Evidence map›Paper›PMID 39425034›Full record

ArticleBMC medical research methodology2024

Application of the estimand framework for an emulated trial using reference based multiple imputation to investigate informative censoring.

A Atkinson, M Zwahlen, S De Wit, H Furrer, J R Carpenter

Abstract read
In one paragraph

Article in BMC medical research methodology, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

A AtkinsonDivision of Infectious Diseases, Washington University in St. Louis School of Medicine, St. Louis, MO, USA. aandrew@wustl.edu.
M ZwahlenInstitute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
S De WitDepartment of Infectious Diseases, Saint Pierre University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
H FurrerDepartment of Infectious Diseases, Bern University Hospital, Inselspital, Bern, Switzerland.
J R CarpenterDepartment of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.

Funding

Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung 324730_149792
6 · The paper itself

Abstract

backgroundThe ICH E9 (R1) addendum on Estimands and Sensitivity analysis in Clinical trials proposes a framework for the design and analysis of clinical trials aimed at improving clarity around the definition of the targeted treatment effect (the estimand) of a study.

methodsWe adopt the estimand framework in the context of a study using "trial emulation" to estimate the risk of pneumocystis pneumonia, an opportunistic disease contracted by people living with HIV and AIDS having a weakened immune system, when considering two antibiotic treatment regimes for stopping antibiotic prophylaxis treatment against this disease. A "while on treatment" strategy has been implemented for post-randomisation (intercurrent) events. We then perform a sensitivity analysis using reference based multiple imputation to model a scenario in which patients lost to follow-up stop taking prophylaxis.

resultsThe primary analysis indicated a protective effect for the new regime which used viral suppression as prophylaxis stopping criteria (hazard ratio (HR) 0.78, 95% confidence interval [0.69, 0.89], p < 0.001). For the sensitivity analysis, when we apply the "jump to off prophylaxis" approach, the hazard ratio is almost the same compared to that from the primary analysis (HR 0.80 [0.69, 0.95], p = 0.009). The sensitivity analysis confirmed that the new regime exhibits a clear improvement over the existing guidelines for PcP prophylaxis when those lost to follow-up "jump to off prophylaxis".

conclusionsOur application using reference based multiple imputation demonstrates the method's flexibility and simplicity for sensitivity analyses in the context of the estimand framework for (emulated) trials.

Indexed as

HIV InfectionsPneumonia, PneumocystisAIDS-Related Opportunistic InfectionsAnti-Bacterial AgentsAntibiotic ProphylaxisClinical Trials as TopicData Interpretation, StatisticalHumansProportional Hazards ModelsResearch DesignAnti-Bacterial AgentsEstimand frameworkInformative censoringMultiple imputationSensitivity analysisTrial emulation

Identifiers

PMID39425034
PMCPMC11487792

What Socratic holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.