Analysis Raises Concerns About News and Biomedical Coverage of Landmark Trials

An analysis of news and journal coverage following the release of the ACCORD-Lipid trial results, raises "questions about the role that news and biomedical journal articles are playing in the dissemination of findings from landmark clinical trials and their prospective use in promoting evidence based practice."

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The analysis, published in JAMA Internal Medicine, is based on 67 news articles and 141 biomedical journal articles discussing ACCORD-Lipid, which tested lipid control among patients with diabetes mellitus using fenofibrate in addition to statin therapy. The ACCORD-Lipid results found the addition of fenofibrate to statin therapy was not superior to statin therapy alone, nor was fenofibrate able to reduce rates of cardiovascular disease. However, in subgroup analysis, men appeared to benefit, while women appeared to be harmed from fenofibrate therapy (p for interaction = 0.01). Also, a high triglyceride (> 203)/low HDL (<35) profile appeared to benefit (p for interaction = 0.06).

Looking closely at news and journal coverage of the results, the analysis authors note that the trial results were "described inconsistently in news and biomedical journal articles" with 30 percent of news and biomedical journal articles describing fenofibrate as ineffective, while nearly 20 percent concluding it was effective. Among articles making a recommendation, approximately 50 percent of news and 67 percent of biomedical journal articles supported continued fibrate use. The authors of the analysis, also suggest that authors with conflicts of interest were more likely to describe fenofibrate as effective (27.1% vs 8.9%; relative risk, 3.03; 95%CI, 1.22-7.50; P = .008) and support continued fibrate use (77.4% vs 45.8%; 1.69; 1.07-2.67; P = .006).

"Together, the unexpected results of ACCORD-Lipid, the sheer cost of the overall trial, and several pharmaceutical companies’ financial stake in fenofibrate make the ACCORD-Lipid trial an interesting case study that may offer insight into how new evidence is disseminated to patients and physicians," the analysis authors write. "In addition to reading actual trial publications, clinicians rely on multiple sources that synthesize evidence and offer interpretations of clinical trial findings, including editorials, commentaries, systematic reviews, and practice guidelines … In addition, patients and physicians increasingly obtain health information from the news media, particularly online outlets."

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Lipid Metabolism, Nonstatins, Novel Agents, Statins

Keywords: Fenofibrate, Writing, Dyslipidemias, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Evidence-Based Practice, Triglycerides, Reading


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