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Registry-based randomized clinical trials—a new clinical trial paradigm


Randomized clinical trials provide the foundation of clinical evidence to guide physicians in their selection of treatment options. Importantly, randomization is the only reliable method to control for confounding factors when comparing treatment groups. However, randomized trials have limitations, including the increasingly prohibitive costs of conducting adequately powered studies. Local and national regulatory requirements, delays in approval, and unnecessary trial processes have led to increased costs and decreased efficiency. Another limitation is that clinical trials involve selected patients who are treated according to protocols that might not represent real-world practice. A possible solution is registry-based randomized clinical trials. By including a randomization module in a large inclusive clinical registry with unselected consecutive enrolment, the advantages of a prospective randomized trial can be combined with the strengths of a large-scale all-comers clinical registry. We believe that prospective registry-based randomized clinical trials are a powerful tool for conducting studies efficiently and cost-effectively.

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Figure 1: Inclusion rate in the TASTE trial.18


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All the authors researched data for the article, substantially contributed to discussion of content, wrote, and reviewed and edited the manuscript before submission.

Corresponding author

Correspondence to Stefan James.

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Competing interests

S.J. has received institutional research grants from Medtronic, Terumo, and Vascular Solutions for the conduct of the TASTE trial. The other authors declare no competing interests.

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James, S., Rao, S. & Granger, C. Registry-based randomized clinical trials—a new clinical trial paradigm. Nat Rev Cardiol 12, 312–316 (2015).

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