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Historical Controls in Randomized Clinical Trials: Opportunities and Challenges
Author(s) -
Hall Kathryn T.,
Vase Lene,
Tobias Deirdre K.,
Dashti Hesam T.,
Vollert Jan,
Kaptchuk Ted J.,
Cook Nancy R.
Publication year - 2021
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1002/cpt.1970
Subject(s) - placebo , randomized controlled trial , clinical trial , medicine , gold standard (test) , pharmacogenomics , intensive care medicine , clinical study design , alternative medicine , pharmacology , pathology
Randomized control trials (RCTs) with placebo are the gold standard for determining efficacy of novel pharmaceutical treatments. Since their inception, over 75 years ago, researchers have amassed a large body of underutilized data on outcomes in the placebo control arms of these trials. Although rare disease indications have used these historical placebo data as synthetic controls to reduce burden on patients and accelerate drug discovery, broad use of historical controls is in its infancy. Large‐scale historical placebo data could be leveraged to benefit both drug developers and patients if warehoused and made more available to guide trial design and analysis. Here, we examine challenges in utilizing historical controls related to heterogeneity in trial design, outcome ascertainment, patient characteristics, and unmeasured pharmacogenomic effects. We then discuss the advantages and disadvantages of current approaches and propose a path forward to broader use of historical controls in RCTs.