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Concomitant care

Item 11d: Relevant concomitant care and interventions that are permitted or prohibited during the trial.

Example

“2. Rescue Medication

For weeks 0-3, topical mometasone furoate 0.1% cream or ointment (30 g/week) will be permitted with participants preferably using ointment. Participants will be instructed to apply the topical mometasone furoate to blisters/lesions as required (not to areas of unaffected skin). If the participant is allergic to mometasone furoate or the hospital pharmacy does not stock it, then an alternative topical steroid may be prescribed but this must be in the potent class. In addition, participants will be advised that they can apply a light moisturiser to blisters/lesions at any time during the study.

For weeks 3-6, use of mometasone furoate (or other topical corticosteroids) is strongly discouraged to prevent potential systemic effects. Accidental use of mometasone furoate or other potent topical steroid during this period will be classified as a protocol deviation.

After week 6, potent topical corticosteroids (up to 30 g/week) may be used to treat symptoms and localised disease if they would have normally been used as part of normal clinical care by the physician in charge of that patient. This must be recorded on the trial treatment log.

However, those patients who are on a dose reducing regime for oral steroids, 30 g/week of a ‘potent’ topical steroid will be allowed.

3. Prohibited Concomitant Medications

The administration of live virus vaccines is not permitted for all participants during weeks 0-6 as the investigator is blinded to treatment allocation, and must therefore warn all participants to refrain for [sic] having a live virus vaccine. However, after week 6, once the investigator knows which medication the participant is on, only those taking prednisolone will not be allowed live virus vaccines.

Participants should continue to take medications for other conditions as normal. However, if it is anticipated that the participant will need a live virus vaccine during the intervention phase, they will be ineligible for entry into the study.” 50

Explanation

In a controlled trial, a key goal is to have comparable study groups that differ only by the intervention being evaluated, so that any difference in outcomes can be attributed to effects of the study intervention. Co-intervention bias can arise when the study groups receive different concomitant care or interventions (in addition to the assigned trial interventions) that may impact trial outcomes.162 To promote comparability of study groups, the protocol should list the relevant concomitant care and interventions that are allowed (including rescue interventions), as well as any that are prohibited.

11c: Adherence 12: Outcomes
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