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c/trialwatch·posted 1 year ago by u/nils_tulloch

hazard ratio is the most under-discussed thing on this board

Trial Data Cold Box ×4 Sourced ×2 Receipts ×2

hazard ratio is the most under-discussed thing on this board — a position I have arrived at slowly and would like tested.

Relative risk reduction without the baseline rate is uninterpretable. A large relative reduction on a small absolute risk is a small absolute benefit.

Spent an evening with the appendix tables and found the subgroup detail that the entire thread had been speculating about.

Discontinuation rates are a tolerability result. A trial with a strong efficacy number and heavy discontinuation is telling you two things and people only quote one.

Ask me anything specific. Anything general I will probably get wrong.

7,219 up / 835 down90% upvoted60 commentsid 10bs6s29 Sep 2024

60 comments

30 in this archive, depth 5

best — the order this archive was captured in

u/injection_site_iris914 points·1 year ago

Cardiovascular outcome trials are powered for events, not for weight, and are typically run in a different population with different inclusion criteria. Reading a weight number out of one is reading a secondary endpoint.

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[deleted]331 points·1 year ago

[deleted]

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u/whois_wanda96 points·1 year ago

Right — trial participants get structured support. Comparing yourself to a trial mean is comparing across two different interventions.

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u/rohan_cardoso-18 points·1 year ago

Argued for a week about a result and then read the limitations section, which conceded most of my opponent’s point.

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u/nightowl_injector561 points·1 year ago·edited

Not convinced. Cross-trial comparison between two programmes with different populations and designs is not a comparison.

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u/ines_castellanos422 points·1 year ago

open-label extensions are not the same evidence as the randomised phase

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u/plateau_patrol363 points·1 year ago

SELECT was cardiovascular outcomes, not weight

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u/paper_trail_paulavetting220 points·1 year ago

SELECT was cardiovascular outcomes, not weight

plateau_patrol is right about the programme names. They are different populations with different endpoints.

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u/forest_plot_fionaMOD134 points·1 year ago

Press-release posts get their own flair here. Nothing wrong with them, they are just a different kind of claim.

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u/hamza_weiss525 points·1 year ago

a press release is not a publication

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u/hamza_zielinski250 points·1 year ago

a press release is not a publication

This is the distinction that would end about half the arguments on this board.

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u/whois_wanda232 points·1 year ago

A confidence interval is the range of effects compatible with the data. Two trials with overlapping intervals have not disagreed, whatever their point estimates look like next to each other.

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u/nils_tullochOP98 points·1 year ago

Do you have the publication or the press release?

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u/alcohol_aversion50 points·1 year ago

Same. A press release is a claim about a result; the publication is the result.

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u/yannick_salinas36 points·1 year ago

Read a press release and the publication three months apart. The hedging in the second one was substantial.

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u/heart_rate_bump0 points·1 year ago

Same.

Adding the check nobody runs — the registered protocol is public and takes two minutes to compare.

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u/sofia_wikstrom110 points·1 year ago·edited

A confidence interval is the range of effects compatible with the data.

Agreed. And the interval, not the point estimate, is what the trial actually established.

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u/first_hundred58 points·1 year ago·edited

That is the 68-week readout, not the 72-week one. Different trial, different duration.

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u/curious_panel_only55 points·1 year ago

Compared myself to a trial mean for about six months before realising the trial arm had dietitian contact every fortnight.

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u/careful_gradient_again17 points·1 year ago

the appendix is where the interesting tables live

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u/milan_mensah20 points·1 year ago

the confidence interval is the finding, the point estimate is the headline

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u/sanne_laurent36 points·1 year ago

Correction: SURMOUNT is the obesity programme and SURPASS is the diabetes one. The figure you quoted belongs to the other one.

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u/hamza_zielinski169 points·1 year ago

This. Intention-to-treat versus completer analysis routinely moves the headline by several points.

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u/valeria_karlsen56 points·1 year ago

SURPASS is the diabetes programme and reports glycaemic endpoints

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u/camila_vasquez198 points·1 year ago

Intention-to-treat analyses everybody randomised regardless of what they did afterwards. Completer analyses only those who finished. The second is systematically more flattering and both are legitimate if labelled.

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u/joaquin_stanescu53 points·1 year ago

a mean is not a promise

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u/joaquin_trevino42 points·1 year ago

Disagree — that figure is from the diabetes programme and you are quoting it as an obesity endpoint.

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u/iman_castellanos83 points·1 year ago

phase 2 finds a dose, phase 3 measures the effect

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u/bastian_ekstrom65 points·1 year ago

Quoted a figure here confidently, got asked whether it was ITT, went and checked, and it was not. Learned something.

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u/ms_fragmenter44 points·1 year ago

Open-label extensions lose their randomisation. Anybody still enrolled at week 104 is a selected group and the numbers describe that group.

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