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Clinical Trials in Traumatic Brain Injury: Past Experience and Current Developments
Open accessAbstract
In this article, we review past and current experience in clinical trials of traumatic brain injuries (TBIs), we discuss limitations and challenges, and we summarize current directions. The focus is on severe and moderate TBIs. A systematic literature search of the years from 1980 to 2009 revealed 27 large phase III trials in TBI; we were aware of a further 6 unpublished trials. Analysis of these 33 trials yielded interesting observations: There was a peak incidence of trial initiations that occurred in the mid-1990s with a sharp decline during the period from 2000 to 2004. Most trials that reported a significant treatment effect were studies on a therapeutic strategy (e.g., decompressive craniectomy, hypothermia), and these were single-center studies. Increasingly, studies have been shifting toward the Far East. The currently existing trial registries permit insight into ongoing or recently conducted trials. Compared with the past decade, the number of studies on neuroprotective agents taken forward into efficacy-oriented studies is low. In contrast, the number of studies on therapeutic strategies appears to be increasing again. The disappointing results in trials on neuroprotective agents in TBI have led to a critical reappraisal of clinical trial methodology. This has resulted in recommendations for preclinical workup and has triggered extensive analysis on approaches to improve the design and analysis of clinical trials in TBI. An interagency initiative toward standardization on selection and coding of data elements across the broad spectrum of TBI is ongoing, and will facilitate comparison of research findings across studies and encourage high-quality meta-analysis of individual patient data in the future.
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“Despite preclinical studies providing evidence for successful pharmacologic intervention, more than 30 phase-III clinical trials have failed to improve secondary injury outcome measures after TBI (35–37).”
From The Inflammatory Continuum of Traumatic Brain Injury and Alzheimer’s Disease (2018) · cites this paper as [36]
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“The Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure (BEST Trip) trial is a prime example of the need to tailor protocols to local conditions [15–19].”
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Ciara, C., & Casey, C. (2012) · InTech eBooks · doi:10.5772/31260 · Cited by 3
“Numerous pharmacological treatments that seemed promising in animal models have failed in clinical trials (Maas et al., 2010; O’Collins et al., 2006).”
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A Preview of Selected Articles
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“Malheureusement, à ce jour, aucun traitement n’a montré d’amélioration substantielle du devenir des patients [6].”
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Tümör Nekroz Faktörü Alfa Blokeri Adalimumabın Deneysel Beyin Hasarında Etkileri
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Neuronal Survival after Traumatic Brain Injury: Cardiolipin-a Critical Target
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Guo, X., Wang, J., Zhu, S., Sun, B., Tian, L., Li, M., Feng, S., & Sun, G. (2026) · Frontiers in Immunology · doi:10.3389/fimmu.2026.1850719
“However, based on prior experience from TBI clinical trials, successful clinical translation is likely to depend on careful optimization of treatment windows, dosing strategies, and patient strati fi cation (153).”
AbouEich, H. K., Izadi, A., Lifshitz, J., Olson, D. E., & Gurkoff, G. G. (2026) · Journal of Neurotrauma · doi:10.1177/08977151261495030
Abdullayev, Z., Mammadbayli, A., & Mehdiyev, E. S. (2026) · NATIONAL JOURNAL OF NEUROLOGY · doi:10.61788/njn.v1i29.01
“Although primary brain injury occurs at the time of trauma, secondary pathophysiological processes may evolve over time and contribute to persistent neurological impairment [6].”
Efficient analysis of ordinal data from clinical trials in head injury
McHugh, G. S. (2012) · ERA
Pharmacological Neuroprotection in Severe Traumatic Brain Injury
Marklund, N. (2012) · Springer eBooks · doi:10.1007/978-3-642-28126-6_50
Metadata
- Authors
- Maas, A. I. R., Roozenbeek, B., & Manley, G. T.
- Affiliations
- Antwerp University Hospital (BE)
- Erasmus MC (NL)
- University of California, San Francisco (US)
- Corresponding author
- Maas, Andrew I.R.
- Venue
- Neurotherapeutics
- Publisher
- Elsevier BV
- Published
- 2010-01
- Volume
- 7
- Issue
- 1
- Pages
- 115-126
- ISSN
- 1878-7479 (ISSN-L)
- PMC
- PMC5084118
- OpenAlex
- W2112462557
- Cited by
- 291
- References
- 44
- Citations by year
- 2026: 9 · 2025: 6 · 2024: 12 · 2023: 13 · 2022: 21 · 2021: 10 · 2020: 17 · 2019: 20 · 2018: 26 · 2017: 19 · 2016: 24 · 2015: 24 · 2014: 20 · 2013: 16 · 2012: 28
- FWCI
- 2.81
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Neurotherapeutics (publishedVersion, public-domain)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Topics
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
- Physical Sciences › Engineering › Biomedical Engineering › Automotive and Human Injury Biomechanics
- Keywords
- traumatic brain injury, clinical trials, neuroprotective agents, decompressive craniectomy, therapeutic hypothermia, clinical trial registries, clinical trial design, data element standardization, individual patient data meta-analysis
- MeSH terms
- Brain Injuries, Clinical Trials as Topic, Humans
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