临床研究的综合终点:重新评估的时间
Paul W Armstrong1, Cynthia M Westerhout2
1From Canadian VIGOUR Centre, Department of Medicine (Cardiology), University of Alberta, Edmonton, Canada. paul.armstrong@ualberta.ca.
Circulation
|June 7, 2017
概括
心血管试验中的综合终点提高了效率,但掩盖了个体事件的严重程度. 本综述探讨了批评和当前使用情况,并提出了更好的临床试验分析和患者结果评估的新方法.
科学领域:
- 心血管医学
- 临床试验方法
- 生物统计学
背景情况:
- 心血管医学取得了显著的进步,导致患者的治疗结果改善,死亡率和发病率下降.
- 临床试验越来越多地使用复合终点,将多个事件 (例如死亡,非致命并发症) 结合起来以提高效率.
研究的目的:
- 批判性地评估心血管临床试验中复合终点的使用.
- 审查目前III期试验中复合终点的应用,并预测未来的趋势.
- 提出新的方法来提高复合终点在研究中的实用性.
主要方法:
- 对复合终点的批评文献综述.
- 使用初级复合终点的最近公布的III期心血管试验分析.
- 探索即将到来的临床试验数据和新兴的统计方法.
主要成果:
- 综合终点虽然有效,但假定事件具有统一的方向性,并且没有区分临床意义.
- 目前的试验往往只考虑第一个事件,可能过度简化了复杂的患者发展轨迹.
- 许多III期心血管试验采用复合终点,预期更多.
结论:
- 目前的心血管试验复合终点方法在事件细粒度和临床相关性方面存在局限性.
- 需要新的方法来更好地捕捉临床试验分析中的患者结果的复杂性.
- 未来的研究应专注于完善复合终点策略,以提高其在心血管医学中的价值和准确性.
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