PT  - JOURNAL ARTICLE
AU  - Nasim A Khan
AU  - Karina D Torralba
AU  - Fawad Aslam
TI  - Missing data in randomised controlled trials of rheumatoid arthritis drug therapy are substantial and handled inappropriately
AID  - 10.1136/rmdopen-2021-001708
DP  - 2021 Jul 01
TA  - RMD Open
PG  - e001708
VI  - 7
IP  - 2
4099  - http://rmdopen.bmj.com/content/7/2/e001708.short
4100  - http://rmdopen.bmj.com/content/7/2/e001708.full
SO  - RMD Open2021 Jul 01; 7
AB  - Objectives To analyse the amount, reporting and handling of missing data, approach to intention-to-treat (ITT) principle application and sensitivity analysis utilisation in randomised clinical trials (RCTs) of rheumatoid arthritis (RA). To assess the trend in such reporting 10 years apart (2006 and 2016).Methods Parallel group drug therapy RA RCTs with a clinical primary endpoint.Results 176 studies enrolling a median of 160 (IQR 62–339) patients were eligible. In terms of actual analysis: 81 (46%) RCTs conducted ITT, 42 (23.9%) conducted modified ITT while 53 (30.1%) conducted non-ITT analysis. Only 58 of 97 (59.8%) RCTs reporting an ITT analysis actually performed it. The median (IQR) numbers of participants completing the trial and included in analysis for primary outcome were 86% (74%–91%) and 100% (97.1%–100%), respectively. 53 (32.7%) and 65 (40.1%) RCTs had >20% and 10%–20% missing primary outcome data, respectively. Missing data handling was unreported by 58 of 171 (33.9%) RCTs. When reported, vast majority used simple imputation methods. No significant trend towards improved reporting was seen between 2006 and 2016. Sensitivity analysis numerically improved from 2006 to 2016 (14.7% vs 21.4%).Conclusions There is significant discrepancy in the reported and the actual performed analysis in RA drug therapy RCTs. Nearly one-third of RCTs had >20% missing data. The reporting and methods of missing data handling remain inadequate with high usage of non-preferred simple imputation methods. Sensitivity analysis utilisation was low. No trend towards better missing data reporting and handling was seen.Data available upon request.