| アブストラクト | Evidence on the comparative effectiveness of osteoporosis treatments is heterogeneous. This may be attributed to different populations and clinical practice, but also to differing methodologies ensuring comparability of treatment groups before treatment effect estimation and the amount of residual confounding by indication. This study assessed the comparability of denosumab vs oral bisphosphonate (OBP) groups using propensity score (PS) methods and negative control outcome (NCO) analysis. A total of 280 288 women aged >/=50 yr initiating denosumab or OBP in 2011-2018 were included from the UK Clinical Practice Research Datalink (CPRD) and the Danish National Registries (DNR). Balance of observed covariates was assessed using absolute standardized mean difference (ASMD) before and after PS weighting, matching, and stratification, with ASMD >0.1 indicating imbalance. Residual confounding was assessed using NCOs with >/=100 events. Hazard ratio (HR) and 95%CI between treatment and NCO were estimated using Cox models. Presence of residual confounding was evaluated with 2 approaches (1) >5% of NCOs with 95% CI excluding 1, (2) >5% of NCOs with an upper CI <0.75 or lower CI >1.3. The number of imbalanced covariates before adjustment (CPRD 22/87; DNR 18/83) decreased, with 2%-11% imbalance remaining after weighting, matching, or stratification. Using approach 1, residual confounding was present for all PS methods in both databases (>/=8% of NCOs), except for stratification in DNR (3.8%). Using approach 2, residual confounding was present in CPRD with PS matching (5.3%) and stratification (6.4%), but not with weighting (4.3%). Within DNR, no NCOs had HR estimates with upper or lower CI limits beyond the specified bounds indicating residual confounding for any PS method. Achievement of covariate balance and determination of residual bias were dependent upon several factors including the population under study, PS method, prevalence of NCO, and the threshold indicating residual confounding. |
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| ジャーナル名 | Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research |
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| Pubmed追加日 | 2024/4/15 |
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| 投稿者 | Tan, Eng Hooi; Rathod-Mistry, Trishna; Strauss, Victoria Y; O'Kelly, James; Giorgianni, Francesco; Baxter, Richard; Brunetti, Vanessa C; Pedersen, Alma Becic; Ehrenstein, Vera; Prieto-Alhambra, Daniel |
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| 組織名 | Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences,;Centre for Statistics in Medicine, University of Oxford, Oxford OX3 7LD, United;Kingdom.;Center for Observantional Research, Amgen Ltd, Uxbridge UB8 1DH, United Kingdom.;Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus;University, Aarhus 8200, Denmark.;Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam;3015 GD, The Netherlands. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/38619297/ |
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