Clinical Endpoint Adjudication

Cardialysis is highly experienced in organizing event/endpoint adjudication through a dedicated Clinical Events Committee (CEC). Cardialysis provides the infrastructure for your clinical trial event adjudication needs, whether this is during face-to-face CEC meetings where the CEC members meet as a group, or during remote adjudication where the individual CEC member can log in to a web-based system.

Cardialysis has been in the lead for establishing clinical trial endpoint definitions, together with important partners. The Cardialysis & Academic Research Consortium(ARC) was initiated together with academic leaders in cardiology and has produced landmark documents that have shaped the design of clinical trials in the last decades. These standard definitions have been implemented in coronary stent and transcatheter valve intervention trials, and cover a wide range of patient-oriented and device-oriented endpoints.

Up to 2016, Cardialysis has managed the CEC for over 100 clinical trials in cardiology, having adjudicated more than 90,000 potential events. The range of trial size goes from first-in-man trials generally coupled with Core Lab endpoints to large multi-national trials with up to 7000 potential events, both with pharma and device interventions. Our network of expert adjudicators allows us to manage multiple CECs at the same time within an efficient and reliable process.

Cardialysis has developed a 100% web–based, customizable application (WebCEC) that can be used by the adjudicator at any time. The user-friendliness of WebCEC is well recognized by CEC members. This system is cost-efficient and provides the sponsor with the flexibility to decide on the main configuration settings. All trial documentation, event definitions, event-related documents, and adjudication questionnaires are available online in a secure environment.

Receipt and Scanning of Event-Related Documents

Event-related documents are processed in digital form, with the digitizing taking place at Cardialysis if needed. These documents are entered into a tracking system and are attached to the relevant event that requires adjudication, becoming immediately available to the adjudicators for review. Imaging data (DICOM format) are also processed for each event and available for review during adjudication. Imaging modalities include angiography, computed tomography, X-rays, and echocardiography. When other invasive or non-invasive imaging modalities are required, Core Lab reports are presented to the adjudicators.

Event Triggering

Potential trial endpoints, commonly referred to as ‘event triggers’, are captured from multiple sources in the central trial database. Sources of event triggers include those reported by the investigators in the study electronic case report form (eCRF), e-CRF-derived programmable event triggers, and Core Lab-derived event triggers.

Event Management

Once the event trigger list is ready, Cardialysis links the electronic event-related documents to these potential endpoints and assigns the resulting ’e-dossiers’ to the CEC members for adjudication. Cardialysis is also highly experienced in writing narratives to facilitate adjudication.

Event Adjudication

Whether remotely or during face-to-face meetings, a CEC member can log in to the WebCEC application at any time, and without any paperwork. The trial protocol, event definitions, event-related documents and imaging data, as well as the adjudication forms, are all online. The web-based application itself is protected (by username, password, and passcode) and runs in a secure environment.

Immediate Results

The WebCEC system checks the consistency among the adjudicators’ individual answers instantly. Matching results are final and immediately available for statistical processing. Inconsistently adjudicated events are discussed among the CEC members and resolved during CEC consensus meetings (face-to-face or by conference call). Consistency rules can be defined as required.

CEC Members

Cardialysis has a network of cardiologists, cardiac surgeons, electrophysiologists and neurologists who are experienced in CEC adjudication. These CEC members are trained to adjudicate events in compliance with Cardialysis SOPs and the trial-specific requirements described in the CEC Charter. Other adjudicators can be trained by Cardialysis and can join the team of CEC members for a specific trial. All CEC members are trained in the use of the WebCEC system. Click here to go to a list of our CEC members

Advantages of Using the Web-based Event Adjudication System

Advantages for the CEC
  • Electronic adjudication remotely or during meetings – convenient, quick and easy
  • No paperwork, immediate online access to: Web-based user manual, trial protocol, event definitions, CEC Charter, event-related documents and imaging data
  • Daily overview of workload
  • Technical assistance

Advantages for the sponsor
  • 100% electronic: direct upload of eCRF data and electronic documents at Cardialysis (digitizing taking place at Cardialysis if needed)
  • Central preparation of electronic patient ’event dossier’ by Cardialysis
  • CEC requests for additional information are managed through WebCEC
  • Highly configurable adjudication process, CEC members (number, specialties), event trigger types, among others
  • The distribution of event triggers and the adjudication methodology can be defined
  • Adaptable to trial-specific terminology
  • Immediate adjudication results
  • Standard and custom-made reports on a periodic basis
  • FDA 21CFR part 11 compliant
  • Protected (by username, password and passcode), secure connection and environment
  • Centralized CEC training by Cardialysis
  • Reduced CEC travel costs due to remote adjudication