论文标题
使用各种策略来定义估计数来处理临床试验中的事件
Defining Estimands Using a Mix of Strategies to Handle Intercurrent Events in Clinical Trials
论文作者
论文摘要
随机对照试验(RCT)是评估研究干预措施有效性和安全性的黄金标准。如果RCT中的每个患者都遵守随机治疗,则可以简单地分析完整的数据以推断治疗效果。但是,发生的事件(ICS),包括使用伴随药物来实现难以令人满意的疗效,由于不良事件或缺乏疗效而导致的治疗中停用,可能会导致干预措施偏离原始治疗分配。因此,在确定统计分析方法并分析数据之前,根据研究的主要目标来定义适当的估计(要估计的适当参数)至关重要。国际协调理事会(ICH)E9(R1)于2019年11月20日发布,提供了5种定义估计性的策略:治疗政策,假设,复合变量,同时在治疗和主要层面上。在本文中,我们提出了使用多种策略来处理ICE的估计。该估计是与安全性有关的ICE的无效治疗差异的平均值,如果其他患者可以完成分配的治疗方法,则它们的治疗差异。提供了评估抗糖尿病治疗的临床试验中的两个例子,以说明对拟议估算的估计,并将其与使用假设和治疗政策策略在处理ICE的估计中进行比较。
Randomized controlled trials (RCT) are the gold standard for evaluation of the efficacy and safety of investigational interventions. If every patient in an RCT were to adhere to the randomized treatment, one could simply analyze the complete data to infer the treatment effect. However, intercurrent events (ICEs) including the use of concomitant medication for unsatisfactory efficacy, treatment discontinuation due to adverse events, or lack of efficacy, may lead to interventions that deviate from the original treatment assignment. Therefore, defining the appropriate estimand (the appropriate parameter to be estimated) based on the primary objective of the study is critical prior to determining the statistical analysis method and analyzing the data. The International Council for Harmonisation (ICH) E9 (R1), published on November 20, 2019, provided 5 strategies to define the estimand: treatment policy, hypothetical, composite variable, while on treatment and principal stratum. In this article, we propose an estimand using a mix of strategies in handling ICEs. This estimand is an average of the null treatment difference for those with ICEs potentially related to safety and the treatment difference for the other patients if they would complete the assigned treatments. Two examples from clinical trials evaluating anti-diabetes treatments are provided to illustrate the estimation of this proposed estimand and to compare it with the estimates for estimands using hypothetical and treatment policy strategies in handling ICEs.