Interpreting clinical trial results of patient-perceived onset of effect in asthma: methods and results of a Delphi panel
- 18 May 2009
- journal article
- research article
- Published by Taylor & Francis Ltd in Current Medical Research and Opinion
- Vol. 25 (6), 1563-1571
- https://doi.org/10.1185/03007990902914403
Abstract
Objective: The purpose of this study was to determine if empirically observed differences in patient perception of, and satisfaction with, onset of effect between an active maintenance treatment and placebo are clinically meaningful to practicing clinicians. A secondary objective was to determine the lowest threshold for a clinically meaningful difference in terms of both between-group differences and maximum acceptable placebo effect. Methods: Twelve community-based healthcare professionals participated in a Delphi consensus panel. Panelists were provided with blinded results of two clinical trials showing statistically significant treatment effects for treatment A (budesonide/formoterol [Symbicort ]) over placebo in the proportion of patients who could perceive the medication working right away and the proportion of patients satisfied with this perception. Panelists were then asked to respond to a series of questions to identify a threshold for clinically important differences in patient-perceived onset of effect and satisfaction with speed of onset of effect. All expert panelists participated in two rounds of the Delphi process. Results: Panelists were unanimous in their conclusion that the statistically significant results from the two trials were clinically meaningful. According to these practitioners, the empirical results presented to them, showing that patients could feel a maintenance inhaler therapy work right away, were meaningful to clinical decision-making, and the attribute could potentially improve patient adherence with therapy. A group consensus was reached that a minimum active treatment response for these outcomes should range from 50% to 75% and be 2–3 times larger than the placebo response, with a maximum placebo effect of 26–40%. Conclusion: A Delphi panel study of practitioners was used to establish a meaningful range of response and a minimal important difference for interpreting results of clinical trials in which patient perception of onset of effect and satisfaction with this perception are tested. While the views of this panel may not be generalized to the entire population of practitioners in the United States, results provide insight into how a typical practitioner is likely to view clinical trial results and how the information might be used in clinical practice.Keywords
This publication has 19 references indexed in Scilit:
- Development and validation of an onset of effect questionnaire for patients with asthmaAllergy and Asthma Proceedings, 2008
- Finding consensus on the physiotherapy management of asymptomatic infants with cystic fibrosisPediatric Pulmonology, 2008
- Development of the Gross Motor Function Classification System (1997)Developmental Medicine and Child Neurology, 2007
- An Overview of AsthmaDimensions of Critical Care Nursing, 2006
- Efficacy and Safety of Budesonide and Formoterol in One Pressurised Metered-Dose Inhaler in Adults and Adolescents with Moderate to Severe AsthmaDrugs, 2006
- The use of a modified Delphi procedure for the determination of 26 prognostic factors in the sub-acute stage of strokeInternational Journal of Rehabilitation Research, 2003
- Clinically important differences in health-related quality of life for patients with asthma: an expert consensus panel reportAnnals of Allergy, Asthma & Immunology, 2003
- Asthma control in the Asia-Pacific region: The asthma insights and reality in Asia-Pacific studyJournal of Allergy and Clinical Immunology, 2003
- An evidence and consensus based guideline for the management of a child after a seizureEmergency Medicine Journal, 2003
- Format and Conduct of Consensus Development ConferencesInternational Journal of Technology Assessment in Health Care, 1990