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Core outcome measurement set for clinical trials in dengue: an international Delphi consensus study (DEN-CORE)

  • DEN-CORE Study Group
  • University of Oxford
  • Sechenov First Moscow State Medical University
  • Medical University of Vienna
  • Princess Marina Hospital
  • George Washington University
  • Mahidol University
  • European Medicines Agency
  • Federal Institute for Drugs and Medical Devices
  • Novartis Pharmaceuticals Corporation
  • Centro de Atención y Diagnóstico de Enfermedades Infecciosas
  • Drugs for Neglected Diseases Initiative South-East Asia
  • World Health Organization
  • Instituto de Infectologia Emílio Ribas
  • National University of Singapore
  • Mahidol-Oxford Tropical Medicine Research Unit
  • China Novartis Institute of Biomedical Research
  • National Centre for Infectious Diseases
  • Tan Tock Seng Hospital
  • Lee Kong Chian School of Medicine
  • Novartis
  • University of North Carolina at Chapel Hill
  • University of Malaya
  • Cancer and Stem Cell Biology Program
  • Queen Mary University of London
  • University College London
  • Universidade Federal do Ceará
  • Kementerian Kesihatan Malaysia
  • Rapidly Emerging Antiviral Drug Discovery Initiative
  • Drugs for Neglected Diseases initiative
  • Fundação Oswaldo Cruz

Research output: Contribution to journalReview articlepeer-review

Abstract

Dengue, caused by any one of four distinct virus serotypes, is the most rapidly spreading mosquito-borne viral disease worldwide. It is a primary arboviral infection with increasing global incidence, driven by climate change, urbanisation, and the expanding range of Aedes mosquito vectors. Despite growing research interest, outcome and measurement instrument heterogeneity in dengue clinical trials remains high, limiting comparability and evidence synthesis. This project aimed to develop a globally relevant Core Outcome Measurement Set (COMS) for use in dengue clinical trials through international consensus. This consensus study followed core outcome measures in effectiveness trials and Core Outcome Set-Standards for Development (COS-STAD) guidelines and was conducted in two phases. Phase 1 focused on developing a Core Outcome Set (COS) through four steps: (1) a systematic literature review; (2) qualitative interviews with people with lived experience of dengue; (3) review by the management group and steering committee; (4) a two-round modified Delphi survey and structured online consensus meetings to finalise the COS for hospitalised and early stages of dengue disease. Input from critical care experts informed recommendations for the intensive care unit (ICU) and high dependency unit COS. Phase 2 consisted of a further two steps: (1) targeted review of outcome measurement instruments; and (2) a hybrid international consensus workshop to finalise the COMS. The agreed COMS for hospitalised dengue included seven outcomes; the early stage dengue COS included these outcomes plus four more. For critical care trials, use of existing ICU-specific COS was recommended. Unified definitions were developed for nine clinician-reported outcomes. The DEN-CORE COMS provides a consensus-based framework for harmonising outcome selection and measurement in dengue trials, improving comparability and supporting policy and clinical decision making.

Original languageEnglish
Pages (from-to)e231-e244
JournalThe Lancet Infectious Diseases
Volume26
Issue number4
DOIs
StatePublished - Apr 2026

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