Patterns of treatment effects in subsets of patients in clinical trials.

Patterns of treatment effects in subsets of patients in clinical trials.
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临床试验中部分患者的治疗效果模式。

DOI:
10.1093/biostatistics/5.3.465
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发表时间:
2004
期刊:
Biostatistics (Oxford, England)
影响因子:
--
通讯作者:
Gelber,RichardD
Gelber,RichardD
中科院分区:
--
文献类型:
--
作者:
Bonetti,Marco;Gelber,RichardD

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我们讨论了在重叠的患者亚群中检查治疗效果模式的实践。特别是,我们关注的情况下,患者亚组定义为包含患者有越来越大(或更小)的一个特定的协变量的值的利益,目的是探索治疗效果和协变量之间可能的相互作用。我们将这些亚组方法形式化(STEPP:亚组治疗效应模式图),并在治疗效应定义为两个治疗组之间在固定时间点的生存差异时实施。推导出治疗效应估计值的联合渐近分布,并用于构建估计值周围的同步置信带,并检验无相互作用的零假设。这些方法说明使用的数据进行的国际乳腺癌研究小组,这表明了关键作用的雌激素受体含量的原发性乳腺癌选择适当的辅助治疗的临床试验。考虑因素也与一般子集分析相关,因为来自相同患者的信息通常用于估计根据不同协变量定义的两个或多个患者亚组内的治疗效果。
We discuss the practice of examining patterns of treatment effects across overlapping patient subpopulations. In particular, we focus on the case in which patient subgroups are defined to contain patients having increasingly larger (or smaller) values of one particular covariate of interest, with the intent of exploring the possible interaction between treatment effect and that covariate. We formalize these subgroup approaches (STEPP: subpopulation treatment effect pattern plots) and implement them when treatment effect is defined as the difference in survival at a fixed time point between two treatment arms. The joint asymptotic distribution of the treatment effect estimates is derived, and used to construct simultaneous confidence bands around the estimates and to test the null hypothesis of no interaction. These methods are illustrated using data from a clinical trial conducted by the International Breast Cancer Study Group, which demonstrates the critical role of estrogen receptor content of the primary breast cancer for selecting appropriate adjuvant therapy. The considerations are also relevant for general subset analysis, since information from the same patients is typically used in the estimation of treatment effects within two or more subgroups of patients defined with respect to different covariates.
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