The second strategy is the setting up of a research database or registry, i.e. a prospective data collection focused on collecting data from clinical practice to answer the above questions. The first category of studies is retrospective and the second is prospective, but this difference is not critical to the scope of long-term assessment. However, two aspects are of the utmost relevance. The first is comprehensiveness. ‘Inception’ is the key term: it means that virtually no eligible patient is excluded, and since the alternative treatment can be also no treatment, ideally every patient qualifies. The second is the set of

measures adopted to Cyclopamine ic50 reduce bias in the collection, analysis and interpretation of the results: ideally, those assessing or reporting the outcome of interest should be blinded to the treatment under study (e.g. the laboratory personnel testing for inhibitors should not know about the treatment of the patient and all laboratory results should automatically flow into the registry), and so should those performing the analysis. Finally, since these cohorts are not randomized, a multivariable or propensity score matching approach including all putative confounders must be adopted. The mandatory reporting of adverse

events to health authorities and drug producers has not been mentioned as a research category. In fact, though a necessary activity, it generates AG14699 a database of cases only, which makes any analysis dependent on linkage to other sources of data. A different model, in this perspective, has recently been proposed by the EMA, with authorization requiring a postmarketing supplementary provision of

data to expand the evidence base in a theoretically more feasible way [35, 36]. Examples of the first type of studies described above are the UK [37-40], Canadian [41-45] and Italian haemophilia databases [46-51] and the Centers for Disease Control and Prevention (CDC) Universal Data Collection (UDC) system [52-55]. Many other national and international registries are at a more advanced or initial stage of development, and will certainly contribute to the field. Performing long-term assessment of drugs is often not the main goal of Protein kinase N1 these registries, but they have been shown to be able to provide important contributions. Examples of the second type are the EUHASS registry [56], the PedNet RODIN registry [57, 58] and the Post Authorization Surveillance Studies (PASS) promoted by industry. They all have a predefined research question and a predefined protocol in common, but differ in other relevant aspects. The main stakeholders in each and every one of the above studies are the manufacturers, the patients, the haemophilia doctors and the regulators.

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