RCTs and duration to answer.Saver JL, 2001 "Strategies for testing combination regimens include: head to head trials of all combinations, which lead to unwieldy trial numbers; very large multi-arm trials, which impractically delay interval information on regimen utility; and hierarchical, serial clinical trials. Systematic literature review revealed seven classes of agents already approved or in late phase III testing for preventing the development or slowing the progression of Alzheimer disease and five for ischemic stroke prevention. Possible combination regimens number 128 (2(7)) for Alzheimer disease and 32 (2(5)) for ischemic stroke. Hierarchical, serial clinical trials would permit identification of the optimum combination of these agent classes for Alzheimer disease through 127 trials, enrolling 63,500 patients, requiring 286 years; for ischemic stroke through 31 trials, enrolling 186,000 patients, requiring 155 years."
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