Discover and read the best of Twitter Threads about #mams

Most recents (3)

We are all being rightly encouraged to be #efficient in our trial design & conduct. Efficiency comes primarily through design choices … whether classic or more modern efficient designs … a few reflections below 1/7
#MethodologyMonday
A #crossover design can be highly efficient. Each person acts as their own control removing large element of variation, making the design more powerful. The outcome needs to be short term however & the intervention can’t have a long-standing effect 2/7
bmj.com/content/316/71… Image
This is particularly the case when a cluster design is also in play. A #ClusterCrossover design can majorly reduce the sample size requirements compared with a std cluster design. A good primer on this was published by @karlahemming and colleagues 3/7
bmj.com/content/371/bm… ImageImage
Read 7 tweets
The preprints of the #SOLIDARITY trial are out on MedRxiv. While many may lament that all four drugs tested did not show benefit, this is a remarkable trial for many reasons. Thread
First, this was another #MultiArmMultiStage #MAMS study design; @MRCCTU made this highly efficient trial design globally acclaimed with #STAMPEDE. The more recent #RECOVERY trial was another example of this.
@MaxParmarMRCUCL @Prof_Nick_James @PeterHorby @MartinLandray
What the #MAMS design does is enable testing multiple drugs simultaneously, flexibility to drop unpromising ones & add new promising ones even midway during the trial. This was crucial in the #COVID__19 pandemic where the situation has been constantly evolving
Read 16 tweets
The power of large, pragmatic randomized trials. Conducted by academic researchers using an adaptive trial design (#MAMS), and you’ve got a winner. Strong reasons why publicly funded research is so very important. Thread
The #RECOVERY trial has answered 3 important, clinically relevant questions about #COVID_19. It has shown that #Dexamethasone is beneficial in patients requiring oxygen/ ventilation & that HCQ and Lopinavir-Ritonavir are not useful.
#HCQ results are now out in preprint!
#RECOVERY randomized 1561 pts to #HCQ and 3155 to standard of care. Primary endpoint of 28-day mortality was 26.8% in the HCQ arm and 25% in the SOC arm. Lack of benefit consistent across all sub-groups. And remember, 28-day mortality in the same trial in the Dexa arm was 21.6%
Read 6 tweets

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