Harnessing Evidence for Better Health
At The George Institute for Global Health we are applying innovative methods and building the evidence base to find new treatments for health conditions that are the biggest causes of poor health and death globally.
We recognise that we need the best evidence to define the best solutions, so we focus on generating and harnessing this evidence, to drive better health for millions of people globally.
We use the most robust, effective and efficient research methods, and contribute to the further development of these methodologies, in order to identify groundbreaking ways of preventing and treating the health problems that cause the greatest burden of illness and premature death.
We do this through:
- building better evidence though innovative study design including discovery research, clinical trials, epidemiological studies and pathways to research translation for new treatments
- pioneering new ways of communicating data to the community and consumers
- promoting higher quality research that will drive government and commercial investments in new solutions, support changes in behaviour and clinical practice, and improve the way illnesses are prevented and treated in order to optimise health and wellbeing
- collaborating with global leaders in this area such as the Australian Clinical Trials Alliance (ACTA), the Clinical Trials: Improving Quality (CT:IQ) group, and the US-based Clinical Trials Transformation Initiative (CTTI), as well as specialty-specific initiatives in key areas
Maximising use of routinely-collected data
A priority is to maximise the use and reliability of routinely-collected data to identify gaps in practice and treatment, and to improve the efficiency of future research studies. Our collaborations with the Australian Department of Health and NSW Health facilitate evaluations of new services using routinely collected hospital, emergency department and mental health data. We are also using routinely-collected general practice data to derive outcomes for many clinical trials as well as working with NSW Health to pilot a project linking general practice data to hospital data.
Innovative clinical trial design
Another priority is around innovative clinical trial designs and how to ensure our research is efficient and allows quick translation to practice. This includes cluster trials (for example, our HeadPoSt trial - a cluster crossover trials of head positioning after stroke), and our Consumer Navigation of Electronic Cardiovascular Tools study (Connect).
We are currently exploring opportunities for use of adaptive designs and platform trials. The idea is to be able to adjust the design of a trial as new information accumulates. This might include adjusting the recruitment to maximise the number of patients allocated to the most promising therapy or assessing multiple potential treatments in a single ongoing trial.
The Canagliflozin and Renal Endpoints in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE) Study
Worldwide, 160 million people with type 2 diabetes have or are at risk of developing chronic kidney disease. CREDENCE was a randomized, double-blind, event-driven, placebo-controlled trial set in in 34 countries that enrolled 4,401 adults with type 2 diabetes.
The study aimed to compare the efficacy and safety of the drug canagliflozin versus a placebo in preventing kidney failure and cardiovascular disease in patients with diabetes and kidney disease. The early results were so compelling we were advised to stop the trial early by the Independent Data Monitoring Committee. The trial demonstrated the potential for this new drug therapy to be the first new treatment to prevent kidney failure in patients with type 2 diabetes in more than 15 years.
China Salt Substitute and Stroke Study (SSaSS)
High blood pressure contributes to increased risk of stroke. We know that lowering salt intake will lower blood pressure levels. However, the evidence to prove that lowering blood pressure will reduce the risks of vascular outcomes is less strong. Using salt substitutes to reduce sodium consumption provides a good opportunity to test this.
Rural Chinese are known to have a high sodium intake and to suffer from high rates of hypertension and stroke, so sodium reduction is a particularly attractive option in China.
The China Salt Substitute and Stroke Study (SaSS) study is a five-year, large scale randomized controlled trial (RCT). The aim is to establish if a low-sodium salt substitute can reduce morbidity and mortality from stroke as a result of reduced sodium intake. So far, the study has recruited 21,000 high risk patients with stroke and hypertension from 600 villages in northern China. Coordinated by the local health and academic institutes in China, the study provided the patients and their families in the intervention group with salt substitute for free to replace their regular salt for five years. Results are expected in late 2019
INTERACT trials - Early intensive blood pressure lowering stroke
The INTERACT trials were designed to establish the effects of early intensive blood pressure (BP) lowering on recovery for patients with acute intracerebral haemorrhage (ICH), the most serious form of acute stroke.
The main study, INTERACT2, involved 2839 participants from 21 countries to show that early intensive BP treatment was safe and improved chances of recovery with better physical function. It resulted in a shift in clinical guidelines recommending better control of BP in ICH.
Interact3 was recently launched and aims to establish the effects of ‘care bundle’ involving the early use of intensive BP lowering, control of glucose and fever, and correction of anticoagulation, as compared to routine care
Low-dose three-in-one ‘Triple Pill’ to treat hypertension
It's estimated more than a billion people globally suffer from high blood pressure with the vast majority having poorly controlled blood pressure. To facilitate ease of management, the George Institute has trialled an entirely new way of treating patients with hypertension.
In the trial patients are given three drugs, each at half dose, in a single pill for early treatment of high blood pressure. Traditionally patients begin treatment with one drug at a very low dose, which is increased over time with additional drugs added and increased in dosage to try to reach target. The ‘Triple Pill’ trial, conducted in Sri Lanka, enrolled 700 patients with an average age of 56 and blood pressure of 154/90 mm Hg. Compared with patients receiving usual care, a significantly higher proportion of patients receiving the Triple Pill achieved their target blood pressure of 140/90 or less (with lower targets of 130/80 for patients with diabetes or chronic kidney disease).
Our results could help millions of people globally reduce their blood pressure and reduce their risk of heart attack or stroke.