Modeling treatment effect modification in multidrug-resistant tuberculosis in an individual patientdata meta-analysis

Effect modification occurs while the effect of the treatment is not homogeneous across the different strata of patient characteristics. When the effect of treatment may vary from individual to individual, precision medicine can be improved by identifying patient covariates to estimate the size and d...

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Veröffentlicht in:Statistical methods in medical research Jg. 31; H. 4; S. 689
Hauptverfasser: Liu, Yan, Schnitzer, Mireille E, Wang, Guanbo, Kennedy, Edward, Viiklepp, Piret, Vargas, Mario H, Sotgiu, Giovanni, Menzies, Dick, Benedetti, Andrea
Format: Journal Article
Sprache:Englisch
Veröffentlicht: England 01.04.2022
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ISSN:1477-0334, 1477-0334
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Abstract Effect modification occurs while the effect of the treatment is not homogeneous across the different strata of patient characteristics. When the effect of treatment may vary from individual to individual, precision medicine can be improved by identifying patient covariates to estimate the size and direction of the effect at the individual level. However, this task is statistically challenging and typically requires large amounts of data. Investigators may be interested in using the individual patient data from multiple studies to estimate these treatment effect models. Our data arise from a systematic review of observational studies contrasting different treatments for multidrug-resistant tuberculosis, where multiple antimicrobial agents are taken concurrently to cure the infection. We propose a marginal structural model for effect modification by different patient characteristics and co-medications in a meta-analysis of observational individual patient data. We develop, evaluate, and apply a targeted maximum likelihood estimator for the doubly robust estimation of the parameters of the proposed marginal structural model in this context. In particular, we allow for differential availability of treatments across studies, measured confounding within and across studies, and random effects by study.
AbstractList Effect modification occurs while the effect of the treatment is not homogeneous across the different strata of patient characteristics. When the effect of treatment may vary from individual to individual, precision medicine can be improved by identifying patient covariates to estimate the size and direction of the effect at the individual level. However, this task is statistically challenging and typically requires large amounts of data. Investigators may be interested in using the individual patient data from multiple studies to estimate these treatment effect models. Our data arise from a systematic review of observational studies contrasting different treatments for multidrug-resistant tuberculosis, where multiple antimicrobial agents are taken concurrently to cure the infection. We propose a marginal structural model for effect modification by different patient characteristics and co-medications in a meta-analysis of observational individual patient data. We develop, evaluate, and apply a targeted maximum likelihood estimator for the doubly robust estimation of the parameters of the proposed marginal structural model in this context. In particular, we allow for differential availability of treatments across studies, measured confounding within and across studies, and random effects by study.
Effect modification occurs while the effect of the treatment is not homogeneous across the different strata of patient characteristics. When the effect of treatment may vary from individual to individual, precision medicine can be improved by identifying patient covariates to estimate the size and direction of the effect at the individual level. However, this task is statistically challenging and typically requires large amounts of data. Investigators may be interested in using the individual patient data from multiple studies to estimate these treatment effect models. Our data arise from a systematic review of observational studies contrasting different treatments for multidrug-resistant tuberculosis, where multiple antimicrobial agents are taken concurrently to cure the infection. We propose a marginal structural model for effect modification by different patient characteristics and co-medications in a meta-analysis of observational individual patient data. We develop, evaluate, and apply a targeted maximum likelihood estimator for the doubly robust estimation of the parameters of the proposed marginal structural model in this context. In particular, we allow for differential availability of treatments across studies, measured confounding within and across studies, and random effects by study.Effect modification occurs while the effect of the treatment is not homogeneous across the different strata of patient characteristics. When the effect of treatment may vary from individual to individual, precision medicine can be improved by identifying patient covariates to estimate the size and direction of the effect at the individual level. However, this task is statistically challenging and typically requires large amounts of data. Investigators may be interested in using the individual patient data from multiple studies to estimate these treatment effect models. Our data arise from a systematic review of observational studies contrasting different treatments for multidrug-resistant tuberculosis, where multiple antimicrobial agents are taken concurrently to cure the infection. We propose a marginal structural model for effect modification by different patient characteristics and co-medications in a meta-analysis of observational individual patient data. We develop, evaluate, and apply a targeted maximum likelihood estimator for the doubly robust estimation of the parameters of the proposed marginal structural model in this context. In particular, we allow for differential availability of treatments across studies, measured confounding within and across studies, and random effects by study.
Author Liu, Yan
Wang, Guanbo
Kennedy, Edward
Menzies, Dick
Benedetti, Andrea
Vargas, Mario H
Viiklepp, Piret
Schnitzer, Mireille E
Sotgiu, Giovanni
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  orcidid: 0000-0001-8835-0467
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  organization: Department of Epidemiology, Biostatistics and Occupational Health, 5620McGill University, Canada
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  givenname: Mireille E
  orcidid: 0000-0001-8049-9646
  surname: Schnitzer
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  givenname: Guanbo
  surname: Wang
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  organization: Department of Epidemiology, Biostatistics and Occupational Health, 5620McGill University, Canada
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  surname: Kennedy
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  organization: Department of Statistics & Data Science, 6612Carnegie Mellon University, USA
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  organization: 42635Instituto Nacional de Enfermedades Respiratorias, Mexico
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  givenname: Dick
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  organization: Montréal Chest Institute & McGill International TB Centre, Research Institute of the McGill University Health Centre, Montréal, Canada
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  givenname: Andrea
  orcidid: 0000-0002-8314-9497
  surname: Benedetti
  fullname: Benedetti, Andrea
  organization: Department of Medicine, McGill University, Canada
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Keywords Conditional average treatment effect
individual patient data
targeted maximum likelihood estimation
meta-analysis
multidrug-resistant tuberculosis
double robustness
marginal structural model
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Snippet Effect modification occurs while the effect of the treatment is not homogeneous across the different strata of patient characteristics. When the effect of...
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SubjectTerms Biometry
Humans
Observational Studies as Topic
Tuberculosis, Multidrug-Resistant - drug therapy
Title Modeling treatment effect modification in multidrug-resistant tuberculosis in an individual patientdata meta-analysis
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