期刊
AMERICAN JOURNAL OF EPIDEMIOLOGY
卷 189, 期 5, 页码 461-469出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kwz272
关键词
accelerated failure time models; balancing weights; causal inference; censored data; dynamic treatment regimens; dynamic weighted survival modeling; individualized treatment rules; precision medicine
资金
- Fonds de Recherche du Quebec-Nature et Technologies
- Natural Sciences and Engineering Research Council of Canada
- Chercheur Boursier senior career award from the Fonds de Recherche du Quebec-Sante
Sequences of treatments that adapt to a patient's changing condition over time are often needed for the management of chronic diseases. An adaptive treatment strategy (ATS) consists of personalized treatment rules to be applied through the course of a disease that input the patient's characteristics at the time of decision-making and output a recommended treatment. An optimal ATS is the sequence of tailored treatments that yields the best clinical outcome for patients sharing similar characteristics. Methods for estimating optimal adaptive treatment strategies, which must disentangle short- and long-term treatment effects, can be theoretically involved and hard to explain to clinicians, especially when the outcome to be optimized is a survival time subject to right-censoring. In this paper, we describe dynamic weighted survival modeling, a method for estimating an optimal ATS with survival outcomes. Using data from the Clinical Practice Research Datalink, a large primary-care database, we illustrate how it can answer an important clinical question about the treatment of type 2 diabetes. We identify an ATS pertaining to which drug add-ons to recommend when metformin in monotherapy does not achieve the therapeutic goals.
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