Paper Information

Journal:   INTERNATIONAL JOURNAL OF FERTILITY AND STERILITY   SUMMER 2011 , Volume 5 , Number SUPPLEMENT 1; Page(s) 13 To 14.
 
Paper: 

EPIDEMIOLOGY AND ETHICS: DECISION TREES FOR IDENTIFYING PREDICTORS OF TREATMENT EFFECTIVENESS IN CLINICAL TRIALS AND ITS APPLICATION TO OVULATION IN A STUDY OF WOMEN WITH POLYCYSTIC OVARY SYNDROME

 
 
Author(s):  ZHANG H.*, LEGRO R.S., CASSON P.R., SCHLAFF W.D., DIAMOND M.P., COUTIFARIS CH., BRZYSKI R.G., CHRISTMAN G.M., SANTORO N., EISENBERG E.
 
* YALE UNIVERSITY SCHOOL OF MEDICINE, NEW HAVEN, USA
 
Abstract: 

Background: Double-blind, randomized clinical trials are the preferred approach to demonstrate the effectiveness of one treatment against another. The comparison is, however, made on the average group effects. While patients and clinicians have always struggled to understand why patients respond differently to the same treatment, and while much hope has been held out for the nascent field of predictive biomarkers (e.g., genetic markers), there is still much utility in exploring whether it is possible to estimate treatment efficacy based on demographic and baseline variables.
Materials and Methods: The Pregnancy in Polycystic Ovary Syndrome (PPCOS) study was a prospective, multi-center, randomized clinical trial comparing three ovulation induction regimens: clomiphene citrate (CC), metformin and the combination of the two. There were 446 women who ovulated in response to the treatments among the entire 626 participants. In this report, we focus on the 418 women who received CC (alone or combined with metformin) to determine if readily available baseline physical characteristics and/or easily obtainable baseline measures could be used to distinguish treatment effectiveness in stimulating ovulation. We used a recursive partitioning technique and developed a node-splitting rule to build decision tree models that reflected within-node and within-treatment responses
Results: Overall, the combination of CC plus metformin resulted in an increased incidence of ovulation compared to CC alone. This is particularly so in women with relatively larger left ovarian volumes, and a left ovarian volume <19.5 was related to treatment outcomes for all subsequent nodes. Women who were older, who had higher baseline insulin, higher waist-to-hip circumference ratio, or higher sex hormone-binding globulin (SHBG) levels had better ovulatory rates with CC alone than with the combination of CC plus metformin.
Conclusion: PCOS is a phenotypically diverse condition. Both baseline laboratory and clinical parameters can predict ovulatory response in women with polycystic ovary syndrome undergoing ovulation induction. Without a priori hypotheses with regard to any predictors, the observation regarding left ovary volume is novel and worthy of further investigation and validation.

 
Keyword(s): POLYCYSTIC OVARY SYNDROME, DECISION TREES, CLINICAL TRIALS
 
References: 
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