用注册数据桥接类风湿关节炎生物制剂一线与二线治疗的断连网络:结合目标试验模拟的贝叶斯证据合成
Bridging disconnected networks of first and second lines of biologic therapies in rheumatoid arthritis with registry data: Bayesian evidence synthesis with target trial emulation
AI总结:
本文利用BSRBR-RA注册数据模拟目标试验,结合RCT证据构建双变量网络荟萃分析,桥接类风湿关节炎生物制剂一线与二线治疗的断连证据网络,降低二线疗效估计不确定性并实现未评估治疗的疗效预测。
摘要:
目的:我们旨在利用真实世界数据进行证据合成,以优化类风湿关节炎生物制剂有效性的证据基础,从而使一线治疗的证据能够为二线有效性估计提供信息。研究设计与设置:我们使用英国风湿病学会类风湿关节炎生物制剂注册(BSRBR-RA)的数据来补充从文献中获得的随机对照试验(RCT)证据,通过模拟治疗序列的目标试验来估计各线治疗中的治疗效果。来自目标试验的治疗效果估计为一线和二线治疗的双变量网络荟萃分析(NMA)提供信息。结果:从21项生物制剂试验中获得了汇总数据,其中2项针对二线治疗,并获得了来自两个治疗线的六项模拟目标试验的结果。与单变量NMA的结果相比,双变量NMA使二线治疗有效性估计的不确定性降低,并允许对未在二线RCT中评估的治疗效果进行预测。结论:双变量NMA为一线和二线的所有治疗提供了有效性估计,包括在数据中不存在这些估计的二线预测效果。这种新颖方法可能有进一步的应用,例如用于桥接儿童和成人试验网络。
英文摘要:
Objective: We aim to utilise real world data in evidence synthesis to optimise an evidence base for the effectiveness of biologic therapies in rheumatoid arthritis in order to allow for evidence on first-line therapies to inform second-line effectiveness estimates. Study design and setting: We use data from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis (BSRBR-RA) to supplement RCT evidence obtained from the literature, by emulating target trials of treatment sequences to estimate treatment effects in each line of therapy. Treatment effects estimates from the target trials inform a bivariate network meta-analysis (NMA) of first and second-line treatments. Results: Summary data were obtained from 21 trials of biologic therapies including 2 for second-line treatment and results from six emulated target trials of both treatment lines. Bivariate NMA resulted in a decrease in uncertainty around the effectiveness estimates of the second-line therapies, when compared to the results of univariate NMA, and allowed for predictions of treatment effects not evaluated in second-line RCTs. Conclusion: Bivariate NMA provides effectiveness estimates for all treatments in first- and second-line, including predicted effects in second-line where these estimates did not exist in the data. This novel methodology may have further applications, for example for bridging networks of trials in children and adults.
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