Real-world evidence: How pragmatic are randomized controlled trials labeled as pragmatic?

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 7 April 2018)

Debate
|   3 April 2018
Real-world evidence: How pragmatic are randomized controlled trials labeled as pragmatic?
Pragmatic randomized controlled trials (RCTs) mimic usual clinical practice and they are critical to inform decision-making by patients, clinicians and policy-makers in real-world settings. Pragmatic RCTs assess effectiveness of available medicines, while explanatory RCTs assess efficacy of investigational medicines. Explanatory and pragmatic are the extremes of a continuum. This debate article seeks to evaluate and provide recommendation on how to characterize pragmatic RCTs in light of the current landscape of RCTs. It is supported by findings from a PubMed search conducted in August 2017, which retrieved 615 RCTs self-labeled in their titles as “pragmatic” or “naturalistic”. We focused on 89 of these trials that assessed medicines (drugs or biologics).
Authors: Rafael Dal-Ré, Perrine Janiaud and John P. A. Ioannidis