Rationale & Design of the Aspirin Dosing-A Patient-Centric Trial Assessing Benefits & Long-term Effectiveness (ADAPTABLE) Trial

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Rationale & Design of the Aspirin Dosing-A
Patient-Centric Trial Assessing Benefits &
Long-term Effectiveness (ADAPTABLE) Trial
Guillaume Marquis-Gravel, et al.

Key Points
Question What is the most appropriate dosage of aspirin in patients with established atherosclerotic cardiovascular disease?

Findings This report highlights the intricate design and details of study conduct for the Aspirin Dosing: a Patient-Centric Trial Assessing Benefits and Long-term Effectiveness (ADAPTABLE) trial. This is the first pragmatic trial using the Patient-Centered Outcomes Research network, which was developed to perform large scale comparative-effectiveness clinical trials.

Meaning The ADAPTABLE study will help to determine the optimal dosage of aspirin in patients with established atherosclerotic cardiovascular disease.

ABSTRACT

Importance Determining the right dosage of aspirin for the secondary prevention treatment of atherosclerotic cardiovascular disease (ASCVD) remains an unanswered and critical question.

Objective To report the rationale and design for a randomized clinical trial to determine the optimal dosage of aspirin to be used for secondary prevention of ASCVD, using an innovative research method.

Design, Setting, and Participants This pragmatic, open-label, patient-centered, randomized clinical trial is being conducted in 15’000 patients within the National Patient-Centered Clinical Research Network (PCORnet), a distributed research network of partners including clinical research networks, health plan research networks, and patient-powered research networks across the United States. Patients with established ASCVD treated in routine clinical practice within the network are eligible. Patient recruitment began in April 2016. Enrollment was completed in June 2019. Final follow-up is expected to be completed by June 2020.

Interventions Participants are randomized on a web platform in a 1:1 fashion to either 81 mg or 325 mg of aspirin daily.

Main Outcomes and Measures The primary efficacy end point is the composite of all-cause mortality, hospitalization for nonfatal myocardial infarction, or hospitalization for a nonfatal stroke. The primary safety end point is hospitalization for major bleeding associated with a blood-product transfusion. End points are captured through regular queries of the health system common data model within the structure of PCORnet distributed data environment.

Conclusions and Relevance As a pragmatic study and the first interventional trial conducted within the PCORnet electronic data infrastructure, this trial is testing several unique and innovative operational approaches that have the potential to disrupt and transform the conduct of future patient-centered randomized clinical trials by evaluating treatments integrated in clinical practice while at the same time determining the optimal dosage of aspirin for secondary prevention of ASCVD.

JAMA Cardiol. 2020;5(5):598-607. doi:10.1001/jamacardio.2020.0116

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