Skip to content

Advertisement

  • Oral presentation
  • Open Access

Risk stratification in clinical trials: a subgroup to be encouraged

  • 1 and
  • 1
Trials201314 (Suppl 1) :O104

https://doi.org/10.1186/1745-6215-14-S1-O104

  • Published:

Keywords

  • Relative Risk
  • Acute Coronary Syndrome
  • Risk Stratification
  • Effect Estimate
  • Major Bleeding

The analysis of randomised controlled trials by subgroups of individuals (e.g. according to age or gender) remains controversial and often misinterpreted. It is recognised that such analyses should be limited to a few pre-specified key baseline factors. In addition an appropriate analysis typically calculates effect estimates and confidence intervals within such subgroups together with an overall interaction test rather than calculating separate p-values within each category of the subgroup.

However, patients vary considerably often presenting with multiple risk factors for the outcome of interest. Hence an alternative approach to analysing subgroups is proposed whereby patients are analysed according to their underlying risk rather than individual characteristics and a single interaction test performed between underlying risk and treatment. Patients can be categorised into several ordered risk groups and the absolute and relative risk reduction in each group presented. This helps the decision making process for an individual patient when considering appropriate treatment strategies. For instance, even if a beneficial relative risk is steady across groups, the absolute benefits in the low-risk group may be too small to justify the new treatment’s use.

These issues will be illustrated using data from trials in acute coronary syndrome. The FIR collaboration combined data from three trials (FRISC-II, RITA-3 and ICTUS) interventional and conservative strategies. The ACUITY trial assessed the impact of three anti-thrombotic therapies for reducing clinical outcomes and major bleeding.

We recommend that risk stratified subgroup analyses be routinely reported in trials that claim a treatment benefit.

Authors’ Affiliations

(1)
London School of Hygiene & Tropical Medicine, London, UK

Copyright

© Clayton and Pocock; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Comments

By submitting a comment you agree to abide by our Terms and Community Guidelines. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. Please note that comments may be removed without notice if they are flagged by another user or do not comply with our community guidelines.

Advertisement