Dealing with heterogeneity of treatment effects: is the literature up to the challenge?
نویسندگان
چکیده
BACKGROUND Some patients will experience more or less benefit from treatment than the averages reported from clinical trials; such variation in therapeutic outcome is termed heterogeneity of treatment effects (HTE). Identifying HTE is necessary to individualize treatment. The degree to which heterogeneity is sought and analyzed correctly in the general medical literature is unknown. We undertook this literature sample to track the use of HTE analyses over time, examine the appropriateness of the statistical methods used, and explore the predictors of such analyses. METHODS Articles were selected through a probability sample of randomized controlled trials (RCTs) published in Annals of Internal Medicine, BMJ, JAMA, The Lancet, and NEJM during odd numbered months of 1994, 1999, and 2004. RCTs were independently reviewed and coded by two abstractors, with adjudication by a third. Studies were classified as reporting: (1) HTE analysis, utilizing a formal test for heterogeneity or treatment-by-covariate interaction, (2) subgroup analysis only, involving no formal test for heterogeneity or interaction; or (3) neither. Chi-square tests and multiple logistic regression were used to identify variables associated with HTE reporting. RESULTS 319 studies were included. Ninety-two (29%) reported HTE analysis; another 88 (28%) reported subgroup analysis only, without examining HTE formally. Major covariates examined included individual risk factors associated with prognosis, responsiveness to treatment, or vulnerability to adverse effects of treatment (56%); gender (30%); age (29%); study site or center (29%); and race/ethnicity (7%). Journal of publication and sample size were significant independent predictors of HTE analysis (p < 0.05 and p < 0.001, respectively). CONCLUSION HTE is frequently ignored or incorrectly analyzed. An iterative process of exploratory analysis followed by confirmatory HTE analysis will generate the data needed to facilitate an individualized approach to evidence-based medicine.
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متن کاملAuthor's response to reviews Title: Dealing with Heterogeneity of Treatment Effects: Is the Literature Up to the Challenge? Authors:
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We are submitting a revised manuscript to correct two oversights in our original submission, dated 3 October 2008. The first revision is the addition of figure legends. The second revision is the reformatting of the abstract to adhere to the structure guidelines (background, methods, results, and conclusion). All other aspects of the manuscript remain as they were in the 3 October 2008 submission.
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عنوان ژورنال:
- Trials
دوره 10 شماره
صفحات -
تاریخ انتشار 2009