↓ Skip to main content

New treatments compared to established treatments in randomized trials

Overview of attention for article published in Cochrane database of systematic reviews, October 2012
Altmetric Badge

About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (99th percentile)
  • High Attention Score compared to outputs of the same age and source (97th percentile)

Mentioned by

news
2 news outlets
blogs
6 blogs
policy
1 policy source
twitter
133 tweeters
facebook
6 Facebook pages
googleplus
1 Google+ user

Citations

dimensions_citation
44 Dimensions

Readers on

mendeley
67 Mendeley
citeulike
1 CiteULike
You are seeing a free-to-access but limited selection of the activity Altmetric has collected about this research output. Click here to find out more.
Title
New treatments compared to established treatments in randomized trials
Published in
Cochrane database of systematic reviews, October 2012
DOI 10.1002/14651858.mr000024.pub3
Pubmed ID
Authors

Benjamin Djulbegovic, Ambuj Kumar, Paul P Glasziou, Rafael Perera, Tea Reljic, Louise Dent, James Raftery, Marit Johansen, Gian Luca Di Tanna, Branko Miladinovic, Heloisa P Soares, Gunn E Vist, Iain Chalmers

Abstract

The proportion of proposed new treatments that are 'successful' is of ethical, scientific, and public importance. We investigated how often new, experimental treatments evaluated in randomized controlled trials (RCTs) are superior to established treatments. Our main question was: "On average how often are new treatments more effective, equally effective or less effective than established treatments?" Additionally, we wanted to explain the observed results, i.e. whether the observed distribution of outcomes is consistent with the 'uncertainty requirement' for enrollment in RCTs. We also investigated the effect of choice of comparator (active versus no treatment/placebo) on the observed results. We searched the Cochrane Methodology Register (CMR) 2010, Issue 1 in The Cochrane Library (searched 31 March 2010); MEDLINE Ovid 1950 to March Week 2 2010 (searched 24 March 2010); and EMBASE Ovid 1980 to 2010 Week 11 (searched 24 March 2010). Cohorts of studies were eligible for the analysis if they met all of the following criteria: (i) consecutive series of RCTs, (ii) registered at or before study onset, and (iii) compared new against established treatments in humans. RCTs from four cohorts of RCTs met all inclusion criteria and provided data from 743 RCTs involving 297,744 patients. All four cohorts consisted of publicly funded trials. Two cohorts involved evaluations of new treatments in cancer, one in neurological disorders, and one for mixed types of diseases. We employed kernel density estimation, meta-analysis and meta-regression to assess the probability of new treatments being superior to established treatments in their effect on primary outcomes and overall survival. The distribution of effects seen was generally symmetrical in the size of difference between new versus established treatments. Meta-analytic pooling indicated that, on average, new treatments were slightly more favorable both in terms of their effect on reducing the primary outcomes (hazard ratio (HR)/odds ratio (OR) 0.91, 99% confidence interval (CI) 0.88 to 0.95) and improving overall survival (HR 0.95, 99% CI 0.92 to 0.98). No heterogeneity was observed in the analysis based on primary outcomes or overall survival (I(2) = 0%). Kernel density analysis was consistent with the meta-analysis, but showed a fairly symmetrical distribution of new versus established treatments indicating unpredictability in the results. This was consistent with the interpretation that new treatments are only slightly superior to established treatments when tested in RCTs. Additionally, meta-regression demonstrated that results have remained stable over time and that the success rate of new treatments has not changed over the last half century of clinical trials. The results were not significantly affected by the choice of comparator (active versus placebo/no therapy). Society can expect that slightly more than half of new experimental treatments will prove to be better than established treatments when tested in RCTs, but few will be substantially better. This is an important finding for patients (as they contemplate participation in RCTs), researchers (as they plan design of the new trials), and funders (as they assess the 'return on investment'). Although we provide the current best evidence on the question of expected 'success rate' of new versus established treatments consistent with a priori theoretical predictions reflective of 'uncertainty or equipoise hypothesis', it should be noted that our sample represents less than 1% of all available randomized trials; therefore, one should exercise the appropriate caution in interpretation of our findings. In addition, our conclusion applies to publicly funded trials only, as we did not include studies funded by commercial sponsors in our analysis.

Twitter Demographics

The data shown below were collected from the profiles of 133 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 67 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 1 1%
Spain 1 1%
Unknown 65 97%

Demographic breakdown

Readers by professional status Count As %
Student > Ph. D. Student 12 18%
Student > Master 10 15%
Student > Bachelor 9 13%
Researcher 8 12%
Other 7 10%
Other 9 13%
Unknown 12 18%
Readers by discipline Count As %
Medicine and Dentistry 27 40%
Nursing and Health Professions 11 16%
Agricultural and Biological Sciences 3 4%
Psychology 3 4%
Pharmacology, Toxicology and Pharmaceutical Science 1 1%
Other 8 12%
Unknown 14 21%

Attention Score in Context

This research output has an Altmetric Attention Score of 140. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 13 August 2020.
All research outputs
#187,350
of 19,021,597 outputs
Outputs from Cochrane database of systematic reviews
#339
of 11,920 outputs
Outputs of similar age
#1,112
of 163,748 outputs
Outputs of similar age from Cochrane database of systematic reviews
#3
of 86 outputs
Altmetric has tracked 19,021,597 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 99th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 11,920 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 26.9. This one has done particularly well, scoring higher than 97% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 163,748 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 99% of its contemporaries.
We're also able to compare this research output to 86 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 97% of its contemporaries.