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There are no immediate ethical problems regarding this trial.
There are several important issues that must be recognized regarding this trial.
At the day of discharge, all patients receive 2 leaflets providing general information for the patient and the general physician (GP) regarding this trial.
The authors were not paid for writing the manuscript or any other activity regarding this trial and have no financial interest in Cytochemia AG.
In a later publication regarding this trial, it is noted that results were not different between patients, who had received prior to the trial, surgery, radiation therapy or who hadn't received either therapy.
Pairs of reviewers (from RMvR, JvO, and MvM) independently assessed the risk of bias of the included studies using the Cochrane Collaboration's tool (RMvR assessed all studies, except the study of which he is the first author; RMvR was not involved in any decision regarding this trial).
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Regarding this negative trial, should we definitively put nails in the coffin of an anti-IL-1 option in OA? Looking at the benefit/risk ratio in the study by Cohen and colleagues, it is tempting to answer yes.
To date, the choice between laparoscopy and robotic surgery has been made on the basis of the surgeon's experience only: there is no evidence in literature that robotic procedures are better than laparoscopy or open surgery and no randomized trial regarding this issue has been reported yet.
An example question of this type would be something along the lines of, "List all witnesses that you intend to call at the trial regarding this incident".
No evidence of statistical heterogeneity was observed between trials regarding this effect (I = 29%, P = 0.21).
Consequently, even though these finding are encouraging, we must be cautious in the definition of the next clinical trials regarding this drug so as not to repeat past failures.
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Since I tried Ludwig back in 2017, I have been constantly using it in both editing and translation. Ever since, I suggest it to my translators at ProSciEditing.

Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com