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In general, these trials adhered to one of three basic protocol designs: comparison of buprenorphine to methadone; dose comparisons using dose response as an indicator of efficacy; and comparison of buprenorphine to placebo.
Muscle biopsies were obtained at baseline, 12 and 52 weeks post-treatment to establish an indicator of efficacy.
For clinicians, the most important indicator of efficacy was represented by the reduction in the number of days with headache, in agreement with the efficacy measures used in the clinical trials and in real-life studies evaluating OBT-A in CM [14, 15, 28, 31, 34, 35].
According to the participants in the survey, the most relevant indicator of efficacy of the prophylaxis with OBT-A was the reduction in the number of days with headache, followed by the reduction in the number of days with migraine and by patient satisfaction/improvement in QoL (Fig. 3a).
Changes in the distribution of voxels under the influence of treatment in terms of percentage viable voxels (i.e., percentage above or below a predetermined cutoff point) within a certain volume of interest may be a better indicator of efficacy and consequently have prognostic value.
Another indicator of efficacy is progression-free survival (PFS).
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In line with this, digital interventions have begun to emerge for a variety of conditions including MDD and have shown promising indicators of efficacy.
Furthermore, CRF-L1 and BDNF could be used as indicators of efficacy related to non-pharmacological interventions in FM patients.
The studies outlined above show that DCE-MRI biomarkers can provide early indicators of efficacy, dose and outcome.
29 We believe that adherence to treatment and determination of daily dose could be considered good indicators of efficacy in population-based studies.
At present, AD biomarkers have not yet been validated as surrogate endpoints for regulatory purposes and therefore cannot be used as the primary indicators of efficacy.
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