Wilson Brooke E, Booth Christopher M
Department of Oncology, Queen's University, Kingston, Ontario, Canada.
Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Canada.
EClinicalMedicine. 2024 Nov 11;78:102915. doi: 10.1016/j.eclinm.2024.102915. eCollection 2024 Dec.
Real-world data (RWD) are rapidly emerging sources of information for patients, clinicians and regulators. While randomized controlled trials (RCTs) reduce bias and confounding through the randomization process and provide the highest quality of evidence regarding drug efficacy, RCTs may be impractical or unfeasible for rare diseases or disease subsets. And yet, studies attempting to replicate clinical trial results using observational datasets have failed. Given the inherent differences between observational data and clinical trial results, this discordance is not surprising. However, RWD may still have independent value as complementary tools to trial results. In this viewpoint, we explore the challenges of RWD and discuss key questions that clinicians, patients, and regulators will need to consider when faced with positive efficacy data from clinical trials, and negative effectiveness data from real world studies. Finally, we explore novel trial designs that might help bridge the gap from RCTs to RWD.
真实世界数据(RWD)正迅速成为患者、临床医生和监管机构的信息来源。虽然随机对照试验(RCT)通过随机化过程减少偏差和混杂因素,并提供有关药物疗效的最高质量证据,但RCT对于罕见疾病或疾病亚组可能不切实际或不可行。然而,试图使用观察性数据集复制临床试验结果的研究却失败了。鉴于观察性数据与临床试验结果之间存在固有差异,这种不一致并不令人惊讶。然而,真实世界数据作为试验结果的补充工具可能仍具有独立价值。在这一观点中,我们探讨了真实世界数据面临的挑战,并讨论了临床医生、患者和监管机构在面对来自临床试验的阳性疗效数据和来自真实世界研究的阴性有效性数据时需要考虑的关键问题。最后,我们探索了可能有助于弥合从随机对照试验到真实世界数据差距的新型试验设计。