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Important considerations for trials for peripheral arterial disease: Lessons learned from the paclitaxel mortality signal: A report on behalf of the registry assessment for peripheral interventional Devices (RAPID) Paclitaxel Pathways Program - 23/01/21

Doi : 10.1016/j.ahj.2020.10.070 
Aaron E. Lottes, PhD a, Eleni M. Whatley, PhD b, , Sara M. Royce, PhD b, Daniel J. Bertges, MD c, Carla A. Erickson, MS d, Andrew Farb, MD b, Megan L. Fox, MBA e, Jenny H. Jiang, MS f, Li Wang, PhD, MS, MBA b, Asiyah Y. Lin, MD, PhD b, Misti L. Malone, PhD b, George Papandreou, PhD g, Rebecca W. Wilgus, RN, MSN h, Kenneth Rosenfield, MD i, Mitchell W. Krucoff, MD h
a Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 
b Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD 
c Division of Vascular Surgery, University of Vermont Medical Center, Burlington, VT 
d Surmodics, Inc., Eden Prairie, MN 
e Aortic, Peripheral, & Venous, Medtronic, Minneapolis, MN 
f Peripheral Interventions, Boston Scientific Corporation, Maple Grove, MN 
g Becton Dickinson Peripheral Intervention, Tempe, AZ 
h Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC 
i Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA 

Reprint requests: Eleni M. Whatley, PhD, Food and Drug Administration, Center for Devices and Radiological Health 10903 New Hampshire Avenue Silver Spring, MD 20993.Food and Drug Administration, Center for Devices and Radiological Health10903 New Hampshire AvenueSilver SpringMD20993

Abstract

The Registry Assessment of Peripheral Devices (RAPID) convened a multidisciplinary group of stakeholders including clinicians, academicians, regulators and industry representatives to conduct an in-depth review of limitations associated with the data available to assess the paclitaxel mortality signal. Available studies were evaluated to identify strengths and limitations in the study design and data quality, which were translated to lessons learned to help guide the design, execution, and analyses of future studies. We suggest numerous actionable responses, such as the development and use of harmonized data points and outcomes in a consensus lean case report form. We advocate for reduction in missing data and efficient means for accrual of larger sample sizes in Peripheral arterial disease studies or use of supplemental datasets. Efforts to share lessons learned and working collaboratively to address such issues may improve future data in this device area and ultimately benefit patients.

Condensed Abstract: Data sources evaluating paclitaxel-coated devices were evaluated to identify strengths and limitations in the study design and data quality, which were translated to lessons learned to help guide the design, execution, and analyses of future studies. We suggest numerous actionable responses, which we believe may improve future data in this device area and ultimately benefit patients.

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 Funding: Nothing to report.
 Disclosure: Aaron E. Lottes, PhD: Consulting fees from Cook Medical; Eleni M. Whatley, PhD: None; Sara M. Royce, PhD: None; Daniel J. Bertges, MD: None; Carla A. Erickson, MS: Employee of Surmodics, Inc.; Andrew Farb: None; Megan L. Fox, MBA: Employee of Medtronic; Jenny H. Jiang, MS: Employee of Boston Scientific Corporation; Asiyah Y. Lin, MD, PhD: None; Misti L. Malone, PhD: None; George Papandreou, PhD: Employee of Becton Dickinson; Rebecca W. Wilgus, RN, MSN: None; Kenneth Rosenfield, MD: Consultant, have grants, own, or received equity from AngioDynamics, Inc.; Philips; Boston Scientific Corporation; Surmodics, Inc.; Janssen; Mayo Clinic; BMS-Pfizer, Inari Medical, Inc.; National Institute of Health; Gettinge; Intact Vascular; Accolade; Access Vascular; Contego; Cruzar Systems; Embolitech; Endospan; Eximo; JanaCare; Magneto; Micell; Orchestra; PQ Bypass; Primacea; Silk Road; Shockwave Medical; Summa Therapeutics; Thrombolex; Valcare; Mitchell W. Krucoff, MD: none.


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