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01.12.2016 | Review | Ausgabe 1/2016 Open Access

Trials 1/2016

Adaptive designs undertaken in clinical research: a review of registered clinical trials

Trials > Ausgabe 1/2016
Isabella Hatfield, Annabel Allison, Laura Flight, Steven A. Julious, Munyaradzi Dimairo
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

MD provided the inception of the research idea and drafted the protocol. MD, LF and AA conducted the feasibility study. IH, AA, MD and LF contributed to the data collection and analysis. MD, LF and AA performed the quality control. AA and MD wrote the first draft of the manuscript. SJ reviewed and contributed to the writing of the paper and provided support as required. All authors revised the manuscript and approved the final version.


The views expressed in this publication are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health or the University of Sheffield.


Adaptive designs have the potential to improve efficiency in the evaluation of new medical treatments in comparison to traditional fixed sample size designs. However, they are still not widely used in practice in clinical research. Little research has been conducted to investigate what adaptive designs are being undertaken. This review highlights the current state of registered adaptive designs and their characteristics. The review looked at phase II, II/III and III trials registered on from 29 February 2000 to 1 June 2014, supplemented with trials from the National Institute for Health Research register and known adaptive trials. A range of adaptive design search terms were applied to the trials extracted from each database. Characteristics of the adaptive designs were then recorded including funder, therapeutic area and type of adaptation. The results in the paper suggest that the use of adaptive designs has increased. They seem to be most often used in phase II trials and in oncology. In phase III trials, the most popular form of adaptation is the group sequential design. The review failed to capture all trials with adaptive designs, which suggests that the reporting of adaptive designs, such as in clinical trials registers, needs much improving. We recommend that clinical trial registers should contain sections dedicated to the type and scope of the adaptation and that the term ‘adaptive design’ should be included in the trial title or at least in the brief summary or design sections.
Additional file 1 Search terms. PDF with a table of the final selection of search terms used in the review. (PDF 6.19 kb)
Additional file 2 Table of summary statistics. PDF containing a table of summary statistics by phase and funder type. Counts and percentages are presented for categorical variables whilst medians and interquartile ranges are presented for continuous variables. (PDF 19.5 kb)
Additional file 3 Case studies. XLSX file containing a list of the trials used in the review. Trial number, title and URL are provided. (XLSX 35.2 kb)
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