提前停止随机试验以获益并估计治疗效果:系统性审查和元回归分析
Dirk Bassler1, Matthias Briel, Victor M Montori
1Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
JAMA
|March 25, 2010
概括
随机对照试验 (RCT) 为了获益而提前停止,高估治疗效果. 无论停止规则如何,这种偏见仍然存在,并且在较小的研究中更明显,事件较少.
科学领域:
- 临床试验方法论 临床试验方法论
- 生物统计学 生物统计学
- 基于证据的医学基于证据的医学.
背景情况:
- 理论和模拟表明,随机对照试验 (RCT) 的早期停止,以获益导致过高估计的治疗效果.
- 这种高估特别影响了导致提前终止的结果.
研究的目的:
- 将截断RCT中的治疗效应与包含在元分析中的非截断RCT中的治疗效应进行比较.
- 确定导致在截断RCT中高估治疗效果的因素.
主要方法:
- 在多个数据库 (MEDLINE,EMBASE等) 中进行系统搜索. 对于截断的RCT和相关的系统审查.
- 由专家进行独立的盲目审查,以选择符合条件的非截断RCT与截断RCT相匹配.
- 独立的数据提取方法专家审查员.
主要成果:
- 分析包括91个截断RCT和424个匹配的非截断RCT,涉及63个研究问题.
- 与非截断RCT相比,截断RCT显示相对风险的汇总比率为0.71.
- 过高估计独立于统计停止规则和研究质量;在<500事件的研究中最大.
结论:
- 截断的RCT与未提前停止的RCT相比,与更大的效果大小有关.
- 观察到的效果大小差异不受统计停止规则或研究质量的影响.
- 在截断的RCT中对治疗效果的高估在较小的研究中最为显著.
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