PDF(Pubmed)
Abstract：
OBJECTIVE: Systematic reviews and medical guidelines are widely used in clinical practice. However, these are often not up-to-date and focussed on the average patient. We therefore aimed to evaluate a guideline add-on, TherapySelector (TS), which is based on monthly updated data of all available high-quality studies, classified in specific patient profiles.
METHODS: We evaluated the TS for the treatment of hepatitis C (HCV) in an international cohort of patients treated with direct-acting antivirals between 2015 and 2020. The primary outcome was the number of patients receiving one of the two preferred treatment options of the HCV TS, based on the highest level of evidence, cure rate, absence of ribavirin-associated adverse effects, and treatment duration.
RESULTS: We enrolled 567 patients. The number of patients treated with one of the two preferred treatment options according to the HCV TS ranged between 27% (2015) and 60% (2020; p < 0.001). Most of the patients received a regimen with a longer treatment-duration (up to 34%) and/or addition of ribavirin (up to 14%). The effect on the expected cure-rate was minimal (1-6% higher) when the first preferred TherapySelector option was given compared to the actual treatment.
CONCLUSIONS: Medical decision-making can be optimised by a guideline add-on; in HCV its use appears to minimise adverse effects and cost. The use of such an add-on might have a greater impact in diseases with suboptimal cure-rates, high costs or adverse effects, for which treatment options rely on specific patient characteristics.
METHODS: We evaluated the TS for the treatment of hepatitis C (HCV) in an international cohort of patients treated with direct-acting antivirals between 2015 and 2020. The primary outcome was the number of patients receiving one of the two preferred treatment options of the HCV TS, based on the highest level of evidence, cure rate, absence of ribavirin-associated adverse effects, and treatment duration.
RESULTS: We enrolled 567 patients. The number of patients treated with one of the two preferred treatment options according to the HCV TS ranged between 27% (2015) and 60% (2020; p < 0.001). Most of the patients received a regimen with a longer treatment-duration (up to 34%) and/or addition of ribavirin (up to 14%). The effect on the expected cure-rate was minimal (1-6% higher) when the first preferred TherapySelector option was given compared to the actual treatment.
CONCLUSIONS: Medical decision-making can be optimised by a guideline add-on; in HCV its use appears to minimise adverse effects and cost. The use of such an add-on might have a greater impact in diseases with suboptimal cure-rates, high costs or adverse effects, for which treatment options rely on specific patient characteristics.
摘要：
目的：系统评价和医学指南在临床实践中被广泛使用。然而,这些通常不是最新的,并且集中在普通患者身上.因此，我们的目标是评估一个指南附加组件，TherapySelector(TS),这是基于所有可用高质量研究的每月更新数据，分类为特定的患者概况。
方法：我们在2015年至2020年期间，在接受直接作用抗病毒药物治疗的国际患者队列中评估了TS对丙型肝炎（HCV）的治疗。主要结果是接受HCVTS两种首选治疗方案之一的患者人数，基于最高水平的证据,治愈率,没有利巴韦林相关的不良反应，和治疗持续时间。
结果：我们招募了567名患者。根据HCVTS，接受两种首选治疗方案之一治疗的患者数量介于27%（2015年）和60%（2020年；p<0.001）之间。大多数患者接受治疗持续时间较长（高达34％）和/或加用利巴韦林（高达14％）的方案。与实际治疗相比,当给予第一优选的TherapySelector选项时,对预期治愈率的影响是最小的(高1-6%)。
结论：医学决策可以通过附加指南来优化；在HCV中，其使用似乎可以最大程度地减少不良反应和成本。使用这种附加功能可能会对治愈率欠佳的疾病产生更大的影响，高成本或不利影响，治疗方案依赖于特定的患者特征。
方法：我们在2015年至2020年期间，在接受直接作用抗病毒药物治疗的国际患者队列中评估了TS对丙型肝炎（HCV）的治疗。主要结果是接受HCVTS两种首选治疗方案之一的患者人数，基于最高水平的证据,治愈率,没有利巴韦林相关的不良反应，和治疗持续时间。
结果：我们招募了567名患者。根据HCVTS，接受两种首选治疗方案之一治疗的患者数量介于27%（2015年）和60%（2020年；p<0.001）之间。大多数患者接受治疗持续时间较长（高达34％）和/或加用利巴韦林（高达14％）的方案。与实际治疗相比,当给予第一优选的TherapySelector选项时,对预期治愈率的影响是最小的(高1-6%)。
结论：医学决策可以通过附加指南来优化；在HCV中，其使用似乎可以最大程度地减少不良反应和成本。使用这种附加功能可能会对治愈率欠佳的疾病产生更大的影响，高成本或不利影响，治疗方案依赖于特定的患者特征。
