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中国临床药理学与治疗学 ›› 2021, Vol. 26 ›› Issue (4): 449-453.doi: 10.12092/j.issn.1009-2501.2021.04.013

• 综述与讲座 • 上一篇    下一篇

新视角解读临床试验中的意向性原则

黄丽红1,6,王陵3,6,言方荣4,6,魏朝晖2,6,赵杨5,6,夏结来3,陈峰5
  

  1. 1 复旦大学附属中山医院生物统计室,上海 200032;2 杭州泰格医药科技股份有限公司,杭州 310053;3 第四军医大学卫生统计学教研室,西安 710032,陕西;4 中国药科大学理学院生物统计教研室,南京 211198,江苏;5 南京医科大学公共卫生学院生物统计学系,南京 211166,江苏;6 CSCO生物统计学专家委员会RWS方法学组

  • 收稿日期:2020-10-19 修回日期:2020-11-19 出版日期:2021-04-26 发布日期:2021-05-11
  • 通讯作者: 赵杨,男,博士,教授,博士生导师,研究方向:复杂生物医学数据整合分析及因果推断方法研究。 Tel: 025-86868436 E-mail: yzhao@njmu.edu.cn
  • 作者简介:黄丽红,女,博士,青年研究员,硕士生导师,研究方向:临床研究中统计理论方法与规范化。 Tel: 021-64041990 E-mail: huang.lihong@zs-hospital.sh.cn
  • 基金资助:
    国家自然科学青年基金(81903407)

New perspectives on the principle of intention to treat in clinical trials#br#

HUANG Lihong 1,6, WANG Ling 3,6, YAN Fangrong 4,6, WEI Zhaohui 2,6, ZHAO Yang 5,6, XIA Jielai 3, CHEN Feng   

  1. 1 Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai 200032, China; 2 Department of Biostatistics, Tiger Medical Company, Hangzhou 310053, Zhejiang, China; 3 Department of Health Statistics, School of Preventive Medicine, Fourth Military Medical University, Xi'an 710032, Shaanxi, China; 4 Department of Biostatistics, China Pharmaceutical University, Nanjing 211198, Jiangsu, China; 5 Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu, China; 6 RWS Panel of Expert Committee on Biostatistics of CSCO
  • Received:2020-10-19 Revised:2020-11-19 Online:2021-04-26 Published:2021-05-11

摘要: 意向性原则(intention to treat, ITT)是以意向性治疗(即计划的治疗方案)为基础,而不以实际给予的治疗为基础进行评价的原则,在随机对照试验(randomized controlled trial, RCT)中广泛应用。随着临床试验的不断发展和进步,对ITT原则需要重新理解和诠释。在ITT原则的标准定义中,受试者的意向性分组并未特指随机化分组,而是计划的治疗方案,非随机化临床试验中受试者同意入组某一治疗方案同样为一种意向性。在单臂临床试验及非随机化的现实世界研究(real world study, RWS)中,应用ITT原则可评价由患者/医生决定的意向性治疗方案的有效性。在实际应用过程中,应根据研究目的结合ITT原则进行分组策略的综合考虑。

关键词: 意向性原则, 临床试验, 现实世界研究, 单臂试验

Abstract: The intention to treat (ITT) principle is widely applied in the randomized controlled trials (RCTs), which is based on the intention to treat a subject (i.e. the planned treatment regimen) rather than the actual treatment given. With the development and progress of clinical trials, ITT principle needs to be reinterpreted. In the standard definition of ITT principle, the intentional grouping of subjects does not specifically refer to randomization, but rather to planned treatment regimen. In non-randomized clinical trials, that subjects agree to be included in a certain treatment regimen is also a type of intention. ITT principles can be applied to evaluate the effectiveness of treatment regimens under patient/doctor determined intentionality in single-arm clinical trials and non-randomized RWS (real world study, RWS). In the practical application, the grouping strategy based on ITT principle should be considered comprehensively according to the research purpose.

Key words: intended to treat, clinical trial, real world study, single-arm trial

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