Propensity score-based approaches to confounding by indication in individual patient data meta-analysis: Non-standardized treatment for multidrug resistant tuberculosis

Gregory J. Fox, Andrea Benedetti, Carole D. Mitnick, Madhukar Pai, Dick Menzies, S. Ahuja, D. Ashkin, M. Avendaño, R. Banerjee, M. Bauer, M. Becerra, M. Burgos, R. Centis, E. D. Chan, C. Y. Chiang, F. Cobelens, H. Cox, L. D'Ambrosio, W. C M De Lange, K. DeRiemerD. Enarson, D. Falzon, K. Flanagan, J. Flood, N. Gandhi, L. Garcia-Garcia, R. M. Granich, M. G. Hollm-Delgado, T. H. Holtz, P. Hopewell, M. Iseman, L. G. Jarlsberg, S. Keshavjee, H. R. Kim, J. Lancaster, C. Lange, V. Leimane, C. C. Leung, W. J. Koh, J. Li, D. Menzies, G. B. Migliori, M. Narita, E. Nathanson, R. Odendaal, P. O'Riordan, M. Pai, D. Palmero, S. K. Park, G. Pasvol, J. Pena, C. Pérez-Guzmán, A. Ponce-de-Leon, M. I D Quelapio, H. T. Quy, V. Riekstina, J. Robert, S. Royce, M. Salim, H. S. Schaaf, K. J. Seung, L. Shah, K. Shean, T. S. Shim, S. S. Shin, Y. Shiraishi, J. Sifuentes-Osornio, G. Sotgiu, M. J. Strand, S. W. Sung, P. Tabarsi, T. E. Tupasi, M. H. Vargas, R. Van Altena, P. Viiklepp, M. Van Der Walt, T. S. Van Der Werf, J. Westenhouse, W. W. Yew, J. J. Yim

研究成果: 雜誌貢獻文章

5 引文 斯高帕斯(Scopus)

摘要

Background: In the absence of randomized clinical trials, meta-analysis of individual patient data (IPD) from observational studies may provide the most accurate effect estimates for an intervention. However, confounding by indication remains an important concern that can be addressed by incorporating individual patient covariates in different ways. We compared different analytic approaches to account for confounding in IPD from patients treated for multidrug resistant tuberculosis (MDR-TB). Methods: Two antibiotic classes were evaluated, fluoroquinolones-considered the cornerstone of effective MDR-TB treatment-and macrolides, which are known to be safe, yet are ineffective in vitro. The primary outcome was treatment success against treatment failure, relapse or death. Effect estimates were obtained using multivariable and propensity-score based approaches. Results: Fluoroquinolone antibiotics were used in 28 included studies, within which 6,612 patients received a fluoroquinolone and 723 patients did not. Macrolides were used in 15 included studies, within which 459 patients received this class of antibiotics and 3,670 did not. Both standard multivariable regression and propensity score-based methods resulted in similar effect estimates for early and late generation fluoroquinolones, while macrolide antibiotics use was associated with reduced treatment success. Conclusions: In this individual patient data meta-analysis, standard multivariable and propensity-score based methods of adjusting for individual patient covariates for observational studies yielded produced similar effect estimates. Even when adjustment is made for potential confounding, interpretation of adjusted estimates must still consider the potential for residual bias.

原文英語
文章編號e0151724
期刊PLoS One
11
發行號3
DOIs
出版狀態已發佈 - 三月 1 2016
對外發佈Yes

    指紋

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

引用此

Fox, G. J., Benedetti, A., Mitnick, C. D., Pai, M., Menzies, D., Ahuja, S., Ashkin, D., Avendaño, M., Banerjee, R., Bauer, M., Becerra, M., Burgos, M., Centis, R., Chan, E. D., Chiang, C. Y., Cobelens, F., Cox, H., D'Ambrosio, L., De Lange, W. C. M., ... Yim, J. J. (2016). Propensity score-based approaches to confounding by indication in individual patient data meta-analysis: Non-standardized treatment for multidrug resistant tuberculosis. PLoS One, 11(3), [e0151724]. https://doi.org/10.1371/journal.pone.0151724