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Independence of clinical events committees: A consensus statement from clinical research organizations - 28/04/22

Doi : 10.1016/j.ahj.2022.03.005 
Ernest Spitzer, MD a, b, , Alexander C. Fanaroff, MD, MHS d, C. Michael Gibson, MD e, f, Jonathan Seltzer, MD c, Eugene McFadden, MD b, h, Maria Ali, MD i, Matthew Wilson, RN g, Venu Menon, MD j, k, Roxana Mehran, MD l, Claes Held, MD m, Kenneth W. Mahaffey, MD n, Renato D. Lopes, MD g
a Department of Cardiology and Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands 
b Cardialysis, Clinical Trial Management and Core Laboratories, Rotterdam, The Netherlands 
c Sandpiper Research, Narberth, PA 
d Cardiovascular Outcomes Quality and Evaluative Research Center, Leonard Davis Institute for Health Economics, and Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, PA 
e Harvard Medical School, Boston, MA 
f Baim Institute for Clinical Research, Boston, MA 
g Division of Cardiology, Duke University Medical Center, Duke Clinical Research Institute, Durham, NC 
h Department of Cardiology, Cork University Hospital, Cork, Ireland 
i George Clinical, Newtown, Australia 
j Cardiac Intensive Care Unit, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 
k C5Research, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 
l Icahn School of Medicine at Mount Sinai, New York, NY 
m Department of Medical Sciences, Cardiology, Uppsala Clinical, Research Center, Uppsala University, Uppsala, Sweden 
n Stanford Center for Clinical Research, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA 

Reprint requests: Dr. Ernest Spitzer at Cardialysis & Erasmus University Medical Center. Westblaak 98, 6th floor, 3012KM, Rotterdam, The Netherlands.Cardialysis and ThoraxcenterErasmus University Medical CenterRotterdamThe Netherlands

Abstract

Background

Randomized clinical trials are the gold standard to assess the causal relationship between an intervention and subsequent outcomes, also known as clinical endpoints. In order to limit bias, central clinical events committees (CEC) are established to ensure consistent event reporting across participating centers, as well as complete and accurate ascertainment of endpoints. However, defining independence is challenging.

Methods

This consensus statement was generated by teleconferences and electronic communications among clinical research organizations from the United States, Europe and Australia. This document does not constitute regulatory guidance.

Results

An independent CEC is defined when the adjudicators are not primarily involved in designing, funding, sponsoring, organizing, conducting, analyzing or regulating the clinical trial for which they serve as an adjudicator, beyond their role as CEC member. Moreover, independence requires absence of conflicts of interest with the steering committee, sponsor, grant giver, manufacturer, coordinating center, other independent committees, core laboratories, medical monitor, safety physician, participating clinical sites, statistician or data manager, regulatory agencies or authorities, which could influence (or be perceived to influence) a member's objectivity in evaluating trial data. Such conflicts of interest include financial benefits, directing or advisory role (paid or unpaid), decision-making position, as well as being a direct relative. An independent adjudicator has no other role within a clinical trial.

Conclusions

This consensus statement presents a standardized definition of an independent CEC to be considered by clinical research organizations, manufacturers, and investigators. In addition, it provides recommendations on best practices for implementation of an independent CEC.

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