The concept of a “pragmatic” clinical trial was first proposed nearly 50 years ago as a study design philosophy that emphasizes answering questions of most interest to decision makers.1 Decision makers, whether patients, physicians, or policy makers, need to know what they can expect from the available diagnostic or therapeutic options when applied in day-to-day clinical practice. This focus on addressing real-world effectiveness questions influences choices about trial design, patient population, interventions, outcomes, and analysis. In this issue of JAMA, Gottenberg et al2 report the results of a trial designed to answer the question “If a biologic agent for rheumatoid arthritis is no longer effective for an individual patient, should the clinician recommend another drug with the same mechanism of action or switch to a biologic with a different mechanism of action?” Because the authors included some pragmatic elements in the trial design, this study illustrates the issues that clinicians should consider in deciding whether a trial result is likely to apply to their patients.
Sox HC, Lewis RJ. Pragmatic Trials: Practical Answers to “Real World” Questions. JAMA. 2016;316(11):1205–1206. doi:10.1001/jama.2016.11409
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