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arXiv 2008.05406stat.AP
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主分层策略:在药物开发中的潜在作用

Principal Stratum Strategy: Potential Role in Drug Development

Björn Bornkamp, Kaspar Rufibach, Jianchang Lin, Yi Liu, Devan V. Mehrotra, Satrajit Roychoudhury, Heinz Schmidli, Yue Shentu, Marcel Wolbers

AI总结:

本文探讨主分层策略在药物开发中的应用,说明其可更透明地处理随机化后并发事件所定义的亚群因果问题,并概述所需假设及敏感性分析的重要性。

摘要:

随机试验允许估计干预相对于对照在总体人群以及由基线特征定义的亚群中的因果效应。然而,临床上常常还会出现关于在随机化后会经历临床或疾病相关事件的患者亚群中治疗效应的问题。在治疗开始后发生、并且可能影响测量结果的解释或存在的事件,在 ICH E9(R1) 指南中被称为并发事件。如果并发事件是治疗的后果,那么仅凭随机化不再足以有意义地估计治疗效应。比较干预组和对照组中未发生并发事件的患者亚组的分析,将无法估计因果效应。这一点已众所周知,但此类事后分析在药物开发中仍被普遍使用。另一种方法是主分层策略,该策略根据受试者在两个研究组上发生并发事件的潜在情况对其进行分类。我们通过示例说明,通过主分层表述的问题在药物开发中自然出现,并论证使用 ICH E9(R1) 估计目标框架来处理这些问题,有可能带来更透明的假设以及更充分的分析和结论。此外,我们概述了估计主分层中效应所需的假设。这些假设大多无法验证,因此应建立在扎实的科学理解之上。需要进行敏感性分析来评估结论的稳健性。

英文摘要:

A randomized trial allows estimation of the causal effect of an intervention compared to a control in the overall population and in subpopulations defined by baseline characteristics. Often, however, clinical questions also arise regarding the treatment effect in subpopulations of patients, which would experience clinical or disease related events post-randomization. Events that occur after treatment initiation and potentially affect the interpretation or the existence of the measurements are called {\it intercurrent events} in the ICH E9(R1) guideline. If the intercurrent event is a consequence of treatment, randomization alone is no longer sufficient to meaningfully estimate the treatment effect. Analyses comparing the subgroups of patients without the intercurrent events for intervention and control will not estimate a causal effect. This is well known, but post-hoc analyses of this kind are commonly performed in drug development. An alternative approach is the principal stratum strategy, which classifies subjects according to their potential occurrence of an intercurrent event on both study arms. We illustrate with examples that questions formulated through principal strata occur naturally in drug development and argue that approaching these questions with the ICH E9(R1) estimand framework has the potential to lead to more transparent assumptions as well as more adequate analyses and conclusions. In addition, we provide an overview of assumptions required for estimation of effects in principal strata. Most of these assumptions are unverifiable and should hence be based on solid scientific understanding. Sensitivity analyses are needed to assess robustness of conclusions.

机构、总结、中文摘要均由AI分析而来,可能存在错误,请以论文正文为准。

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