论文标题

有针对性的学习:朝着现实世界证据告知的未来

Targeted learning: Towards a future informed by real-world evidence

论文作者

Gruber, Susan, Phillips, Rachael V., Lee, Hana, Ho, Martin, Concato, John, van der Laan, Mark J.

论文摘要

2016年的《 21世纪治疗法案》包括美国食品药品监督管理局(FDA)评估现实世界证据(RWE)的潜在使用,以支持用于以前批准的药物的新指示,并满足批准后研究的要求。从实际数据(RWD)中提取可靠的证据通常是由于缺乏治疗随机性,潜在的间交流事件以及随访的信息损失而变得复杂。有针对性的学习(TL)是统计的子场,提供了一个严格的框架来帮助解决这些挑战。 TL路线图提供了生成有效证据并评估其可靠性的分步指南。遵循这些步骤会产生大量信息,用于评估该研究是否提供了支持监管决策的可靠科学证据。本文介绍了两个案例研究,说明了遵循路线图的实用性。我们使用有针对性的最小损失估计与超级学习相结合来估计因果关系。我们还将这些发现与从未调整的分析,倾向得分匹配和逆概率加权获得的发现进行了比较。非参数敏感性分析阐明了(无法测试的)因果假设如何影响点估计和置信区间界限,这将影响研究中得出的实质性结论。 TL从数据中学习的彻底方法可提供透明度,从而使RWE的信任在有必要的情况下获得。

The 21st Century Cures Act of 2016 includes a provision for the U.S. Food and Drug Administration (FDA) to evaluate the potential use of real-world evidence (RWE) to support new indications for use for previously approved drugs, and to satisfy post-approval study requirements. Extracting reliable evidence from real-world data (RWD) is often complicated by a lack of treatment randomization, potential intercurrent events, and informative loss to follow up. Targeted Learning (TL) is a sub-field of statistics that provides a rigorous framework to help address these challenges. The TL Roadmap offers a step-by-step guide to generating valid evidence and assessing its reliability. Following these steps produces an extensive amount of information for assessing whether the study provides reliable scientific evidence in support regulatory decision making. This paper presents two case studies that illustrate the utility of following the roadmap. We use targeted minimum loss-based estimation combined with super learning to estimate causal effects. We also compared these findings with those obtained from an unadjusted analysis, propensity score matching, and inverse probability weighting. Non-parametric sensitivity analyses illuminate how departures from (untestable) causal assumptions would affect point estimates and confidence interval bounds that would impact the substantive conclusion drawn from the study. TL's thorough approach to learning from data provides transparency, allowing trust in RWE to be earned whenever it is warranted.

扫码加入交流群

加入微信交流群

微信交流群二维码

扫码加入学术交流群,获取更多资源