提高耐药结核病治疗试验的效率:用于细菌学反应的时间对事件替代标记物和随机化适应性最小化
Elise De Vos1,2, Annelies Van Rie3, Steven Abrams3,4
1Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium. elise.de.vos@live.be.
BMC medical research methodology
|November 26, 2025
概括
测量真菌细菌负载变化的新模型显著减少了对Rifampicin耐药结核病 (RR-TB) 试验的样本大小. 这种方法与最小化相结合,提高了临床试验的效率.
科学领域:
- 传染性疾病 传染性疾病
- 临床试验设计 临床试验设计
- 生物统计学 生物统计学
背景情况:
- 耐利素结核病 (RR-TB) 治疗疗效试验面临的挑战是长期终点,如无复发的生存率.
- 评估新的RR-TB治疗需要有效和可靠的方法来评估治疗反应.
研究的目的:
- 根据随时间变化的真菌细菌负载 (MBL) 来评估治疗反应的替代指标.
- 评估这一新型指标对RR-TB临床试验样本大小要求的影响.
- 为了比较患者随机化与最小化策略在控制共同变量失衡方面的有效性.
主要方法:
- 对12周稳定培养转换 (SCC) 的样本大小需求与MBL模型进行比较.
- 使用了与RR-TB队列数据校准的非线性混合效应模型.
- 模拟数据用于比较检测不同终点和样本大小治疗效应的功率.
- 随机分配与最小化对应的评估共变异不平衡.
主要成果:
- MBL模型需要110名参与者,而SCC需要410名参与者才能达到80%的功率,减少了73%.
- 使用小样本大小 (110名参与者) 随机分配导致显著的共同变量失衡 (中位相对失衡0.104).
- 在110名参与者中,最小化将失衡减少到0.036.
结论:
- 作为治疗反应指标的MBL模型在RR-TB试验中显著减少了样本大小.
- 将MBL模型与最小化相结合,可以提高临床试验设计效率.
- 这些验证的方法可以加速开发新的RR-TB治疗方法.
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