Advertisement

Subgroup analysis in randomized controlled trials: Useful or misleading?

  • Tobias Tritschler
    Affiliations
    Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland

    Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
    Search for articles by this author
  • Parham Sadeghipour
    Affiliations
    Cardiovascular Intervention Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
    Search for articles by this author
  • Behnood Bikdeli
    Correspondence
    Corresponding author at: Cardiovascular Medicine Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
    Affiliations
    Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

    Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

    YNHH/ Yale Center for Outcomes Research and Evaluation (CORE), New Haven, CT, USA

    Cardiovascular Research Foundation (CRF), New York, NY, USA
    Search for articles by this author
      Venous thromboembolism (VTE) afflicts persons across all age groups with a broad range of characteristics, varying from previously healthy to multimorbid, polymedicated patients [
      • Heit J.A.
      Epidemiology of venous thromboembolism.
      ]. To assess potential heterogenous treatment effects in specific subgroups of participants or consistency of effects across different subgroups (such as women and men, those with or without certain co-morbidities, older vs younger patients, and others), investigators frequently perform subgroup analyses, which may provide important information for patients, clinicians, policymakers, and future research [
      • Wang R.
      • Lagakos S.W.
      • Ware J.H.
      • Hunter D.J.
      • Drazen J.M.
      Statistics in medicine–reporting of subgroup analyses in clinical trials.
      ]. However, inappropriate conduct and interpretation of subgroup analyses can result in misleading reporting of under- or overestimated subgroup effects [
      • Wallach J.D.
      • Sullivan P.G.
      • Trepanowski J.F.
      • Sainani K.L.
      • Steyerberg E.W.
      • Ioannidis J.P.
      Evaluation of evidence of statistical support and corroboration of subgroup claims in randomized clinical trials.
      ,
      • Brookes S.T.
      • Whitley E.
      • Peters T.J.
      • Mulheran P.A.
      • Egger M.
      • Davey Smith G.
      Subgroup analyses in randomised controlled trials: quantifying the risks of false-positives and false-negatives.
      ].

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Thrombosis Research
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Heit J.A.
        Epidemiology of venous thromboembolism.
        Nat. Rev. Cardiol. 2015; 12: 464-474https://doi.org/10.1038/nrcardio.2015.83
        • Wang R.
        • Lagakos S.W.
        • Ware J.H.
        • Hunter D.J.
        • Drazen J.M.
        Statistics in medicine–reporting of subgroup analyses in clinical trials.
        N. Engl. J. Med. 2007; 357: 2189-2194https://doi.org/10.1056/NEJMsr077003
        • Wallach J.D.
        • Sullivan P.G.
        • Trepanowski J.F.
        • Sainani K.L.
        • Steyerberg E.W.
        • Ioannidis J.P.
        Evaluation of evidence of statistical support and corroboration of subgroup claims in randomized clinical trials.
        JAMA Intern. Med. 2017; 177: 554-560https://doi.org/10.1001/jamainternmed.2016.9125
        • Brookes S.T.
        • Whitley E.
        • Peters T.J.
        • Mulheran P.A.
        • Egger M.
        • Davey Smith G.
        Subgroup analyses in randomised controlled trials: quantifying the risks of false-positives and false-negatives.
        Health Technol. Assess. 2001; 5: 1-56https://doi.org/10.3310/hta5330
        • Rodríguez-Ramalloa H.
        • Báez-Gutiérrez N.
        • Abdel-Kader-Martín L.
        • Otero-Candelera R.
        Subgroup analyses in venous thromboembolism trials reporting pharmacological interventions: a systematic review.
        Thromb. Res. 2022; https://doi.org/10.1016/j.thromres.Q3 2022.09.023
        • Sun X.
        • Briel M.
        • Busse J.W.
        • You J.J.
        • Akl E.A.
        • Mejza F.
        • Bala M.M.
        • Bassler D.
        • Mertz D.
        • Diaz-Granados N.
        • Vandvik P.O.
        • Malaga G.
        • Srinathan S.K.
        • Dahm P.
        • Johnston B.C.
        • Alonso-Coello P.
        • Hassouneh B.
        • Walter S.D.
        • Heels-Ansdell D.
        • Bhatnagar N.
        • Altman D.G.
        • Guyatt G.H.
        Credibility of claims of subgroup effects in randomised controlled trials: systematic review.
        BMJ. 2012; 344e1553https://doi.org/10.1136/bmj.e1553
        • Hernandez A.V.
        • Boersma E.
        • Murray G.D.
        • Habbema J.D.
        • Steyerberg E.W.
        Subgroup analyses in therapeutic cardiovascular clinical trials: are most of them misleading?.
        Am. Heart J. 2006; 151: 257-264https://doi.org/10.1016/j.ahj.2005.04.020
        • National Institutes of Health
        Analyses by sex or gender, race and ethnicity for NIH-defined Phase III Clinical Trials (valid analysis).
        (Available at) (accessed September 24, 2022)
        • National Institutes of Health
        NIH policy on sex as a biological variable.
        (Available at) (accessed September 24, 2022)
        • Rothwell P.M.
        Treating individuals 2. Subgroup analysis in randomised controlled trials: importance, indications, and interpretation.
        Lancet. 2005; 365: 176-186https://doi.org/10.1016/S0140-6736(05)17709-5
        • Kasenda B.
        • Schandelmaier S.
        • Sun X.
        • von Elm E.
        • You J.
        • Blumle A.
        • Tomonaga Y.
        • Saccilotto R.
        • Amstutz A.
        • Bengough T.
        • Meerpohl J.J.
        • Stegert M.
        • Olu K.K.
        • Tikkinen K.A.
        • Neumann I.
        • Carrasco-Labra A.
        • Faulhaber M.
        • Mulla S.M.
        • Mertz D.
        • Akl E.A.
        • Bassler D.
        • Busse J.W.
        • Ferreira-Gonzalez I.
        • Lamontagne F.
        • Nordmann A.
        • Gloy V.
        • Raatz H.
        • Moja L.
        • Rosenthal R.
        • Ebrahim S.
        • Vandvik P.O.
        • Johnston B.C.
        • Walter M.A.
        • Burnand B.
        • Schwenkglenks M.
        • Hemkens L.G.
        • Bucher H.C.
        • Guyatt G.H.
        • Briel M.
        • D.S. Group
        Subgroup analyses in randomised controlled trials: cohort study on trial protocols and journal publications.
        BMJ. 2014; 349g4539https://doi.org/10.1136/bmj.g4539
        • Harrington D.
        • D'Agostino Sr., R.B.
        • Gatsonis C.
        • Hogan J.W.
        • Hunter D.J.
        • Normand S.T.
        • Drazen J.M.
        • Hamel M.B.
        New guidelines for statistical reporting in the journal.
        N. Engl. J. Med. 2019; 381: 285-286https://doi.org/10.1056/NEJMe1906559