TY - JOUR T1 - Answering patient-centred questions efficiently: response-adaptive platform trials in primary care JF - British Journal of General Practice JO - Br J Gen Pract SP - 294 LP - 295 DO - 10.3399/bjgp18X696569 VL - 68 IS - 671 AU - Christopher C Butler AU - Jason T Connor AU - Roger J Lewis AU - Kristine Broglio AU - Benjamin R Saville AU - Johanna Cook AU - Alike van der Velden AU - Theo Verheij Y1 - 2018/06/01 UR - http://bjgp.org/content/68/671/294.abstract N2 - As currently designed and conducted, randomised controlled trials rarely address the complexity of patient characteristics that need to be taken into account when making clinical decisions in primary care. We introduce the concept of a response-adaptive platform trial design, as this approach may be better suited to answering patient-centred primary care research questions.The primary question addressed by a traditional clinical trial is whether a treatment is beneficial in the average patient. However, the question that trials should ideally provide would instead answer the question: ‘What is the best treatment for each individual patient, given all of their characteristics that could influence the effectiveness, or otherwise, of the treatment?’Although sub-group analyses are often performed in traditional trials to determine if the treatment effect is associated with certain patient or disease characteristics (for example, comorbidities, age, or illness severity), these analyses are typically post-hoc, underpowered, and usually consider only one patient characteristic at a time. Thus we might learn something about the influence of age in general on the outcome of treatment from sub-group analysis of a traditional trial, but not about the influence of age, illness severity, and symptom duration combined. Furthermore, participants in traditional clinical trials are often selected to be homogeneous in terms of their illness and to be free of comorbid conditions and any concomitant medications that might complicate the assessment of the effect of a treatment. This leads to a lack of applicability of trial findings to many complex primary care patients.Most registration trials (those intended to support regulatory approvals of new medications) also fail to address important comparative effectiveness questions such as which therapy or combination of therapies may be the most or least effective, or which therapy, out of all of the available therapies, has the best compliance or tolerability. The traditional … ER -