Practical clinical trials in psychopharmacology: A systematic review

Benedetto Vitiello

Research output: Contribution to journalArticle

Abstract

Practical clinical trials (PCTs) are randomized experiments under typical practice conditions with the aim of testing the "real-life" benefits and risks of therapeutic interventions. Influential PCTs have been conducted in cardiology, oncology, and internal medicine. Psychotropic medications are widely and increasingly used in medical practice. This review examines recent progress in conducting PCTs in psychopharmacology. The January 2000 to October 2014 MEDLINE, Scopus, and ClinicalTrials.gov databases were searched for peer-reviewed publications of PCTs with at least 100 subjects per treatment arm. Most PCTs in psychiatry evaluated mental health services or psychosocial interventions rather than specific pharmacotherapies. Of 157 PCTs in psychiatry, 30 (19%) were in psychopharmacology, with a median of 2 publications per year and no increase during the period of observation. Sample size ranged from 200 to 18,154; only 11 studies randomized 500 patients or more. Psychopharmacology PCTs were equally likely to be funded by industry as by public agencies. There were 10 PCTs of antidepressants, for a total of 4206 patients (in comparison with at least 46 PCTs of antihypertensive medications, for a total of 208,014 patients). Some psychopharmacology PCTs used suicidal behavior, treatment discontinuation, or mortality as primary outcome and produced effectiveness and safety data that have influenced both practice guidelines and regulatory decisions. Practical clinical trials can constitute an important source of information for clinicians, patients, regulators, and policy makers but have been relatively underused in psychopharmacology. Electronic medical records and integrated practice research networks offer promising platforms for a more efficient conduct of PCTs.

Original languageEnglish (US)
Pages (from-to)178-183
Number of pages6
JournalJournal of Clinical Psychopharmacology
Volume35
Issue number2
DOIs
StatePublished - Apr 12 2015
Externally publishedYes

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Pragmatic Clinical Trials
Psychopharmacology
Psychiatry
Publications
Electronic Health Records
Mental Health Services
Internal Medicine
Cardiology
Administrative Personnel
Practice Guidelines
MEDLINE
Sample Size
Antihypertensive Agents
Antidepressive Agents

Keywords

  • large simple trials
  • practical trials
  • psychopharmacology

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Pharmacology (medical)

Cite this

Practical clinical trials in psychopharmacology : A systematic review. / Vitiello, Benedetto.

In: Journal of Clinical Psychopharmacology, Vol. 35, No. 2, 12.04.2015, p. 178-183.

Research output: Contribution to journalArticle

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