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Drug development traditionally follows a sequential clinical trial paradigm to address specific objectives at each trial phase.
The identification and evaluation of effective neuroprotective therapies within a trial paradigm are key unmet needs.
Dietary habits in these cohorts are likely longstanding rather than short-lived, as in a clinical trial paradigm.
It is a crucial stage that differs the most from the pharmacological evaluations in the phase I IV trial paradigm.
The traditional trial paradigm which places great emphasis on defining a primary outcome has limitations in relation to the evaluation of health service innovations.
This study employed a 'no difference' trial paradigm in which all participants are given access to the same intervention while other aspects of the research process are experimentally manipulated [ 22].
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Last year, results of the phase 3 clinical trial PARADIGM-HF were published, comparing the efficacy and safety of LCZ696 versus enalapril (a RAAS-blocker) in chronic HF patients.
LCZ696 is the first ARNI to be tested in patients, and here we describe the design of the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortalilty and morbidity in Heart Failure trial (PARADIGM-HF).
Patients with chronic HF, NYHA class II IV symptoms, an elevated plasma BNP or NT-proBNP level, and an LVEF of ≤40% were enrolled in the Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortailty and morbidity in Heart Failure trial (PARADIGM-HF).
3, 7, 9 The Prospective comparison of ARNi with ACEi to Determine Impact on Global Mortality and morbidity in Heart Failure trial (PARADIGM-HF) is testing the hypothesis that LCZ696 200 mg b.i.d is superior to enalapril 10 mg bid is reducing mortality and morbidity in patients with heart failure and reduced ejection fraction (HF-REF).
Clinical trial paradigms examining acute inflammatory optic neuritis (ON) may help overcome this barrier by demonstrating a 'proof-of-concept' neuroprotective benefit for repurposed or novel therapies.
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Justyna Jupowicz-Kozak
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