A Framework for Extension Studies Using Real-World Data to Examine Long-Term Safety and Effectiveness

Mehmet Burcu, Cyntia B. Manzano-Salgado, Anne M. Butler, Jennifer B. Christian

Research output: Contribution to journalReview articlepeer-review

8 Scopus citations


Understanding the long-term benefits and risks of treatments, devices, and vaccines is critically important for individual- and population-level healthcare decision-making. Extension studies, or ‘roll-over studies,’ are studies that allow for patients participating in a parent clinical trial to ‘roll-over’ into a subsequent related study to continue to observe and measure long-term safety, tolerability, and/or effectiveness. These designs are not new and are often used as an approach to satisfy regulatory post-approval safety requirements. However, designs using traditional clinical trial infrastructure can be expensive and burdensome to conduct, particularly, when following patients for many years post trial completion. Given the increasing availability and access of real-world data (RWD) sources, direct-to-patient technologies, and novel real-world study designs, there are more cost-efficient approaches to conducting extension studies while assessing important long-term outcomes. Here, we describe various fit-for-purpose design options for extension studies, discuss related methodological considerations, and provide scientific and operational guidance on practices when planning to conduct an extension study using RWD. This manuscript is endorsed by the International Society for Pharmacoepidemiology (ISPE).

Original languageEnglish
Pages (from-to)15-22
Number of pages8
JournalTherapeutic Innovation and Regulatory Science
Issue number1
StatePublished - Jan 2022


  • Direct-to-patient
  • Enriched studies
  • Extension studies
  • Long-term outcomes
  • Observational follow-up
  • Patient-mediated data
  • Pragmatic approaches
  • Real-world data
  • Real-world evidence
  • Roll-over studies


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