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To answer pressing clinical questions, innovative trial designs are needed, along with operational strategies that include risk factor enrichment, target-based end point selection and validation, flexible study accrual and monitoring, and techniques that permit early termination when initial treatment outcomes are poor.
End point selection.
Descriptive statistics were used to summarize trial characteristics and end point selection.
Discrepancies among the same cell line arisen from culture may certainly lead to different responses, and the dose schedule and end point selection may also explain the differences.
In addition, trials were evaluated based on whether rituximab was included in at least one of the treatment arms, and differences in primary end point selection were determined using Fisher's exact test.
As with end point selection, NTP studies are sufficiently flexible to allow the use of the most appropriate strain or model, and historically the NTP has followed this practice.
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Details regarding the quality of dosimetry, assessment of disease end points, selection criteria to determine cohort eligibility, circulatory disease risk factors assessed, and statistical analyses used in the 10 studies are provided in Supplemental Material, Table S2 (http://dx.doi.org/10.1289/ehp.1204982).org/10.1289/ehp.1204982
The phase 2 and phase 3 Japanese trials of pirfenidone were not included in this analysis because they differed from the three multinational trials in study design and end-point selection.
Unsupervised and expert-driven approaches to end-point selection and subsequent chemical classification yielded near identical sets of target organs from which to select specific effects or aggregated effects.
This uncertainty is mainly caused by methodological limitations such as poor study design, relatively small sample sizes without a power calculation, inappropriate outcome measures and primary and secondary end-point selection, and invalid statistical analysis.
There are a number of potential causes of variability, including sources of ENM, ENM suspension protocols, selection of target cells, end points selected to evaluate ENM bioactivity, and details of cell culture and end point assays.
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