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Jent S, Bez NS, Catalano L, Rogler G. The Efficacy of a Diet Low in Fermentable Oligo-, Di-, Monosaccharides, and Polyols in Irritable Bowel Syndrome Compared to Its "Real-world" Effectiveness: Protocol for a Systematic Review. JMIR Res Protoc 2023; 12:e41399. [PMID: 37307063 DOI: 10.2196/41399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is associated with various gastrointestinal and nongastrointestinal symptoms and reduced quality of life. A diet low in fermentable oligo-, di-, monosaccharides, and polyols (FODMAPs) is one therapeutic option for IBS. Although the efficacy of the low FODMAP diet has been reported in several systematic reviews, the efficacy-effectiveness gap of the low FODMAP diet has not yet been assessed. OBJECTIVE This systematic review aims to compare the efficacy of the low FODMAP diet from efficacy randomized controlled trials (RCTs) with the effectiveness of studies conducted in "real-world" settings. METHODS RCTs, prospective and retrospective cohort studies, and retrospective audits assessing the low FODMAP diet in adults with IBS will be searched in 4 databases: Embase, MEDLINE, CENTRAL, and CINAHL. Two independent reviewers will perform study selection, data extraction, and risk of bias assessment and assess selected quality aspects from the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) protocol. Outcomes assessed are stool frequency, stool consistency, abdominal pain, overall symptom scores, adequate symptom relief, IBS-specific quality of life, and diet adherence. Data will be summarized with forest plots without summary statistics, tables, and narrative descriptions. RESULTS The search, title and abstract screening, and full-text screening were completed in March 2021, and an updated search was done in May 2022. As of May 2023, data analysis is almost finished, and manuscript writing is in progress. Submission of the manuscript is expected by July 2023. CONCLUSIONS The findings of this systematic review will compare the efficacy of the low FODMAP diet for IBS found in RCTs to the diet's real-world effectiveness. TRIAL REGISTRATION PROSPERO CRD42021278952; https://tinyurl.com/32jk43ev. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41399.
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Affiliation(s)
- Sandra Jent
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Natalie Sara Bez
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Loan Catalano
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Gerhard Rogler
- Department of Gastroenterology and Hepatology, University of Zurich, Zürich, Switzerland
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Seo M, Debray TP, Ruffieux Y, Gsteiger S, Bujkiewicz S, Finckh A, Egger M, Efthimiou O. Combining individual patient data from randomized and non-randomized studies to predict real-world effectiveness of interventions. Stat Methods Med Res 2022; 31:1355-1373. [PMID: 35469504 PMCID: PMC9251754 DOI: 10.1177/09622802221090759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Meta-analysis of randomized controlled trials is generally considered the most reliable source of estimates of relative treatment effects. However, in the last few years, there has been interest in using non-randomized studies to complement evidence from randomized controlled trials. Several meta-analytical models have been proposed to this end. Such models mainly focussed on estimating the average relative effects of interventions. In real-life clinical practice, when deciding on how to treat a patient, it might be of great interest to have personalized predictions of absolute outcomes under several available treatment options. This paper describes a general framework for developing models that combine individual patient data from randomized controlled trials and non-randomized study when aiming to predict outcomes for a set of competing medical interventions applied in real-world clinical settings. We also discuss methods for measuring the models' performance to identify the optimal model to use in each setting. We focus on the case of continuous outcomes and illustrate our methods using a data set from rheumatoid arthritis, comprising patient-level data from three randomized controlled trials and two registries from Switzerland and Britain.
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Affiliation(s)
- Michael Seo
- Institute of Social and Preventive Medicine, 27210University of Bern, Bern, Switzerland.,Graduate School for Health Sciences, 27210University of Bern, Bern, Switzerland
| | - Thomas Pa Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 8125Utrecht University, Utrecht, The Netherlands.,Smart Data Analysis and Statistics B.V., Utrecht, The Netherlands
| | - Yann Ruffieux
- Institute of Social and Preventive Medicine, 27210University of Bern, Bern, Switzerland
| | - Sandro Gsteiger
- Pharmaceuticals Division, Global Access, F. Hoffmann-La Roche, Basel, Switzerland
| | - Sylwia Bujkiewicz
- Biostatistics Research Group, Department of Health Sciences, 4488University of Leicester, Leicester, UK
| | - Axel Finckh
- Division of Rheumatology, 30576University Hospitals of Geneva, Geneva, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, 27210University of Bern, Bern, Switzerland.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine, 27210University of Bern, Bern, Switzerland.,Department of Psychiatry, 6396University of Oxford, Oxford, UK
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Sankar K, Bryant AK, Strohbehn GW, Zhao L, Elliott D, Moghanaki D, Kelley MJ, Ramnath N, Green MD. Real World Outcomes versus Clinical Trial Results of Durvalumab Maintenance in Veterans with Stage III Non-Small Cell Lung Cancer. Cancers (Basel) 2022; 14:cancers14030614. [PMID: 35158881 PMCID: PMC8833364 DOI: 10.3390/cancers14030614] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary The standard of care for patients with stage III non-small cell lung cancer is concurrent chemoradiotherapy followed by maintenance durvalumab based on outcomes from the PACIFIC trial. The efficacy of this regimen in a real-world population has not been extensively studied. We found that the addition of durvalumab has significantly improved both progression-free and overall survival in veterans with stage III non-small cell lung cancer as compared to veterans who received concurrent chemoradiotherapy alone, but overall survival of veterans is reduced compared to patients in the PACIFIC trial. Additional studies will need to be performed to understand this efficacy-effectiveness gap. Abstract One year of durvalumab following concurrent chemoradiotherapy improves progression-free (PFS) and overall survival (OS) for patients with stage III non-small cell lung cancer (NSCLC). However, the real-world efficacy of durvalumab has not been determined. We conducted a multi-center observational cohort study across the Veterans Health Administration, including patients with stage III NSCLC who received concurrent chemoradiotherapy and durvalumab, compared to patients who received concurrent chemoradiotherapy alone. Kaplan–Meier and Cox regression approaches were used to identify factors associated with PFS and OS. We calculated a hazard ratio and efficacy-effectiveness factor to compare OS of veterans to the referenced clinical trial population. A total of 1006 patients with stage III NSCLC who received concurrent chemoradiotherapy and at least one dose of durvalumab from November 2017 to April 2021 were compared to 989 patients who received concurrent chemoradiotherapy alone from January 2015 to December 2016. Adjuvant durvalumab was associated with higher PFS (HR 0.62, 95% CI 0.55–0.70, p < 0.001) and OS (HR 0.57, 95% CI 0.50–0.66, p < 0.001). OS was shorter in veterans compared to PACIFIC (HR 1.24, 95% CI 1.03–1.48, p = 0.02: EE gap 0.73). OS of veterans with stage III NSCLC treated with adjuvant durvalumab is improved compared to a modern comparator but is reduced compared to the PACIFIC population.
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Affiliation(s)
- Kamya Sankar
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA;
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA; (A.K.B.); (L.Z.); (D.E.)
| | - Alex K. Bryant
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA; (A.K.B.); (L.Z.); (D.E.)
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Garth W. Strohbehn
- Section of Hematology and Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA;
| | - Lili Zhao
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA; (A.K.B.); (L.Z.); (D.E.)
- Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA
| | - David Elliott
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA; (A.K.B.); (L.Z.); (D.E.)
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Radiation Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
| | - Drew Moghanaki
- Department of Radiation Oncology, UCLA Jonsson Cancer Center, Los Angeles, CA 90024, USA;
| | - Michael J. Kelley
- Department of Veterans Affairs, Durham VA Medical Center, Durham, NC 27705, USA;
- Medical Oncology, Department of Medicine, Duke Medical Center, Durham, NC 27710, USA
| | - Nithya Ramnath
- Division of Hematology and Oncology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA;
- Section of Hematology and Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA;
- Correspondence: (N.R.); (M.D.G.); Tel.: +1-734-232-6789 (N.R.); +1-734-763-1512 (M.D.G.)
| | - Michael D. Green
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI 48109, USA; (A.K.B.); (L.Z.); (D.E.)
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Radiation Oncology, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
- Correspondence: (N.R.); (M.D.G.); Tel.: +1-734-232-6789 (N.R.); +1-734-763-1512 (M.D.G.)
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Kostos L, Hong W, Lee B, Tran B, Lok SW, Anton A, Gard G, To YH, Wong V, Shapiro J, Wong R, Wong S, de Boer R, Gibbs P. Cancer clinical trial vs real-world outcomes for standard of care first-line treatment in the advanced disease setting. Int J Cancer 2021; 149:409-419. [PMID: 33729581 DOI: 10.1002/ijc.33568] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 01/05/2023]
Abstract
Clinical trials have strict eligibility criteria, potentially limiting external validity. However, while often discussed this has seldom been explored, particularly across cancer types and at variable time frames posttrial completion. We examined comprehensive registry data (January 2014 to June 2019) for standard first-line treatments for metastatic colorectal cancer (CRC), advanced pancreatic cancer (PC), metastatic HER2-amplified breast cancer (BC) and castrate-resistant prostate cancer (CaP). Registry patient characteristics and outcomes were compared to the practice-changing trial. Registry patients were older than the matched trial cohort by a median of 2-6 years (all P = <.01) for the CRC, BC and PC cohorts. The proportion of Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-1 patients was lower for CRC (94.1% vs 99.2%, P = .001) and BC (94.9% vs 99.3%, P = .001). Progression-free survival (PFS) for registry patients was similar to the trial patients or significantly longer (CaP, Hazard Ratio [HR] = 0.65, P = <.001). Overall survival (OS) was also similar or significantly longer (CaP, HR 0.49, P = <.001). In conclusion, despite real-world patients sometimes being older or having inferior PS to trial cohorts, the survival outcomes achieved were consistently equal or superior to those reported for the same treatment in the trial. We suggest that this is potentially due to optimised use of each treatment over time, improved multidisciplinary care and increased postprogression options. We can reassure clinicians and patients that outcomes matching or exceeding those reported in trials are possible. The potential for survival gains over time should routinely be factored into future trial statistical plans.
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Affiliation(s)
- Louise Kostos
- Department of Medical Oncology, Western Health, Melbourne, Victoria, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Wei Hong
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Belinda Lee
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Medical Oncology, Northern Health, Melbourne, Victoria, Australia
| | - Ben Tran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Sheau Wen Lok
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Angelyn Anton
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Medical Oncology, Eastern Health, Box Hill, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Grace Gard
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Yat Hang To
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Vanessa Wong
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
| | - Jeremy Shapiro
- Cabrini Haematology and Oncology Centre, Melbourne, Victoria, Australia
| | - Rachel Wong
- Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia.,Department of Medical Oncology, Eastern Health, Box Hill, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Shirley Wong
- Department of Medical Oncology, Western Health, Melbourne, Victoria, Australia
| | - Richard de Boer
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Peter Gibbs
- Department of Medical Oncology, Western Health, Melbourne, Victoria, Australia.,Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia
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Didden EM, Ruffieux Y, Hummel N, Efthimiou O, Reichenbach S, Gsteiger S, Finckh A, Fletcher C, Salanti G, Egger M. Prediction of Real-World Drug Effectiveness Prelaunch: Case Study in Rheumatoid Arthritis. Med Decis Making 2019; 38:719-729. [PMID: 30074882 DOI: 10.1177/0272989x18775975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Decision makers often need to assess the real-world effectiveness of new drugs prelaunch, when phase II/III randomized controlled trials (RCTs) but no other data are available. OBJECTIVE To develop a method to predict drug effectiveness prelaunch and to apply it in a case study in rheumatoid arthritis (RA). METHODS The approach 1) identifies a market-approved treatment ( S) currently used in a target population similar to that of the new drug ( N); 2) quantifies the impact of treatment, prognostic factors, and effect modifiers on clinical outcome; 3) determines the characteristics of patients likely to receive N in routine care; and 4) predicts treatment outcome in simulated patients with these characteristics. Sources of evidence include expert opinion, RCTs, and observational studies. The framework relies on generalized linear models. RESULTS The case study assessed the effectiveness of tocilizumab (TCZ), a biologic disease-modifying antirheumatic drug (DMARD), combined with conventional DMARDs, compared to conventional DMARDs alone. Rituximab (RTX) combined with conventional DMARDs was identified as treatment S. Individual participant data from 2 RCTs and 2 national registries were analyzed. The model predicted the 6-month changes in the Disease Activity Score 28 (DAS28) accurately: the mean change was -2.101 (standard deviation [SD] = 1.494) in the simulated patients receiving TCZ and conventional DMARDs compared to -1.873 (SD = 1.220) in retrospectively assessed observational data. It was -0.792 (SD = 1.499) in registry patients treated with conventional DMARDs. CONCLUSION The approach performed well in the RA case study, but further work is required to better define its strengths and limitations.
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Affiliation(s)
- Eva-Maria Didden
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Yann Ruffieux
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Noemi Hummel
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.,University of Ioannina, School of Medicine, Ioannina, Ioannina, Greece
| | - Stephan Reichenbach
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.,Department of Rheumatology, Immunology and Allergology, University Hospital and University of Bern, Switzerland
| | - Sandro Gsteiger
- F. Hoffmann-La Roche Ltd., MORSE-Health Technology Assessment Group, Basel, Switzerland
| | - Axel Finckh
- University Hospital of Geneva (HUG), Geneva, Switzerland
| | | | - Georgia Salanti
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.,University of Ioannina, School of Medicine, Ioannina, Ioannina, Greece
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Bui TBV, Burgers DM, Agterof MJ, van de Garde EM. Real-World Effectiveness of Palbociclib Versus Clinical Trial Results in Patients With Advanced/Metastatic Breast Cancer That Progressed on Previous Endocrine Therapy. Breast Cancer (Auckl) 2019; 13:1178223418823238. [PMID: 30675102 PMCID: PMC6330732 DOI: 10.1177/1178223418823238] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 12/09/2018] [Indexed: 11/23/2022]
Abstract
Objective: The aim of this study was to assess the real-world effectiveness and
tolerability of palbociclib combined with endocrine therapy for the
treatment of hormone receptor positive (HR-positive), human epidermal growth
factor receptor 2 negative (HER2-negative), advanced/metastatic breast
cancer that progressed on previous endocrine therapy, and to compare these
results with the outcomes of the PALOMA-3 clinical trial. Methods: This study was a retrospective observational cohort study including all
patients who started with palbociclib in the St. Antonius Hospital between
September 1, 2016 and April 1, 2018 for the treatment of HR-positive,
HER2-negative advanced/metastatic breast cancer that progressed on previous
endocrine therapy. Individual patient data were collected from electronic
medical records. Primary study outcomes were progression-free survival (PFS)
and the number of permanent treatment discontinuations before disease
progression due to adverse events (AEs). Secondary outcomes were the
frequency of all (serious) AEs and the frequency of and reasons for dose
reductions, -interruptions and cycle delays. Results: A total of 46 patients were studied with a median follow-up of 13.0 months.
Overall, the median PFS in real-world clinical practice was 10.0 months (95%
confidence interval (CI) 4.9-15.1), compared with 9.5 months in PALOMA-3
(95% CI 9.2-11.0). Two patients discontinued treatment because of AEs.
Neutropenia was the most frequent grade 3-4 AE, but with no febrile
neutropenia events. Most AEs were managed with palbociclib dose
modifications. Regarding these modifications, more cycle delays, less dose
reductions, and less dose interruptions occurred in clinical practice
compared with PALOMA-3 (59 vs 36%, 22 vs 34%, and 9 vs 54%, respectively).
Patients who did not meet the PALOMA-3 study eligibility criteria (n = 16)
showed a lower median PFS of 5.5 months (95% CI 4.7-6.4). Conclusions: The effectiveness and tolerability of palbociclib in real-world clinical
practice corresponded well with the results obtained in the PALOMA-3
clinical trial. Despite the differences in dose modifications, this study
suggests that there is no efficacy-effectiveness gap in this patient
population.
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Affiliation(s)
- Tam Binh V Bui
- Department of Clinical Pharmacy, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands
| | - Desirée Mt Burgers
- Department of Clinical Pharmacy, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands
| | - Mariette J Agterof
- Department of Internal Medicine, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands
| | - Ewoudt Mw van de Garde
- Department of Clinical Pharmacy, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands.,Division of Pharmacoepidemiology and Clinical Pharmacology, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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Panayidou K, Gsteiger S, Egger M, Kilcher G, Carreras M, Efthimiou O, Debray TPA, Trelle S, Hummel N. GetReal in mathematical modelling: a review of studies predicting drug effectiveness in the real world. Res Synth Methods 2016; 7:264-77. [PMID: 27529762 PMCID: PMC5129568 DOI: 10.1002/jrsm.1202] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 12/21/2015] [Accepted: 12/28/2015] [Indexed: 11/18/2022]
Abstract
The performance of a drug in a clinical trial setting often does not reflect its effect in daily clinical practice. In this third of three reviews, we examine the applications that have been used in the literature to predict real‐world effectiveness from randomized controlled trial efficacy data. We searched MEDLINE, EMBASE from inception to March 2014, the Cochrane Methodology Register, and websites of key journals and organisations and reference lists. We extracted data on the type of model and predictions, data sources, validation and sensitivity analyses, disease area and software. We identified 12 articles in which four approaches were used: multi‐state models, discrete event simulation models, physiology‐based models and survival and generalized linear models. Studies predicted outcomes over longer time periods in different patient populations, including patients with lower levels of adherence or persistence to treatment or examined doses not tested in trials. Eight studies included individual patient data. Seven examined cardiovascular and metabolic diseases and three neurological conditions. Most studies included sensitivity analyses, but external validation was performed in only three studies. We conclude that mathematical modelling to predict real‐world effectiveness of drug interventions is not widely used at present and not well validated. © 2016 The Authors Research Synthesis Methods Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Klea Panayidou
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Sandro Gsteiger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
| | - Gablu Kilcher
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | | | - Orestis Efthimiou
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sven Trelle
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.,Department of Clinical Research, Clinical Trials Unit, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Noemi Hummel
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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Nordon C, Karcher H, Groenwold RHH, Ankarfeldt MZ, Pichler F, Chevrou-Severac H, Rossignol M, Abbe A, Abenhaim L. The " Efficacy-Effectiveness Gap": Historical Background and Current Conceptualization. Value Health 2016; 19:75-81. [PMID: 26797239 DOI: 10.1016/j.jval.2015.09.2938] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 09/01/2015] [Accepted: 09/30/2015] [Indexed: 05/22/2023]
Abstract
BACKGROUND The concept of the "efficacy-effectiveness gap" (EEG) has started to challenge confidence in decisions made for drugs when based on randomized controlled trials alone. Launched by the Innovative Medicines Initiative, the GetReal project aims to improve understanding of how to reconcile evidence to support efficacy and effectiveness and at proposing operational solutions. OBJECTIVES The objectives of the present narrative review were 1) to understand the historical background in which the concept of the EEG has emerged and 2) to describe the conceptualization of EEG. METHODS A focused literature review was conducted across the gray literature and articles published in English reporting insights on the EEG concept. The identification of different "paradigms" was performed by simple inductive analysis of the documents' content. RESULTS The literature on the EEG falls into three major paradigms, in which EEG is related to 1) real-life characteristics of the health care system; 2) the method used to measure the drug's effect; and 3) a complex interaction between the drug's biological effect and contextual factors. CONCLUSIONS The third paradigm provides an opportunity to look beyond any dichotomy between "standardized" versus "real-life" characteristics of the health care system and study designs. Namely, future research will determine whether the identification of these contextual factors can help to best design randomized controlled trials that provide better estimates of drugs' effectiveness.
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Affiliation(s)
| | | | - Rolf H H Groenwold
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | | | | | - Michel Rossignol
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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