[Discussion] TRIUMPH is doing more work than we give it credit for
TRIUMPH is doing more work than we give it credit for. It is the sort of thing everyone half-believes and nobody writes down.
Spent an evening with the appendix tables and found the subgroup detail that the entire thread had been speculating about.
Quoted a figure here confidently, got asked whether it was ITT, went and checked, and it was not. Learned something.
Read a press release and the publication three months apart. The hedging in the second one was substantial.
Please do not ask me what dose you should be on. I genuinely do not know and neither does anyone else here.
best — the order this archive was captured in
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.
Intention-to-treat analyses everybody randomised regardless of what they did afterwards. Completer analyses only those who finished. The second is systematically more flattering and both are legitimate if labelled.
The discontinuation numbers were the most useful thing in the paper for me and they were in a supplementary table.
Cardiovascular outcome trials are powered for events, not for weight, and are typically run in a different population with different inclusion criteria. Reading a weight number out of one is reading a secondary endpoint.
a press release is not a publication
a press release is not a publication
milan_mensah is right about the programme names. They are different populations with different endpoints.
a press release is not a publication
Agreed. And the interval, not the point estimate, is what the trial actually established.
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.
How long was the randomised phase before any extension?
A confidence interval is the range of effects compatible with the data.
This is the distinction that would end about half the arguments on this board.
Agreed on comparators. "Superior" means nothing until you know superior to what and at what dose.
Went looking for the registered protocol to see whether the endpoint had changed. It had not, which was reassuring and worth checking.