Prioritised endpoints for device-based hypertension trials: the win ratio methodology.
EuroIntervention
; 16(18): e1496-e1502, 2021 Apr 02.
Article
in En
| MEDLINE
| ID: mdl-33226002
ABSTRACT
AIMS:
Multiple endpoints with varying clinical relevance are available to establish the efficacy of device-based treatments. Given the variance among blood pressure measures and medication changes in hypertension trials, we performed a win ratio analysis of outcomes in a sham-controlled, randomised trial of renal denervation (RDN) in patients with uncontrolled hypertension despite commonly prescribed antihypertensive medications. We propose a novel prioritised endpoint framework for determining the treatment benefit of RDN compared with sham control. METHODS ANDRESULTS:
We analysed the SPYRAL HTN-ON MED pilot study data using a prioritised hierarchical endpoint comprised of 24-hour mean ambulatory systolic blood pressure (SBP), office SBP, and medication burden. A generalised pairwise comparisons methodology (win ratio) was extended to examine this endpoint. Clinically relevant thresholds of 5 and 10 mmHg were used for comparisons of ambulatory and office SBP, respectively, and therefore to define treatment "winners" and "losers". For a total number of 1,596 unmatched pairs, the RDN subject was the winner in 1,050 pairs, the RDN subject was the loser in 378 pairs, and 168 pairs were tied. The win ratio in favour of RDN was 2.78 (95% confidence interval [CI] 1.58 to 5.48; p<0.001) and corresponding net benefit statistic was 0.42 (95% CI 0.20 to 0.63). Sensitivity analyses performed with differing blood pressure thresholds and according to drug adherence testing demonstrated consistent results.CONCLUSIONS:
The win ratio method addresses prior limitations by enabling inclusion of more patient-oriented results while prioritising those endpoints considered most clinically important. Applying these methods to the SPYRAL HTN-ON MED pilot study (ClinicalTrials.gov Identifier NCT02439775), RDN was determined to be superior regarding a hierarchical endpoint and a "winner" compared with sham control patients.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Sympathectomy
/
Hypertension
Type of study:
Clinical_trials
Limits:
Humans
Language:
En
Journal:
EuroIntervention
Journal subject:
ANGIOLOGIA
/
CARDIOLOGIA
/
TERAPEUTICA
Year:
2021
Document type:
Article
Affiliation country:
United States