Using observational data to emulate a randomized trial of dynamic treatment-switching strategies: an application to antiretroviral therapy.

ABSTRACT:

Background

When a clinical treatment fails or shows suboptimal results, the question of when to switch to another treatment arises. Treatment switching strategies are often dynamic because the time of switching depends on the evolution of an individual's time-varying covariates. Dynamic strategies can be directly compared in randomized trials. For example, HIV-infected individuals receiving antiretroviral therapy could be randomized to switching therapy within 90 days of HIV-1 RNA crossing above a threshold of either 400 copies/ml (tight-control strategy) or 1000 copies/ml (loose-control strategy).

Methods

We review an approach to emulate a randomized trial of dynamic switching strategies using observational data from the Antiretroviral Therapy Cohort Collaboration, the Cent

SUBMITTER: Cain LE 

PROVIDER: S-EPMC5841611 | biostudies-literature | 2016 Dec

REPOSITORIES: biostudies-literature