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. 2013 May;10(5-6 Suppl A):4S-19S.

Defining a clinically meaningful effect for the design and interpretation of randomized controlled trials

Richard S E Keefe  1 , Helena C Kraemer, Robert S Epstein, Ellen Frank, Ginger Haynes, Thomas P Laughren, James McNulty, Shelby D Reed, Juan Sanchez, Andrew C Leon
Affiliations

Defining a clinically meaningful effect for the design and interpretation of randomized controlled trials

Richard S E Keefe et al. Innov Clin Neurosci. 2013 May.

Abstract

Objective: This article captures the proceedings of a meeting aimed at defining clinically meaningful effects for use in randomized controlled trials for psychopharmacological agents.

Design: Experts from a variety of disciplines defined clinically meaningful effects from their perspectives along with viewpoints about how to design and interpret randomized controlled trials.

Setting: The article offers relevant, practical, and sometimes anecdotal information about clinically meaningful effects and how to interpret them.

Participants: The concept for this session was the work of co-chairs Richard Keefe and the late Andy Leon. Faculty included Richard Keefe, PhD; James McNulty, AbScB; Robert S. Epstein, MD, MS; Shelby D. Reed, PhD; Juan Sanchez, MD; Ginger Haynes, PhD; Andrew C. Leon, PhD; Helena Chmura Kraemer, PhD; Ellen Frank, PhD, and Kenneth L. Davis, MD.

Results: The term clinically meaningful effect is an important aspect of designing and interpreting randomized controlled trials but can be particularly difficult in the setting of psychopharmacology where effect size may be modest, particularly over the short term, because of a strong response to placebo. Payers, regulators, patients, and clinicians have different concerns about clinically meaningful effects and may describe these terms differently. The use of moderators in success rate differences may help better delineate clinically meaningful effects.

Conclusion: There is no clear consensus on a single definition for clinically meaningful differences in randomized controlled trials, and investigators must be sensitive to specific concerns of stakeholders in psychopharmacology in order to design and execute appropriate clinical trials.

Keywords: Clinically meaningful effect; psychopharmacology drug trials.

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Figures

FIGURE 1
FIGURE 1
Linear model of the relationship between outcome measure and moderator
FIGURE 2
FIGURE 2
Pair of patients from the same dataset, but this time with a nonspecific predictor
FIGURE 3
FIGURE 3
The size of the moderator effect attenuates the overall treatment effect size
FIGURE 4
FIGURE 4
Effect of combined moderator ES=0.31, cross point M*=0.003
See this image and copyright information in PMC

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