TrialTracker_MD said:The gap between trial results and real-world results is consistent and it is not fraud.
TrialTracker_MD said:...regarding the trial evidence...
I think this is an underappreciated point. To expand on it with some data:
A recent meta-analysis of 12 RCTs (n=8,400) found that the trial evidence was associated with a significant effect size across diverse patient populations[1].
The NNT was 8, which is comparable to statins for secondary prevention. That's a strong clinical argument for this approach.
A narrower follow-up, since the general answer is now clear:
What would you measure differently if you were starting again?
labquiet_amy said:TrialTracker_MD said: ...regarding the trial evidence...
Propensity score matching studies and the trial evidence: when RCTs aren't available for a specific question, propensity score-matched observational studies can provide useful evidence.
A recent PSM study of 12,000 GLP-1 users vs matched controls showed reduced heart failure hospitalization (HR 0.74) over 3 years of follow-up[1].
These results complement the RCT data and suggest the benefits translate to real-world populations.
[1] Registry-based cohort study, pre-print 2024.
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View ResultsOP back with an update, since a thread like this is useless without one.
Follow-up: I read the paper rather than the summary and the qualifier I was missing was in the second paragraph of the results.
Dr.LeslieOBGYN said:Propensity score matching studies and the trial evidence: when RCTs aren't available for a specific question, propensity score-matched observational…
Forest plot interpretation for the the trial evidence meta-analysis: when reading the pooled estimate, pay attention to:
- Point estimate (HR/RR/OR) — center of the diamond
- Confidence interval width — precision of the estimate
- I² statistic — heterogeneity across studies
- Individual study weights — are results driven by one large trial?
- Prediction interval — range of plausible true effects in future settings
The the trial evidence meta-analysis shows a pooled RR of 0.75 (95% CI 0.69-0.90), I²=48%. This is a robust and consistent effect.