Reporting of primary endpoint and associated spin in randomized myeloma trials

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Abstract
Background: Oncology clinical trials, regardless of success in meeting their primary endpoint, often suffer from spin—the misrepresentation of research findings. Despite dramatic improvements in myeloma outcomes, numerous recent myeloma trials have failed to meet their primary endpoints while others have amplified marginally positive findings. A thorough evaluation of reporting practices and spin in myeloma randomized controlled trials (RCTs) is needed. Materials and Methods: We performed a cross-sectional analysis of myeloma RCTs that began enrollment in January 2015 or later, with final search conducted in March 2025. Reporting of prespecified primary endpoints and sample size calculations was abstracted. Two reviewers screened for the presence of spin, defined as at least one reporting practice that could mislead readers by emphasizing benefit or minimizing unfavorable findings. Multivariable logistic regression was used to determine factors associated with spin. The methods were registered on the Open Science Framework. Results: Of 82 screened studies, 71 RCTs were included. The prespecified primary endpoint was statistically significant in 46 trials (64.8%). Sample size calculations were reported in 51 trials (71.8%), and conclusions aligned with primary endpoint results in 63 trials (88.7%). Spin occurred in 25 trials (35.2%), most commonly through optimistic language and emphasis on secondary/subgroup findings. In multivariable analysis, meeting the prespecified primary endpoint was associated with lower odds of spin (adjusted odds ratio [OR] = 0.15; 95% CI, 0.03-0.70; P = .016). Conclusion: Spin affected one-third of contemporary myeloma RCTs and was strongly associated with nonsignificant primary endpoints, highlighting the need for primary endpoint-aligned interpretation and transparent sample size reporting.

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