• Evidence generation and outcomes assessment evolved toward evaluating real-world effectiveness, incorporating patient-centered outcomes, and standardized reporting practices across trials [18], [3], [20], [11], [4].

• Trial design optimization and multicentre coordination emphasized robust methodologies such as randomization, blinding, intention-to-treat, and multicentre collaboration to enhance validity and generalisability [2], [6], [19], [12], [10].

• Transparency and reporting quality focus highlights underreporting concerns, the need for structured reporting, and registries to support meta-analyses and patient recruitment [5], [4], [9].

• Measuring quality of life and patient-reported outcomes addresses the integration of generic and disease-specific instruments to capture patient-centered end-points in trials [3], [18].

• Ethics, governance, and access considerations examine scientific integrity, reporting discipline, trial access, and governance within policy contexts [5], [14], [15], [8].