the STEP thing finally clicked for me and I want to write it down
the STEP thing finally clicked for me and I want to write it down. Not a hot take, just something I have not seen said plainly here.
Spent an evening with the appendix tables and found the subgroup detail that the entire thread had been speculating about.
Relative risk reduction without the baseline rate is uninterpretable. A large relative reduction on a small absolute risk is a small absolute benefit.
The registered protocol is public. Comparing the registered primary endpoint with the reported one is a two-minute check and it is how outcome switching gets caught.
That is everything I have. The rest is opinion and I have tried to keep it out.
best — the order this archive was captured in
Open-label extensions lose their randomisation. Anybody still enrolled at week 104 is a selected group and the numbers describe that group.
Cosigning on discontinuation. It is a result about tolerability and it gets buried every time.
Correcting myself upthread: I gave the completer figure and labelled it intention-to-treat.
check who the comparator was before you compare anything
The press release said that; the publication says something more hedged. Worth reading both.
Why comparing across trials almost never works, with the specific failure modes.
Different populations: an obesity programme and a diabetes programme enrol different people with different baseline characteristics. Different endpoints: body weight change, glycaemic control and cardiovascular events are not convertible. Different durations: 68 weeks and 72 weeks are not the same, and the curves have not flattened by either.
Different analysis populations: one paper reports intention-to-treat, another emphasises completers. Different support: some trial designs include structured lifestyle contact that no member of this board receives.
Stack those and the "X beats Y" tables that circulate here are comparing five things at once and attributing the difference to the molecule.
The discontinuation numbers were the most useful thing in the paper for me and they were in a supplementary table.
Not convinced. Cross-trial comparison between two programmes with different populations and designs is not a comparison.
How to read one of these papers in fifteen minutes, in the order that actually helps.
Start with the registered protocol and check the primary endpoint against what is reported. Then the methods: who was included, what the comparator was, how long the randomised phase ran. Then the discontinuation numbers, which are a tolerability result and are usually in a supplementary table.
Only then the efficacy figure, and read the interval rather than the point estimate. Finish with the limitations section, which is where the authors say what they actually think.
Fifteen minutes, and you will know more than any thread summarising it.
A confidence interval is the range of effects compatible with the data. Two trials with overlapping intervals have not disagreed, whatever their point estimates look like next to each other.
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That is a relative risk reduction. Quoting it without the absolute numbers overstates the case considerably.
discontinuation rate is a result, not a footnote
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