Data collection
Data collection and processing of this study are summarized in Figure 1. Trial data were downloaded from the ClinicatTrials.gov database in CSV format as of August 9, 2019, using the following keywords: “study-type” field to “interventional” and “condition/disease” field to “PD,” “stroke (STR),” “SCI,” or “TBI.” Next, trials evaluating the targeted three different types of treatment modalities, namely, low-molecular-weight compound (LMWC), BLG, and GCT, were screened and classified. Trials as of August 9, 2019, or earlier in the “Primary Completion Date” field were further extracted. However, trials described as “withdrawn” in the “status” field were excluded. The resulting dataset, including 1731 clinical trials, was designated as 20190809. The dataset 20190809 was updated on July 12, 2021, about 2 years after the original data collection date, to gather possible collectible information. The reported status as of July 5, 2021, was reviewed in both the ClinicalTrials.gov registry and PubMed, and 34 trials whose reports were under review in ClinicalTrials.gov but not listed in PubMed were excluded. Then, four trials that are additionally withdrawn from the registry were also excluded. Furthermore, we considered trials as “actually completed trials” when the “Actual Primary Completion Date” field was filled, which yielded 1,376 trials. To extract the relevant subset, the “Actual Primary Completion Date” was narrowed from January 1, 2005, to June 30, 2019, and obtained 1298 trials. Lastly, all Phase II–IV trials were selected, for which the result reporting rate is mandatory, resulting in 1017 trials designated as 20210630 datasets.
Analysis of result reporting
Tables 1 and 2 show the results of the multivariate analysis regarding the result reporting rate of ClinicalTrials.gov and PubMed, respectively. Table 3 indicates the results of the multivariate analysis on the total result disclosure rates (either ClinicalTrials.gov or PubMed or both).
Diseases
TBI was selected as a reference for multivariate analysis according to disease type. Table 3 shows SCI had significantly lower rates of total result disclosure with adjusted odds ratio (OR: 0.43 [95% confidence interval {CI}: 0.23–0.80]; p = 0.008). Next, Table 2 shows low reporting rates from PubMed with adjusted OR (0.30 [0.15–0.61]; p < 0.001). Conversely, no difference was observed in that from ClinicalTrials.gov (Table 1). The lower reporting rate of SCI to PubMed was interpreted as a cause of reduction in the total disclosure rate. In PD, no significance in the reporting rates was observed in total disclosure or ClinicalTrials.gov, but those in PubMed were slightly lower and more significant with an adjusted OR of 0.48 (0.29–0.82); p = 0.007. In STR, no difference in the reporting rate was observed in the total disclosure, but that in ClinicalTrials.gov was lower and more significant with an adjusted OR of 0.49 (0.26–0.76); p = 0.003. In contrast, the PubMed reporting rate was significantly higher only for the crude OR (2.06 [1.29–3.30]; p = 0.003).
Figure 2a shows the comparison of reporting rates by disease category. The reporting rate of STR trial results to Clinicaltrials.gov is the lowest among four neurological diseases, which are just <40%, whereas the other neurological diseases have also not reached 50% of the reporting rate. Nevertheless, the results of the STR trial were well published in journals, with a total disclosure rate exceeding 60%. The total result disclosure rate of PD and TBI also attained 60%. Conversely, the total disclosure rate of SCI trials was <50%.
Primary completion date (year)
For the analysis of the primary completion date, data for the year 2017 was used as a reference. The total result disclosure rate was significantly lower with both crude and adjusted OR from 2005 to 2007 but was significantly higher with adjusted OR in 2008, 2010, 2012, 2014, 2015, 2016, and 2018. We also observed a significantly higher reporting rate to PubMed with adjusted ORs from 2008 and 2010 to 2016.
Recruitment status
To analyze the recruitment status, trials with the field of “Recruiting Status” described as “Completion” were used as reference. Regarding the field described as “Terminated,” the reporting rate to PubMed was significantly low with adjusted odds ratios (0.39 [(0.26–0.59)]; p < 0.001), whereas the total result disclosure rate was significantly low with adjusted OR of 0.68 (0.47–0.99); p = 0.042; however, the result reporting rate to ClinicalTrials.gov was significantly high with crude OR of 1.39 (1.00–1.94); p = 0.048.
Phases
In multivariate analysis, phase III was used as a reference, and both phases II and IV had significantly lower outcome reporting rates than phase III for any reporting destination (whether the results were posted to ClinicalTrials.gov or publication in a journal). In both phases II and IV, the reporting rate was significantly lower than that in phase III (whether the results were posted to ClinicalTrials.gov or publication in a journal).
Figure 2b shows the publication status of trial results classified by clinical phases. The total disclosure rate was highest for phase III trials and significantly lower for Phase II and IV trials.
Sponsor
The academic institution (AC) was set up as a reference. The big pharma (BIG) had significantly higher reporting rates in ClinicalTrials.gov and PubMed, whereas small pharma (SMALL) had a similar reporting rate to AC in all result reporting statuses.
Figure 2c illustrates the result reporting rate classified by the sponsor. Regarding the disclosure of trial results to ClinicalTrials.gov, SMALL and AC were reportedly low at 35%, whereas BIG was reportedly high at >60%. Furthermore, the reporting rate of BIG was high in PubMed and Clinicaltrials.gov.
Treatment modality
LMWC was set up as a reference for treatment modality. For BLG, no difference was confirmed in any resultant reporting rates in ClinicalTrials.gov and total disclosure, but the reporting rate was slightly higher than that in PubMed with a significant crude OR. The reporting rate for both Clinicaltrials.gov and PubMed in GCT was significantly lower with a crude OR (0.52 [0.28–0.98]; p = 0.041), however, no significant difference was observed with the adjusted OR, and the reporting rate to PubMed was not significant either. Conversely, the reporting rate to ClinicalTrials.gov was revealed to be significantly lower adjusted OR (0.10 [0.03–0.35]; p < 0.001). Therefore, trials that evaluated the targeted treatment modality, i.e., GCT, contributed somehow to be one of the factors that reduce the reporting rate of study results to Clinicaltrials.gov.
Figure 2d illustrates how the treatment modality affects the disclosure of trial results. The BLG trial had the highest rate of reporting trial results, followed by the LMWC. The GCT trial had a low reporting rate of trial results. The reporting rate for GCT results to Clinicaltrials.gov was remarkably low although there no significant difference was observed in PubMed. Consequently, the total disclosure rate was reduced correspondingly. Next, we examined the time required from study completion to result in reporting by treatment modality.
Figure 3 shows the decrement in the unreported rate of results using the Kaplan–Meier method over time from the primary completion date of the trials to the disclosure on ClinicalTrials.gov, PubMed, or both. In all cases, the unreported rate decreased over time but to various degrees. For example, when comparing the unreported rate at 60 months in both databases, the GCT group had more unreported results (56%) than the BLG (34%) and LMWC (43%) groups, a ranking that remained unchanged throughout the study period. The log-rank method showed a significant difference between BLG and GCT (p = 0.012); however, when the reporting destination was limited to PubMed, these differences were reduced and reversed to 53% for BLG, 63% for LMWC, and 57% for GCT, without significant differences among them. Conversely, when only trials that reported results to the ClinicalTrials.gov registry were included, and trials that reported results to PubMed were not counted, the difference significantly increased in reporting rates. The unreported rate for both BLG and LMWC was 57% and 61%, respectively, at 60 months after the primary completion date, whereas 95% of GCTs were unreported, a tendency that remained unchanged throughout the study period. The results of the log-lank method showed significant differences (p < 0.001) between BLG and GCT and between LMWC and GCT.