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Since the initiating events that result in the cartilage degradation are poorly understood, there has been very limited success in demonstrating disease modification in clinical trials of potential therapies.
Changes in biological markers levels may indicate a modification in clinical status.
Current evidence of effect modification in clinical trials indicates that certain characteristics do hamper the likelihood for success of self-management interventions.
To our knowledge, only few observational studies comprehensively investigated predictors of ART regimen modification in clinical settings in low- and middle-income countries [ 6, 7, 15].
Analysis of the epigenome is more complex, and the majority of studies have therefore focused on the methylome, because DNA methylation is the most accessible epigenetic modification in clinical samples [ 19].
Since the initiating events that result in the cartilage degradation are poorly understood, there has been very limited success in demonstrating disease modification in clinical trials of potential therapies [ 2].
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Strategies for improving accrual and modifications in clinical trial design are outlined.
Additionally, they offer flexibility to adapt to different clinical settings, important aspects if one wishes to implement modifications in clinical protocols to decrease or increase CS rates.
In the radiotherapy part of treatment only modifications in clinical target volume delineation have been introduced.
The next step will be to test risk factor modifications in clinical trials.
Further studies could assess to what extent modifications in clinical practice and/or external interventions might cause changes in the patient mix.
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