[danepowell]

I disagree that ending trials early is solid science, or at least not _as_ solid as running them to completion. It makes it hard to know whether results are due to a treatment effect or just random fluctuations over time. Essentially, it allows for cherry-picking of significant results in a way that bypasses family-wise error correction.

[jrumbut]

You can quantify, perhaps by simulation, the amount that it's less solid.

What's balancing against that is continuing the trial means giving patients a placebo when you have evidence of a better treatment.

It's a really complex issue both scientifically and ethically.

[xiphias2]

The solution to this is changing the stopping criterion in the trial protocol description, so that the real confidence interval can be calculated for the trial _with_ stopping (which is very different from running the trial until the end).

[jrumbut]

Good point, I should have added prospectively to that.

But even then, more participants and more time for follow-ups is generally better all other things being equal (which they never are).

[xiphias2]

Things got extremely political around these experiments.

When 2 days ago Orban announced from nothing that they will provide Remdesivir to everyone, I knew that again they did something stupid...I want the experimental drug that Trump got, not some leftover drug with lots of side effects.

Now I know that it was not Orban who was screwed, but the whole EU.

[cyphar]

As I said, ideally RCTs would run for as long as possible. But in meatspace we cannot ignore that if a treatment shows serious promise it is unethical to deprive control group patients of the treatment. If we ran RCTs for all CoVID-19 treatments for something like 3 years before using any treatment, it seems pretty apparent we'd be looking at a significantly higher death toll.

My point about it being solid science is not that it is a good (from a scientific perspective) to end trials early, merely that the early part of the trial was still an RCT and the data is just as solid as any other RCT which ran for the same period of time. From what I've seen, this is a contentious topic in academia because the ethics of this make it harder to argue that RCTs should always be run to completion (with no exceptions).

But any good RCT will have a stopping criteria established before the trial starts to eliminate ex-post-facto cherry-picking. I'm not familiar with the exact details of the Remdesivir trial and whether they had a reasonable stopping criteria defined beforehand -- I was speaking more broadly about the topic of ending RCTs early.