1. A Bayesian Analysis of a Randomized Clinical Trial Comparing Antimetabolite Therapies for Non-Infectious Uveitis
- Author
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Browne, Erica N, Rathinam, Sivakumar R, Kanakath, Anuradha, Thundikandy, Radhika, Babu, Manohar, Lietman, Thomas M, and Acharya, Nisha R
- Subjects
Biomedical and Clinical Sciences ,Ophthalmology and Optometry ,Clinical Trials and Supportive Activities ,Clinical Research ,Good Health and Well Being ,Adolescent ,Adult ,Anti-Inflammatory Agents ,Antimetabolites ,Bayes Theorem ,Female ,Humans ,Immunosuppressive Agents ,Male ,Methotrexate ,Mycophenolic Acid ,Uveitis ,Young Adult ,Antimetabolite ,Bayesian ,clinical trial ,non-infectious uveitis ,statistics ,Clinical Sciences ,Opthalmology and Optometry ,Public Health and Health Services ,Epidemiology ,Ophthalmology and optometry ,Public health - Abstract
PurposeTo conduct a Bayesian analysis of a randomized clinical trial (RCT) for non-infectious uveitis using expert opinion as a subjective prior belief.MethodsA RCT was conducted to determine which antimetabolite, methotrexate or mycophenolate mofetil, is more effective as an initial corticosteroid-sparing agent for the treatment of intermediate, posterior, and pan-uveitis. Before the release of trial results, expert opinion on the relative effectiveness of these two medications was collected via online survey. Members of the American Uveitis Society executive committee were invited to provide an estimate for the relative decrease in efficacy with a 95% credible interval (CrI). A prior probability distribution was created from experts' estimates. A Bayesian analysis was performed using the constructed expert prior probability distribution and the trial's primary outcome.ResultsA total of 11 of the 12 invited uveitis specialists provided estimates. Eight of 11 experts (73%) believed mycophenolate mofetil is more effective. The group prior belief was that the odds of treatment success for patients taking mycophenolate mofetil were 1.4-fold the odds of those taking methotrexate (95% CrI 0.03-45.0). The odds of treatment success with mycophenolate mofetil compared to methotrexate was 0.4 from the RCT (95% confidence interval 0.1-1.2) and 0.7 (95% CrI 0.2-1.7) from the Bayesian analysis.ConclusionsA Bayesian analysis combining expert belief with the trial's result did not indicate preference for one drug. However, the wide credible interval leaves open the possibility of a substantial treatment effect. This suggests clinical equipoise necessary to allow a larger, more definitive RCT.
- Published
- 2017