使用血液癌症患者的真实世界数据进行的外部对照研究:系统评价。
Externally Controlled Studies Using Real-World Data in Patients With Hematological Cancers: A Systematic Review.
发表日期:2024 Aug 29
作者:
Sjoerd J F Hermans, Niek G van der Maas, Yvette van Norden, Avinash G Dinmohamed, Elizabeth Berkx, Peter C Huijgens, Donna R Rivera, R Angelo de Claro, Francesco Pignatti, Jurjen Versluis, Jan J Cornelissen
来源:
JAMA Oncology
摘要:
在前瞻性研究中,真实世界数据 (RWD) 外部控制臂的使用正在增加。其优势,包括立即获得对照人群,必须与满足证据标准的要求相平衡。要解决 RWD 研究方法是否以及在多大程度上与随机临床试验中使用的标准方法进行比较的问题。从 2000 年 1 月 1 日到 2023 年 10 月 23 日,在 4 个电子数据库和 Google Scholar 中进行了搜索。如果研究将临床试验中的干预组与 RWD 对照组在血液系统癌症患者中进行比较,则纳入系统评价。如果它们是在 2000 年至 2023 年之间发表的。我们确定了 32 项前瞻性干预研究,其中纳入了血液癌症患者 RWD 来源的外部对照数据。所有研究共纳入了来自干预组的 4306 名患者和来自 RWD 对照组的 10594 名患者。只有 2 项研究 (6%) 纳入了前瞻性收集的 RWD。 7 项研究 (22%) 将完整的试验纳入标准应用于 RWD 队列。 4 项研究(13%)公布了 RWD 的统计分析计划和预定用途。共有 23 项研究 (72%) 对试验和 RWD 队列应用了匹配算法,包括人口统计、疾病和/或治疗相关特征的匹配。终点标准与 8 项研究中的试验相同 (25%)。相比之下,12 项研究 (38%) 使用了不同的终点,12 项研究 (38%) 没有提供 RWD 的终点定义。十二项研究 (38%) 的中位随访差异小于一年。八项研究 (25%) 报告了试验组的毒性效应数据,其中 5 项研究报告了 RWD 组的毒性效应数据。 在这项系统评价中,观察到 RWD 临床试验资格标准的应用、统计严谨性和匹配方法的应用、终点的定义、随访和不良事件的报告,这可能会挑战使用 RWD 的研究中报告的结论。
The use of real-world data (RWD) external control arms in prospective studies is increasing. The advantages, including the immediate availability of a control population, must be balanced with the requirements of meeting evidentiary standards.To address the question of whether and to what extent the methods of RWD studies compare to standard methods used in randomized clinical trials.A systematic search across 4 electronic databases and Google Scholar was conducted from January 1, 2000, to October 23, 2023. Studies were included in the systematic review if they compared an intervention arm in a clinical trial to an RWD control arm in patients with hematological cancers and if they were published between 2000 and 2023.Thirty-two prospective intervention studies incorporating external control data from RWD sources of patients with hematological cancers were identified. A total of 4306 patients from intervention arms and 10 594 from RWD control arms were included across all studies. Only 2 studies (6%) included prospectively collected RWD. The complete trial inclusion criteria were applied to the RWD cohort in 7 studies (22%). Four studies (13%) published the statistical analysis plan and prespecified use of RWD. A total of 23 studies (72%) applied matching algorithms for trial and RWD cohorts, including matching for demographic, disease, and/or therapy-related characteristics. The end point criteria were the same as the trial in 8 studies (25%). In contrast, 12 studies (38%) used different end points, and 12 (38%) did not provide an end point definition for the RWD. Twelve studies (38%) had a median follow-up difference of less than a year between arms. Eight studies (25%) reported toxic effect data for the trial arm, of which 5 studies reported toxic effect data for the RWD arm.In this systematic review, limitations were observed in the application of clinical trial eligibility criteria to RWD, statistical rigor and application of matching methods, the definition of end points, follow-up, and reporting of adverse events, which may challenge the conclusions reported in studies using RWD.