Dr.PainCLE said:The gap between trial results and real-world results is consistent and it is not fraud.
I read this differently from Dr.PainCLE, on substance rather than tone. I would add the less popular caveat: these trial populations under-represented several groups, older adults and the highest BMI categories among them. The results probably generalise, and "probably" should be stated as an assumption rather than dropped.
I would rather be corrected than agreed with, if it comes to it.
JessicaH_TX said:I keep finding that the number in the press summary and the number in the paper are not the same number, and the difference is always in the same…
JessicaH_TX said:...regarding the trial evidence...
I think this is an underappreciated point. To expand on it with some data:
A recent meta-analysis of 15 RCTs (n=12,300) found that the trial evidence was associated with a clinically meaningful effect size across diverse patient populations[1].
The NNT was 12, which is comparable to statins for secondary prevention. That's a strong clinical argument for this approach.
HPLC_Greg said:I would add the less popular caveat: these trial populations under-represented several groups, older adults and the highest BMI categories among them.
Forest plot interpretation for the the trial evidence meta-analysis: when reading the pooled estimate, pay attention to:
- Point estimate (HR/RR/OR) — center of the diamond
- Confidence interval width — precision of the estimate
- I² statistic — heterogeneity across studies
- Individual study weights — are results driven by one large trial?
- Prediction interval — range of plausible true effects in future settings
The the trial evidence meta-analysis shows a pooled RR of 0.78 (95% CI 0.69-0.88), I²=36%. This is a robust and consistent effect.
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View ResultsFollowing on from paul_denver — and this may be the naive question:
How would you tell the difference between that and the alternative explanation?
Closing the loop on my own question.
Update — my curve sits below the published mean and the explanation is that the trial arm had support I do not have. That was reassuring rather than otherwise.