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阿尔茨海默病研究与照护中的临床意义上的益处及真实世界证据。

Clinically meaningful benefit and real-world evidence in Alzheimer's disease research and care.

作者信息

Perneczky Robert, Froelich Lutz

机构信息

Department of Psychiatry and Psychotherapy University Hospital, LMU Munich Munich Germany.

German Center for Neurodegenerative Diseases (DZNE) Munich Munich Germany.

出版信息

Alzheimers Dement (N Y). 2025 Apr 24;11(2):e70090. doi: 10.1002/trc2.70090. eCollection 2025 Apr-Jun.

DOI:10.1002/trc2.70090
PMID:40291121
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12022225/
Abstract

In the realm of medical research, assessing novel therapies extends beyond statistical significance. The concept of meaningful benefits plays a pivotal role in determining the practical impact of interventions on patient outcomes. Clinical trials, which form the bedrock of evidence-based medicine, guide treatment decisions and shape health-care practices. While statistical significance remains a fundamental criterion, it falls short in fully evaluating the clinical relevance of therapeutic interventions. Clinically meaningful benefits focus on tangible improvements in patient health and well-being, transcending mere statistical thresholds. Key considerations include survival rates, symptom relief, functional status, and other patient-oriented outcomes. Determining meaningful benefits varies across diseases, patient populations, and available treatments. Balancing statistical rigor with clinical relevance is crucial. Overpowered trials may detect smaller differences than anticipated, necessitating careful interpretation. Researchers must view trial results through a patient-centric lens. Beyond survival, evaluating quality of life and side effects is equally relevant. Quantifying meaningful benefits involves metrics like numbers needed to treat and progression-free survival. Consistency across outcomes matters, as clinicians weigh gains in survival against improvements in quality of life. The pursuit of meaningful benefits elevates clinical trials from mere statistical exercises to patient-centered endeavors. Researchers, clinicians, and regulators must prioritize outcomes that genuinely matter to patients, ensuring that medical progress translates into meaningful improvements for them and their families.

摘要

在医学研究领域,评估新疗法不仅仅局限于统计学意义。有意义的获益这一概念在确定干预措施对患者预后的实际影响方面起着关键作用。临床试验作为循证医学的基石,指导治疗决策并塑造医疗实践。虽然统计学意义仍然是一个基本标准,但它在全面评估治疗干预的临床相关性方面存在不足。具有临床意义的获益关注患者健康和福祉的切实改善,超越了单纯的统计阈值。关键考虑因素包括生存率、症状缓解、功能状态以及其他以患者为导向的预后指标。确定有意义的获益因疾病、患者群体和可用治疗方法而异。在统计严谨性与临床相关性之间取得平衡至关重要。效力过强的试验可能检测到比预期更小的差异,这就需要谨慎解读。研究人员必须从以患者为中心的角度看待试验结果。除了生存率,评估生活质量和副作用同样重要。量化有意义的获益涉及诸如治疗所需人数和无进展生存期等指标。各预后指标之间的一致性很重要,因为临床医生会权衡生存率的提高与生活质量的改善。对有意义的获益的追求将临床试验从单纯的统计活动提升为以患者为中心的努力。研究人员、临床医生和监管机构必须优先考虑对患者真正重要的预后指标,确保医学进步转化为对他们及其家人有意义的改善。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dc6b/12022225/33d1a2cc58b5/TRC2-11-e70090-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dc6b/12022225/33d1a2cc58b5/TRC2-11-e70090-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/dc6b/12022225/33d1a2cc58b5/TRC2-11-e70090-g001.jpg

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本文引用的文献

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Real-world datasets for the International Registry for Alzheimer's Disease and Other Dementias (InRAD) and other registries: An international consensus.国际阿尔茨海默病及其他痴呆症登记处(InRAD)及其他登记处的真实世界数据集:一项国际共识。
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基于人群策略的阿尔茨海默病预防与治疗。
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Lecanemab Clarity AD: Quality-of-Life Results from a Randomized, Double-Blind Phase 3 Trial in Early Alzheimer's Disease.Lecanemab Clarity AD:早期阿尔茨海默病的一项随机、双盲 3 期临床试验的生活质量结果。
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The Meaning and Purpose Scales (MAPS): development and multi-study validation of short measures of meaningfulness, crisis of meaning, and sources of purpose.意义与目的量表(MAPS):有意义、意义危机和目的来源的简短测量工具的开发及多研究验证。
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Donanemab in Early Symptomatic Alzheimer Disease: The TRAILBLAZER-ALZ 2 Randomized Clinical Trial.多奈哌齐治疗早期症状性阿尔茨海默病的随机临床试验。
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