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Comparative effectiveness research using matching-adjusted indirect comparison: an application to treatment with guanfacine extended release or atomoxetine in children with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder.

AbstractOBJECTIVES:
To illustrate a matching-adjusted indirect comparison by comparing the efficacy of guanfacine extended release (GXR) and atomoxetine (ATX) in reducing oppositional symptoms in children with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder.
METHODS:
Individual patient data were used from a GXR trial; only published summary data were used from ATX trials. In a matching-adjusted indirect comparison, individual patients from the GXR trial were weighted such that their mean baseline characteristics matched those published for ATX trials. Placebo-arm outcomes were then compared to further assess balance between the matched populations. Changes in the Conners' Parent Rating Scale-Revised Short Form Oppositional Subscale from baseline to endpoint among GXR-treated and ATX-treated patients were then compared.
RESULTS:
Before matching, the GXR (n = 143) and ATX (n = 98) trial populations had significant differences in baseline characteristics and placebo-arm outcomes. After matching, baseline characteristics were well balanced across trials, and placebo-arm outcomes became nearly identical. Comparing active treatment arms across the matched populations, GXR was associated with a significantly greater reduction in mean Conners' Parent Rating Scale-Revised Short form oppositional subscale compared with ATX {-5.0 [95% confidence interval (CI): -6.6 to -3.4] vs. -2.4 [CI: -3.7 to -1.1], p = 0.01, effect size = 0.58}.
CONCLUSIONS:
In the absence of head-to-head randomized trials, matching-adjusted indirect comparisons can provide timely and reliable comparative evidence for decision makers and can be applied even when very few trials are available for the treatments of interest.
AuthorsJames Signorovitch, M Haim Erder, Jipan Xie, Vanja Sikirica, Mei Lu, Paul S Hodgkins, Eric Q Wu
JournalPharmacoepidemiology and drug safety (Pharmacoepidemiol Drug Saf) Vol. 21 Suppl 2 Pg. 130-7 (May 2012) ISSN: 1099-1557 [Electronic] England
PMID22552988 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
CopyrightCopyright © 2012 John Wiley & Sons, Ltd.
Chemical References
  • Delayed-Action Preparations
  • Propylamines
  • Guanfacine
  • Atomoxetine Hydrochloride
Topics
  • Adolescent
  • Atomoxetine Hydrochloride
  • Attention Deficit Disorder with Hyperactivity (complications, drug therapy, epidemiology)
  • Attention Deficit and Disruptive Behavior Disorders (complications, drug therapy, epidemiology)
  • Child
  • Comparative Effectiveness Research
  • Delayed-Action Preparations
  • Guanfacine (administration & dosage, therapeutic use)
  • Humans
  • Outcome and Process Assessment, Health Care (statistics & numerical data)
  • Pharmacoepidemiology (methods, statistics & numerical data)
  • Propylamines (administration & dosage, therapeutic use)
  • Randomized Controlled Trials as Topic (standards, statistics & numerical data)

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