TY - JOUR
T1 - Comparing inverse probability of treatment weighting and instrumental variable methods for the evaluation of adenosine diphosphate receptor inhibitors after percutaneous coronary intervention
AU - Treatment With Adenosine Diphosphate Receptor Inhibitors–Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) Investigators
AU - Federspiel, Jerome J.
AU - Anstrom, Kevin J.
AU - Xian, Ying
AU - McCoy, Lisa A.
AU - Effron, Mark B.
AU - Faries, Douglas E.
AU - Zettler, Marjorie
AU - Mauri, Laura
AU - Yeh, Robert W.
AU - Peterson, Eric D.
AU - Wang, Tracy Y.
N1 - Funding Information:
All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Anstrom reported receiving research support from AstraZeneca, Bristol-Myers Squibb, Lilly USA, LLC, Boehringer Ingelheim, the Pulmonary Fibrosis Foundation, and Medtronic; reported serving as a consultant for Abbott Vascular, AstraZeneca, Bristol-Myers Squibb, Gilead, Pfizer, and GlaxoSmithKline; reported serving on data monitoring committees for the National Institutes of Health, Forest, Pfizer, and GlaxoSmithKline; and reported having an equity interest in Biscardia. Dr Effron reported full-time employment and shareholding with Lilly USA, LLC. Dr Faries reported full-time employment and minor shareholding with Lilly USA, LLC. Dr Zettler reported shareholding with Lilly USA, LLC. Dr Peterson reported receiving institutional grant support from the American College of Cardiology, American Heart Association, Lilly USA, LLC, and Janssen and reported receiving consulting fees (including continuing medical education) from Merck & Co, Boehringer Ingelheim, Genentech, Janssen, and Sanofi. Dr Wang reported receiving research grant support from Lilly USA, LLC, Daiichi Sankyo Inc, AstraZeneca, Bristol-Myers Squibb, Boston Scientific, Gilead, GlaxoSmithKline, and Regeneron and reported providing consulting services for Lilly USA, LLC, AstraZeneca, and Premier. No other disclosures were reported. The Treatment With Adenosine Diphosphate Receptor Inhibitors–Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) study was funded by Daiichi Sankyo Inc and Lilly USA, LLC.
Funding Information:
Funding/Support: The Treatment With Adenosine Diphosphate Receptor Inhibitors–Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) study was funded by Daiichi Sankyo Inc and Lilly USA, LLC.
Funding Information:
completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Anstrom reported receiving research support from AstraZeneca, Bristol-Myers Squibb, Lilly USA, LLC, Boehringer Ingelheim, the Pulmonary Fibrosis Foundation, and Medtronic; reported serving as a consultant for Abbott Vascular, AstraZeneca, Bristol-Myers Squibb, Gilead, Pfizer, and GlaxoSmithKline; reported serving on data monitoring committees for the National Institutes of Health, Forest, Pfizer, and GlaxoSmithKline; and reported having an equity interest in Biscardia. Dr Effron reported full-time employment and shareholding with Lilly USA, LLC. Dr Faries reported full-time employment and minor shareholding with Lilly USA, LLC. Dr Zettler reported shareholding with Lilly USA, LLC. Dr Peterson reported receiving institutional grant support from the American College of Cardiology, American Heart Association, Lilly USA, LLC, and Janssen and reported receiving consulting fees (including continuing medical education) from Merck & Co, Boehringer Ingelheim, Genentech, Janssen, and Sanofi. Dr Wang reported receiving research grant support from Lilly USA, LLC, Daiichi Sankyo Inc, AstraZeneca, Bristol-Myers Squibb, Boston Scientific, Gilead, GlaxoSmithKline, and Regeneron and reported providing consulting services for Lilly USA, LLC, AstraZeneca, and Premier. No other disclosures were reported.
Publisher Copyright:
Copyright 2016 American Medical Association. All rights reserved.
PY - 2016/9
Y1 - 2016/9
N2 - IMPORTANCE: There is increasing interest in performing comparative effectiveness analyses in large observational databases, yet these analyses must adjust for treatment selection issues. OBJECTIVES: To conduct comparative safety and efficacy analyses of prasugrel vs clopidogrel bisulfate after percutaneous coronary intervention and to evaluate inverse probability of treatment weighting (a propensity score method) and instrumental variable methods. DESIGN, SETTING, AND PARTICIPANTS: This study used data from the Treatment With Adenosine Diphosphate Receptor Inhibitors–Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) study. Included in the study were patients undergoing percutaneous coronary intervention for myocardial infarction, 26.0% of whom received prasugrel. The study dates were April 4, 2010, to October 31, 2012. EXPOSURES: Choice of initial antiplatelet agent (prasugrel or clopidogrel). MAIN OUTCOMES AND MEASURES: Safety and efficacy outcomes included 1-year composite major adverse cardiovascular events, moderate to severe bleeding, and stent thrombosis. Hospitalizations for pneumonia, bone fractures, and planned percutaneous coronary intervention were used as the falsification end points. RESULTS: The study cohort comprised 11 784 participants (mean [SD] age, 60.0 [11.6] years, and 28.0% were female). Using inverse probability of treatment weighting adjustment, prasugrel and clopidogrel had similar major adverse cardiovascular events (hazard ratio [HR], 0.98; 95% CI, 0.83-1.16) and bleeding outcomes (1.18; 0.77-1.80), but prasugrel had a lower rate of stent thrombosis (0.51; 0.31-0.85). Using instrumental variable methods, prasugrel use was associated with a lower rate of the major adverse cardiovascular event end point (HR, 0.68; 95% CI, 0.47-1.00) but nonsignificant differences in the rates of bleeding (0.95; 0.41-2.08) and stent thrombosis (0.67; 0.16-2.00). There was no significant treatment difference noted in any of the falsification end-point rates when analyses were performed using inverse probability of treatment weighting, although the bone fracture end point approached statistical significance. Nevertheless, a lower rate of pneumonia-related hospitalizations was noted in the prasugrel-treated patients when analyses were performed using instrumental variable methods. CONCLUSIONS AND RELEVANCE: Conclusions regarding the safety and efficacy of antiplatelet therapy varied depending on analytic technique, and none were concordant with the results from randomized trials. In addition, both statistical strategies demonstrated concerning associations when tested in the falsification analyses. A high level of scrutiny and careful attention to assumptions and validity are required when interpreting complex analyses of observational data.
AB - IMPORTANCE: There is increasing interest in performing comparative effectiveness analyses in large observational databases, yet these analyses must adjust for treatment selection issues. OBJECTIVES: To conduct comparative safety and efficacy analyses of prasugrel vs clopidogrel bisulfate after percutaneous coronary intervention and to evaluate inverse probability of treatment weighting (a propensity score method) and instrumental variable methods. DESIGN, SETTING, AND PARTICIPANTS: This study used data from the Treatment With Adenosine Diphosphate Receptor Inhibitors–Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE-ACS) study. Included in the study were patients undergoing percutaneous coronary intervention for myocardial infarction, 26.0% of whom received prasugrel. The study dates were April 4, 2010, to October 31, 2012. EXPOSURES: Choice of initial antiplatelet agent (prasugrel or clopidogrel). MAIN OUTCOMES AND MEASURES: Safety and efficacy outcomes included 1-year composite major adverse cardiovascular events, moderate to severe bleeding, and stent thrombosis. Hospitalizations for pneumonia, bone fractures, and planned percutaneous coronary intervention were used as the falsification end points. RESULTS: The study cohort comprised 11 784 participants (mean [SD] age, 60.0 [11.6] years, and 28.0% were female). Using inverse probability of treatment weighting adjustment, prasugrel and clopidogrel had similar major adverse cardiovascular events (hazard ratio [HR], 0.98; 95% CI, 0.83-1.16) and bleeding outcomes (1.18; 0.77-1.80), but prasugrel had a lower rate of stent thrombosis (0.51; 0.31-0.85). Using instrumental variable methods, prasugrel use was associated with a lower rate of the major adverse cardiovascular event end point (HR, 0.68; 95% CI, 0.47-1.00) but nonsignificant differences in the rates of bleeding (0.95; 0.41-2.08) and stent thrombosis (0.67; 0.16-2.00). There was no significant treatment difference noted in any of the falsification end-point rates when analyses were performed using inverse probability of treatment weighting, although the bone fracture end point approached statistical significance. Nevertheless, a lower rate of pneumonia-related hospitalizations was noted in the prasugrel-treated patients when analyses were performed using instrumental variable methods. CONCLUSIONS AND RELEVANCE: Conclusions regarding the safety and efficacy of antiplatelet therapy varied depending on analytic technique, and none were concordant with the results from randomized trials. In addition, both statistical strategies demonstrated concerning associations when tested in the falsification analyses. A high level of scrutiny and careful attention to assumptions and validity are required when interpreting complex analyses of observational data.
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U2 - 10.1001/jamacardio.2016.1783
DO - 10.1001/jamacardio.2016.1783
M3 - Article
C2 - 27438179
AN - SCOPUS:85018984238
SN - 2380-6583
VL - 1
SP - 655
EP - 665
JO - JAMA Cardiology
JF - JAMA Cardiology
IS - 6
ER -