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To describe the whole disease process and gain a complete picture of treatment effects, methods for recurrent time to event analysis considering terminal events were proposed, i.e. methods considering all events that occur per individual. However, these methods are not often applied in clinical studies. This might be due to the researchers\u2019 uncertainties about underlying model assumptions and interpretation of results. We therefore aim to give a comprehensive overview of methods for the analysis of multiple time to events comparing model assumptions and interpretation. We illustrate the methods using a cardiovascular trial and provide the corresponding R code.<\/jats:p>","DOI":"10.1186\/s12874-026-03008-7","type":"journal-article","created":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T11:13:23Z","timestamp":1789211603000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Methods for analyzing recurrent and terminal events considering composite and competing endpoints in clinical trials: a practical overview"],"prefix":"10.1186","volume":"26","author":[{"given":"Alidan","family":"Duoerkongjiang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"Zapf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulus","family":"Kirchhof","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann-Kathrin","family":"Ozga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,12]]},"reference":[{"issue":"13","key":"3008_CR1","doi-asserted-by":"publisher","first-page":"1167","DOI":"10.1056\/NEJMoa2303062","volume":"389","author":"P Kirchhof","year":"2023","unstructured":"Kirchhof P, Toennis T, Goette A, Camm A, Diener H, Becher N, et al. 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According to the original trial protocol and patient information and informed consent documents, the original trial was approved by the competent ethics committee and the competent authority as required by legislation and was conducted in accordance with ICH-GCP and EU Directive 2001\/20\/EC. Approval or favorable opinion from the responsible institutional review boards\/independent ethics committees was required before study initiation in the respective participating country or study site. For Germany, the EU Clinical Trials Register reports authorization by the German competent authority (BfArM) and a favorable ethics committee opinion dated 9 February 2011. Written informed consent was obtained from all participants in the original trial before participation. The original trial was registered under EudraCT number 2010-021258-20, ISRCTN04708680, and NCT01288352. No additional ethical approval was required for the present secondary analysis of de-identified data.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"206"}}