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Selby JV, Maas CCHM, Fireman BH, Kent DM. Impact of the PATH Statement on Analysis and Reporting of Heterogeneity of Treatment Effect in Clinical Trials: A Scoping Review. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.06.24306774. [PMID: 38766150 PMCID: PMC11100853 DOI: 10.1101/2024.05.06.24306774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Background The Predictive Approaches to Treatment Effect Heterogeneity (PATH) Statement provides guidance for using predictive modeling to identify differences (i.e., heterogeneity) in treatment effects (benefits and harms) among participants in randomized clinical trials (RCTs). It distinguished risk modeling, which uses a multivariable model to predict risk of trial outcome(s) and then examines treatment effects within strata of predicted risk, from effect modeling, which predicts trial outcomes using models that include treatment, individual participant characteristics and interactions of treatment with selected characteristics. Purpose To describe studies of heterogeneous treatment effects (HTE) that use predictive modeling in RCT data and cite the PATH Statement. Data Sources The Cited By functions in PubMed, Google Scholar, Web of Science and SCOPUS databases (Jan 7, 2020 - June 5, 2023). Study Selection 42 reports presenting 45 predictive models. Data Extraction Double review with adjudication to identify risk and effect modeling and examine consistency with Statement consensus statements. Credibility of HTE findings was assessed using criteria adapted from the Instrument to assess Credibility of Effect Modification Analyses (ICEMAN). Clinical importance of credible HTE findings was also assessed. Data Synthesis The numbers of reports, especially risk modeling reports, increased year-on-year. Consistency with consensus statements was high, except for two: only 15 of 32 studies with positive overall findings included a risk model; and most effect models explored many candidate covariates with little prior evidence for effect modification. Risk modeling was more likely than effect modeling to identify both credible HTE (14/19 vs 5/26) and clinically important HTE (10/19 vs 4/26). Limitations Risk of reviewer bias: reviewers assessing credibility and clinical importance were not blinded to adherence to PATH recommendations. Conclusions The PATH Statement appears to be influencing research practice. Risk modeling often uncovered clinically important HTE; effect modeling was more often exploratory.
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Affiliation(s)
- Joe V Selby
- Division of Research, Kaiser Permanente Northern California, Oakland, CA (emeritus)
| | - Carolien C H M Maas
- Tufts Predictive Analytics and Comparative Effectiveness Center, Tufts University School of Medicine, Boston MA
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bruce H Fireman
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - David M Kent
- Tufts Predictive Analytics and Comparative Effectiveness Center, Tufts University School of Medicine, Boston MA
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Cheng C, Messerschmidt L, Bravo I, Waldbauer M, Bhavikatti R, Schenk C, Grujic V, Model T, Kubinec R, Barceló J. A General Primer for Data Harmonization. Sci Data 2024; 11:152. [PMID: 38297013 PMCID: PMC10831085 DOI: 10.1038/s41597-024-02956-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024] Open
Affiliation(s)
- Cindy Cheng
- Hochschule für Politik, Technical University of Munich, Richard-Wagner Str. 1, Munich, 80333, Bavaria, Germany.
| | - Luca Messerschmidt
- Hochschule für Politik, Technical University of Munich, Richard-Wagner Str. 1, Munich, 80333, Bavaria, Germany
| | - Isaac Bravo
- Hochschule für Politik, Technical University of Munich, Richard-Wagner Str. 1, Munich, 80333, Bavaria, Germany
| | - Marco Waldbauer
- Hochschule für Politik, Technical University of Munich, Richard-Wagner Str. 1, Munich, 80333, Bavaria, Germany
| | | | - Caress Schenk
- School of Humanities and Social Sciences, Nazarbayev University, Kabanbay Batry Ave., 53, Astana, 010000, Kazakhstan
| | - Vanja Grujic
- Faculty of Law, University of Brasilia, Campus Universitário Darcy Ribeiro Asa Norte, Brasília, 10587, Brazil
| | - Tim Model
- Delve, 2225 3rd St, San Francisco, 94107, California, USA
| | - Robert Kubinec
- Division of Social Science, New York University Abu Dhabi, Social Science Building (A5), Abu Dhabi, 129188, United Arab Emirates
| | - Joan Barceló
- Division of Social Science, New York University Abu Dhabi, Social Science Building (A5), Abu Dhabi, 129188, United Arab Emirates
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Inoue K, Hsu W. Transportability Analysis-A Tool for Extending Trial Results to a Representative Target Population. JAMA Netw Open 2024; 7:e2346302. [PMID: 38289608 PMCID: PMC11167697 DOI: 10.1001/jamanetworkopen.2023.46302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Affiliation(s)
- Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Hakubi Center, Kyoto University, Kyoto, Japan
| | - William Hsu
- Medical & Imaging Informatics Group, Department of Radiological Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, 90024, USA
- Department of Bioengineering, UCLA Samueli School of Engineering, Los Angeles, California, USA
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Robertson SE, Joyce NR, Steingrimsson JA, Stuart EA, Aberle DR, Gatsonis CA, Dahabreh IJ. Comparing Lung Cancer Screening Strategies in a Nationally Representative US Population Using Transportability Methods for the National Lung Cancer Screening Trial. JAMA Netw Open 2024; 7:e2346295. [PMID: 38289605 PMCID: PMC10828917 DOI: 10.1001/jamanetworkopen.2023.46295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/19/2023] [Indexed: 02/01/2024] Open
Abstract
Importance The National Lung Screening Trial (NLST) found that screening for lung cancer with low-dose computed tomography (CT) reduced lung cancer-specific and all-cause mortality compared with chest radiography. It is uncertain whether these results apply to a nationally representative target population. Objective To extend inferences about the effects of lung cancer screening strategies from the NLST to a nationally representative target population of NLST-eligible US adults. Design, Setting, and Participants This comparative effectiveness study included NLST data from US adults at 33 participating centers enrolled between August 2002 and April 2004 with follow-up through 2009 along with National Health Interview Survey (NHIS) cross-sectional household interview survey data from 2010. Eligible participants were adults aged 55 to 74 years, and were current or former smokers with at least 30 pack-years of smoking (former smokers were required to have quit within the last 15 years). Transportability analyses combined baseline covariate, treatment, and outcome data from the NLST with covariate data from the NHIS and reweighted the trial data to the target population. Data were analyzed from March 2020 to May 2023. Interventions Low-dose CT or chest radiography screening with a screening assessment at baseline, then yearly for 2 more years. Main Outcomes and Measures For the outcomes of lung-cancer specific and all-cause death, mortality rates, rate differences, and ratios were calculated at a median (25th percentile and 75th percentile) follow-up of 5.5 (5.2-5.9) years for lung cancer-specific mortality and 6.5 (6.1-6.9) years for all-cause mortality. Results The transportability analysis included 51 274 NLST participants and 685 NHIS participants representing the target population (of approximately 5 700 000 individuals after survey-weighting). Compared with the target population, NLST participants were younger (median [25th percentile and 75th percentile] age, 60 [57 to 65] years vs 63 [58 to 67] years), had fewer comorbidities (eg, heart disease, 6551 of 51 274 [12.8%] vs 1 025 951 of 5 739 532 [17.9%]), and were more educated (bachelor's degree or higher, 16 349 of 51 274 [31.9%] vs 859 812 of 5 739 532 [15.0%]). In the target population, for lung cancer-specific mortality, the estimated relative rate reduction was 18% (95% CI, 1% to 33%) and the estimated absolute rate reduction with low-dose CT vs chest radiography was 71 deaths per 100 000 person-years (95% CI, 4 to 138 deaths per 100 000 person-years); for all-cause mortality the estimated relative rate reduction was 6% (95% CI, -2% to 12%). In the NLST, for lung cancer-specific mortality, the estimated relative rate reduction was 21% (95% CI, 9% to 32%) and the estimated absolute rate reduction was 67 deaths per 100 000 person-years (95% CI, 27 to 106 deaths per 100 000 person-years); for all-cause mortality, the estimated relative rate reduction was 7% (95% CI, 0% to 12%). Conclusions and Relevance Estimates of the comparative effectiveness of low-dose CT screening compared with chest radiography in a nationally representative target population were similar to those from unweighted NLST analyses, particularly on the relative scale. Increased uncertainty around effect estimates for the target population reflects large differences in the observed characteristics of trial participants and the target population.
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Affiliation(s)
- Sarah E. Robertson
- CAUSALab, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Nina R. Joyce
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island
| | - Jon A. Steingrimsson
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
| | - Elizabeth A. Stuart
- Departments of Mental Health, Biostatistics, and Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Denise R. Aberle
- Medical & Imaging Informatics Group, Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles
| | - Constantine A. Gatsonis
- Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island
| | - Issa J. Dahabreh
- CAUSALab, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Cook RR, Foot C, Arah OA, Humphreys K, Rudolph KE, Luo SX, Tsui JI, Levander XA, Korthuis PT. Estimating the impact of stimulant use on initiation of buprenorphine and extended-release naltrexone in two clinical trials and real-world populations. Addict Sci Clin Pract 2023; 18:11. [PMID: 36788634 PMCID: PMC9930351 DOI: 10.1186/s13722-023-00364-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 02/01/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Co-use of stimulants and opioids is rapidly increasing. Randomized clinical trials (RCTs) have established the efficacy of medications for opioid use disorder (MOUD), but stimulant use may decrease the likelihood of initiating MOUD treatment. Furthermore, trial participants may not represent "real-world" populations who would benefit from treatment. METHODS We conducted a two-stage analysis. First, associations between stimulant use (time-varying urine drug screens for cocaine, methamphetamine, or amphetamines) and initiation of buprenorphine or extended-release naltrexone (XR-NTX) were estimated across two RCTs (CTN-0051 X:BOT and CTN-0067 CHOICES) using adjusted Cox regression models. Second, results were generalized to three target populations who would benefit from MOUD: Housed adults identifying the need for OUD treatment, as characterized by the National Survey on Drug Use and Health (NSDUH); adults entering OUD treatment, as characterized by Treatment Episodes Dataset (TEDS); and adults living in rural regions of the U.S. with high rates of injection drug use, as characterized by the Rural Opioids Initiative (ROI). Generalizability analyses adjusted for differences in demographic characteristics, substance use, housing status, and depression between RCT and target populations using inverse probability of selection weighting. RESULTS Analyses included 673 clinical trial participants, 139 NSDUH respondents (weighted to represent 661,650 people), 71,751 TEDS treatment episodes, and 1,933 ROI participants. The majority were aged 30-49 years, male, and non-Hispanic White. In RCTs, stimulant use reduced the likelihood of MOUD initiation by 32% (adjusted HR [aHR] = 0.68, 95% CI 0.49-0.94, p = 0.019). Stimulant use associations were slightly attenuated and non-significant among housed adults needing treatment (25% reduction, aHR = 0.75, 0.48-1.18, p = 0.215) and adults entering OUD treatment (28% reduction, aHR = 0.72, 0.51-1.01, p = 0.061). The association was more pronounced, but still non-significant among rural people injecting drugs (39% reduction, aHR = 0.61, 0.35-1.06, p = 0.081). Stimulant use had a larger negative impact on XR-NTX initiation compared to buprenorphine, especially in the rural population (76% reduction, aHR = 0.24, 0.08-0.69, p = 0.008). CONCLUSIONS Stimulant use is a barrier to buprenorphine or XR-NTX initiation in clinical trials and real-world populations that would benefit from OUD treatment. Interventions to address stimulant use among patients with OUD are urgently needed, especially among rural people injecting drugs, who already suffer from limited access to MOUD.
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Affiliation(s)
- R R Cook
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Sam Jackson Hall, Suite 3370, 3245 SW Pavilion Loop, Portland, OR, 97239, USA.
| | - C Foot
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Sam Jackson Hall, Suite 3370, 3245 SW Pavilion Loop, Portland, OR, 97239, USA
| | - O A Arah
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
- Division of Physical Sciences, Department of Statistics, UCLA College, Los Angeles, CA, USA
- Research Unit for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - K Humphreys
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - K E Rudolph
- Department of Epidemiology, School of Public Health, Columbia University, New York, NY, USA
| | - S X Luo
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University, New York, USA
| | - J I Tsui
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - X A Levander
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Sam Jackson Hall, Suite 3370, 3245 SW Pavilion Loop, Portland, OR, 97239, USA
| | - P T Korthuis
- Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Sam Jackson Hall, Suite 3370, 3245 SW Pavilion Loop, Portland, OR, 97239, USA
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Inoue K, Watson KE, Kondo N, Horwich T, Hsu W, Bui AAT, Duru OK. Association of Intensive Blood Pressure Control and Living Arrangement on Cardiovascular Outcomes by Race: Post Hoc Analysis of SPRINT Randomized Clinical Trial. JAMA Netw Open 2022; 5:e222037. [PMID: 35285922 PMCID: PMC9608340 DOI: 10.1001/jamanetworkopen.2022.2037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Living alone, a key proxy of social isolation, is a risk factor for cardiovascular disease. In addition, Black race is associated with less optimal blood pressure (BP) control than in other racial or ethnic groups. However, it is not clear whether living arrangement status modifies the beneficial effects of intensive BP control on reduction in cardiovascular events among Black individuals. OBJECTIVE To examine whether the association of intensive BP control with cardiovascular events differs by living arrangement among Black individuals and non-Black individuals (eg, individuals who identified as Alaskan Native, American Indian, Asian, Native Hawaiian, Pacific Islander, White, or other) in the Systolic Blood Pressure Intervention Trial (SPRINT). DESIGN, SETTING, AND PARTICIPANTS This secondary analysis incorporated data from SPRINT, a multicenter study of individuals with increased risk for cardiovascular disease and free of diabetes, enrolled at 102 clinical sites in the United States between November 2010 and March 2013. Race and living arrangement (ie, living alone or living with others) were self-reported. Data were collected between November 2010 and March 2013 and analyzed from January 2021 to October 2021. EXPOSURES The SPRINT participants were randomized to a systolic BP target of either less than 120 mm Hg (intensive treatment group) or less than 140 mm Hg (standard treatment group). Antihypertensive medications were adjusted to achieve the targets in each group. MAIN OUTCOMES AND MEASURES Cox proportional hazards model was used to investigate the association of intensive treatment with the incident composite cardiovascular outcome (by August 20, 2015) according to living arrangement among Black individuals and other individuals. Transportability formula was applied to generalize the SPRINT findings to hypothetical external populations by varying the proportion of Black race and living arrangement status. RESULTS Among the 9342 total participants, the mean (SD) age was 67.9 (9.4) years; 2793 participants [30%] were Black, 2714 [29%] lived alone, and 3320 participants (35.5%) were female. Over a median (IQR) follow-up of 3.22 (2.74-3.76) years, the primary composite cardiovascular outcome was observed in 67 of 1001 Black individuals living alone (6.7%), 76 of 1792 Black individuals living with others (4.2%), 108 of 1713 non-Black individuals living alone (6.3%), and 311 of 4836 non-Black individuals living with others (6.4%). The intensive treatment group showed a significantly lower rate of the composite cardiovascular outcome than the standard treatment group among Black individuals living with others (hazard ratio [HR], 0.53 [95% CI, 0.33-0.85]) but not among those living alone (HR, 1.07 [95% CI, 0.66-1.73]; P for interaction = .04). The association was observed among individuals who were not Black regardless of living arrangement status. Using transportability, we found a smaller or null association between intensive control and cardiovascular outcomes among hypothetical populations of 60% Black individuals or more and 60% or more of individuals living alone. CONCLUSIONS AND RELEVANCE Intensive BP control was associated with a lower rate of cardiovascular events among Black individuals living with others and individuals who were not Black but not among Black individuals living alone. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01206062.
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Affiliation(s)
- Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Epidemiology, University of California Los Angeles Fielding School of Public Health, Los Angeles
| | - Karol E. Watson
- Department of Medicine, Division of Cardiology, University of California Los Angeles, Los Angeles
| | - Naoki Kondo
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan
| | - Tamara Horwich
- Department of Medicine, Division of Cardiology, University of California Los Angeles, Los Angeles
| | - William Hsu
- Medical and Imaging Informatics Group, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles
- Department of Bioengineering, University of California Los Angeles Samueli School of Engineering, Los Angeles
| | - Alex A. T. Bui
- Medical and Imaging Informatics Group, Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles
| | - O. Kenrik Duru
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California Los Angeles, Los Angeles
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