Evidence map›Paper›PMID 34631917›Full record

ArticleOpen forum infectious diseases2021

Impact of Changes of the 2020 Consensus Definitions of Invasive Aspergillosis on Clinical Trial Design: Unintended Consequences for Prevention Trials?

John R Wingard, Barbara D Alexander, Lindsey R Baden, Min Chen, Michele W Sugrue, Helen L Leather, Angela M Caliendo, Cornelius J Clancy, David W Denning, Francisco M Marty and 5 more

Open access · goldAbstract read
In one paragraph

Article in Open forum infectious diseases, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
0.2field-weighted citation impact, top 46% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 4 citations in OpenAlex.

  1. Article
  2. Plasma Microbial Cell-free DNA Metagenomic Sequencing for Diagnosis of Invasive Fungal Diseases Among High-risk Outpatient and Inpatient Immunocompromised Hosts.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025
    Article
  3. An Update on Invasive Fungal Infections in Solid Organ Transplant Recipients.Transplant infectious disease : an official journal of the Transplantation Society
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 8 institutions in 2 countries.

John R WingardDepartment of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.ORCID https://orcid.org/0000-0001-7478-5398
Barbara D AlexanderDepartments of Medicine and Pathology, Duke University, Durham, North Carolina, USA.
Lindsey R BadenDepartment of Medicine, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA.
Min ChenCIBMTR Milwaukee, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Michele W SugrueDepartment of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.
Helen L LeatherDepartment of Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.
Angela M CaliendoDepartment of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Cornelius J ClancyDepartment of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
David W DenningDivision of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
Francisco M MartyDepartment of Medicine, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts, USA.
M Hong NguyenDepartment of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
L Joseph WheatMiraVista Diagnostics, Indianapolis, Indiana, USA.
Brent R LoganCIBMTR Milwaukee, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Mary M HorowitzCIBMTR Milwaukee, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Kieren A MarrDepartment of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Medical College of Wisconsin · USUniversity of Florida · USBrigham and Women's Hospital · USUniversity of Pittsburgh · USBrown University · USDuke University · USJohns Hopkins University · USManchester Academic Health Science Centre · GB

Funding

Easy-to-read Informed Consent for HCT Clinical TrialsU10HL069294 · NHLBI · MEDICAL COLLEGE OF WISCONSIN · PI HOROWITZ, MARY MARESCA · 2011 to 2016
$43.8M
BMT CTN Core - Dana-Farber Cancer Institute and MGH ConsortiumUG1HL069249 · NHLBI · DANA-FARBER CANCER INST · PI Mahasweta Gooptu · 2017 to 2026
$2.2M
Core Clinical Center For BMT Clinical Research NetworkU01HL069301 · NHLBI · UNIVERSITY OF FLORIDA · PI WINGARD, JOHN R. · 2001 to 2010
$1.7M
Core Clinical Consortium for Blood and Marrow Transplant Clinical Trials NetworkUG1HL069301 · NHLBI · UNIVERSITY OF FLORIDA · PI HSU, JACK W · 2017 to 2023
$1.1M
Core Clinical Consortium for Blood and Marrow Transplant Clinical Trials NetworkU10HL069301 · NHLBI · UNIVERSITY OF FLORIDA · PI WINGARD, JOHN R. · 2011 to 2016
$882k
NHLBI NIH HHS U01 HL069301NHLBI NIH HHS U10 HL069294NHLBI NIH HHS U10 HL069301NHLBI NIH HHS UG1 HL069249NHLBI NIH HHS UG1 HL069301NIAID NIH HHS N01 AI070023
6 · The paper itself

Abstract

backgroundConsensus definitions for the diagnosis of invasive fungal diseases (IFDs) were updated in 2020 to increase the certainty of IFD for inclusion in clinical trials, for instance by increasing biomarker cutoff limits to define positivity. To date, there is a paucity of data as to the impact of the revised definitions on clinical trials.

methodsIn this study, we sought to determine the impact of the new definitions on classifying invasive aspergillosis (IA), the most common invasive mold disease in immunocompromised patients. We reclassified 226 proven and probable IA cases plus 139 possible IFD cases in the Aspergillus Technology Consortium (AsTeC) and in an antifungal prophylaxis trial (BMT CTN 0101) using the new criteria.

resultsFewer cases met the more stringent diagnostic 2020 criteria after applying the reclassification criteria to define probable IA. Of 188 evaluable probable cases, 41 (22%) were reclassified to 40 possible IA and 1 probable IFD. Reclassification to possible IFD occurred in 22% of hematologic malignancy (HM) patients, 29% of hematopoietic cell transplant (HCT) patients, and in no lung transplant (LT) patients. Date of diagnosis was established a median (range) of 3 (1-105) days later in 15% of probable IA cases using the new criteria. Applying the new definitions to the BMT CTN 0101 trial, the power to detect the same odds ratio decreased substantially.

conclusionsThe updated IA consensus definitions may impact future trial designs, especially for antifungal prophylaxis studies.

Indexed as

antifungal clinical trialsantifungal prophylaxisantifungal treatmentinvasive aspergillosisinvasive fungal diseases

Identifiers

PMID34631917
PMCPMC8496761
OpenAlexW3200958721

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.