在评估治疗效果修饰剂时使用多重共变量:对个体参与者数据的方法审查和元分析
Peter J Godolphin1, Nadine Marlin2, Chantelle Cornett1
1MRC Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, London, UK.
Research synthesis methods
|September 29, 2023
概括
个人参与者数据 (IPD) 的元分析可以更好地识别治疗效果修饰剂. 调整模型中的额外共变量可以提高准确性和患者的选择,最大限度地利用IPD进行研究.
科学领域:
- 生物统计学 生物统计学
- 临床流行病学临床流行病学
- 医学研究方法学 医学研究方法学
背景情况:
- 个人参与者数据 (IPD) 的元分析对于评估治疗效果修饰剂非常有价值.
- 目前的方法可能无法充分利用现有数据,可能会在相互作用分析中产生混.
- 探索治疗-共变相互作用对于个性化医学至关重要.
研究的目的:
- 评估IPD元分析中估计治疗-共变相互作用的当前实践.
- 评估在相互作用模型中包含额外的共变量的影响.
- 为优化IPD元分析方法提供建议.
主要方法:
- 在2015-2020年间发表的100项IPD元分析的综述,评估治疗-共变体相互作用.
- 在相互作用模型中处理额外的共变量的四种方法的分类.
- 使用示例数据集来比较不同的建模策略的演示.
主要成果:
- 大多数IPD元分析 (57%) 使用未经调整的单个相互作用模型,不包括额外的共变量.
- 较小的比例 (35%) 经过额外的共同变量的主要影响的调整.
- 很少使用涉及多个或三向相互作用的复杂模型 (8%的组合).
结论:
- 在IPD元分析中的当前实践往往低估了数据对相互作用分析的潜力.
- 建议对额外的共变量进行调整,特别是主要影响,以减少混.
- 应考虑更复杂的建模方法,以更好地确定从治疗中获益最多的患者子组.
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