Clinical Trials With Pragmatic Elements: A Review of Use Cases and Real‐World Data Utilization

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Abstract
Clinical trials with pragmatic elements can capture diverse patient populations, enable efficient follow‐up, and reflect routine clinical practices; yet there is limited understanding of their design features, characteristics, and use of real‐world data (RWD). Based on a targeted search of PubMed/EMBASE (Jan‐2016 to Jul‐2024), a review was conducted to characterize clinical trial use cases with pragmatic elements during the design and conduct of trials, as well as clinical trials that utilized RWD for long‐term follow‐up in the extension phase of the original (“parent”) trial. A total of 27 use cases were characterized. There were 22 use cases with pragmatic elements, and nearly all employed randomization ( n = 21, 95.5%), open‐label design ( n = 20, 90.9%), with usual/standard of care ( n = 13, 59.1%) as comparators. Most generated evidence on both effectiveness and safety ( n = 18, 81.8%), primarily in diabetes and cardiovascular disease areas ( n = 14, 63.6%). The most common pragmatic elements were broad eligibility criteria, flexible treatment management, minimal or no follow‐up, and streamlined endpoint collection. RWD (including electronic health records, claims, registries) was utilized in half of the use cases ( n = 4 to enrich trial data with additional information abstracted from RWD; n = 7 to embed trials within routine healthcare databases/systems). In addition, 5 use cases were identified that utilized RWD in the extension phase of the original “parent” trials (4 utilizing RWD for long‐term follow‐up purposes, and one utilizing RWD to construct external controls for clinical trial infrastructure‐based extension study). This review underscores the emerging role of pragmatic elements in enhancing trial efficiency, generalizability, and evidence generation on long‐term outcomes.

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