Another Study Warns That Evidence From Observational Studies Provides Unreliable Results For Therapies
We have previously mentioned the enormous contributions made by John Ioannidis MD in the area of understanding the reliability of medical evidence. [Ioannidis, Delfini Blog, Giannakakis] We want to draw your attention to a recent publication dealing with the risks of relying on observational data for cause and effect conclusions. [Hemkens] In this recent study, Hemkens, Ioannidis and other colleagues assessed differences in mortality effect size reported in observational (routinely collected data [RCD]) studies as compared with results reported in RCTs.
Eligible RCD studies used propensity scores in an effort to address confounding bias in the observational studies. The authors compared the results of RCD and RCTs. The analysis included only RCD studies conducted before any RCT was published on the same topic. They assessed the risk of bias for RCD studies and randomized controlled trials (RCTs) using The Cochrane Collaboration risk of bias tools. The direction of treatment effects, confidence intervals and effect sizes (odds ratios) were compared between RCD studies and RCTs. The relative odds ratios were calculated across all pairs of RCD studies and trials.
The authors found that RCD studies systematically and substantially overestimated mortality benefits of medical treatments compared with subsequent trials investigating the same question. Overall, RCD studies reported significantly more favorable mortality estimates by a relative 31% than subsequent trials (summary relative odds ratio 1.31 (95% confidence interval 1.03 to 1.65; I2 (I square)=0%)).
These authors remind us yet again that If no randomized trials exist, clinicians and other decision-makers should not trust results from observational data from sources such as local or national databases, registries, cohort or case-control studies.
Delfini Blog: http://delfini.org/blog/?p=292
Giannakakis IA, Haidich AB, Contopoulos-Ioannidis DG, Papanikolaou GN, Baltogianni MS, Ioannidis JP. Citation of randomized evidence in support of guidelines of therapeutic and preventive interventions. J Clin Epidemiol. 2002 Jun;55(6):545-55. PubMed PMID: 12063096.
Hemkens LG, Contopoulos-Ioannidis DG, Ioannidis JP. Agreement of treatment effects for mortality from routinely collected data and subsequent randomized trials: meta-epidemiological survey. BMJ. 2016 Feb 8;352:i493. doi: 10.1136/bmj.i493. PubMed PMID: 26858277.
Ioannidis JPA. Why Most Published Research Findings are False. PLoS Med 2005; 2(8):696-701 PMID: 16060722