This article appears in the following Rheumatology issue: Update in systemic sclerosis [View the issue table of contents]
Trial design: how must we move ahead?
1University of Michigan Scleroderma Program, Ann Arbor, Michigan, MI, USA, 2Department of Rheumatology, University of Basel, Basel, Switzerland and 3Division of Rheumatology, UCLA Medical School, Los Angeles, CA, USA.
Correspondence to: J. R. Seibold, University of Michigan Scleroderma Program, 24 Frank Lloyd Wright Drive, PO Box 481 Lobby M-2500, Ann Arbor, MI 48106, USA. E-mail: jseibold{at}umich.edu
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Abstract |
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Scleroderma is clinically heterogeneous and a variety of plausible mechanisms of disease have been hypothesized. Recent years have witnessed a significant improvement in overall survival although all of the gains in management have been therapies for specific organ involvement, e.g. renal crisis and pulmonary arterial hypertension. Future studies will rely on improved clinical science, which involves structured validation of proposed measures of outcome; development of a combined response index; and further refinement of specific subsets of disease expression. Immunoablation with stem cell reconstitution is an example of aggressive therapy chosen as appropriate for a particularly severe disease subset and in whom the pilot data are encouraging. Good science and clinical ethics force continued consideration of equipoise between risk and benefit.
KEY WORDS: Scleroderma, Systemic sclerosis, Outcome measures, Trial design, Disease modification
Submitted 1 May 2008; Accepted 3 July 2008