Homophily and co-occurrence patterns shape randomized trials agendas: illustration in antifungal agents
Homophily and co-occurrence patterns shape randomized trials agendas: illustration in antifungal agents
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DOI：
10.1016/j.jclinepi.2010.11.017
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发表时间：
2011-08-01
影响因子：
7.2
通讯作者：
Ioannidis, John P. A.
中科院分区：
文献类型：
--
作者：
Rizos, Evangelos C.;Salanti, Georgia;Ioannidis, John P. A.
目的：为了评估是否有偏好和回避特定的比较在临床试验agenda.Study设计和设置：我们测试了同质性（偏好比较代理对其他同类）和共现（偏好或避免特定的头对头比较）在随机试验议程的抗真菌药物。我们检索了MEDLINE和科克伦图书馆数据库中评价成人系统性抗真菌药抗念珠菌或曲霉菌的英文随机试验。我们提取的数据比较方案，样本量，出版年份，适应症（治疗/预防），和潜在的diseases.Results：一百四十四个试验（74个治疗，70个放松）被发现（n = 27,497例患者）。在多烯和唑组中，药物在同一类别内的比较比跨类别的比较更频繁（同质性检验P < 0.001）。几乎完全将脂质阿替西汀与常规阿替西汀进行了比较（18项试验），只有3项与唑类进行了比较。避免了与新药剂进行头对头的比较。在14项棘白菌素试验中，只有一项试验对两种不同的棘白菌素进行了头对头比较（共现P < 0.001）。在11项关于新型唑类药物的试验中，只有一项将新型唑类药物与棘白菌素进行了比较（共现P < 0.001）。结论：抗真菌药物的试验网络表明，首选特定比较，避免其他比较，从而产生潜在偏倚的临床研究议程。(C)2011年由Elsevier Inc.出版
Objective: To assess whether there are preferences and avoidances for specific comparisons in a clinical trials agenda.Study Design and Setting: We tested for homophily (preference to compare agents against others in the same class) and co-occurrence (preference or avoidance of specific head-to-head comparisons) in the randomized trials agenda of antifungal agents. We searched MEDLINE and Cochrane Library databases for English language randomized trials evaluating systemic antifungals against Candida or Aspergillus in adults. We extracted data on compared regimens, sample size, publication year, indication (treatment/prophylaxis), and underlying disease.Results: One hundred forty-four trials (74 treatments, 70 prophylaxes) were found (n = 27,497 patients). Among polyene and azole groups, agents were compared within the same class more often than across classes (homophily test P < 0.001). Lipid amphotericin was compared almost entirely against conventional amphotericin (18 trials), with only three comparisons against azoles. Head-to-head comparisons of newer agents were avoided. Only one of 14 trials for echinocandins compared head-to-head two different echinocandins (P < 0.001 for co-occurrence). Of 11 trials on newer azoles, only one compared a newer azole with an echinocandin (P < 0.001 for co-occurrence).Conclusions: Trial networks for antifungals show that specific comparisons are preferred and others avoided, generating a potentially biased clinical research agenda. (C) 2011 Published by Elsevier Inc.