Immortal time bias in the association between toxicity and response for immune checkpoint inhibitors: a meta-analysis.

Abstract:

:Only a minority of studies addressing the association between immune-related adverse events (IrAE) and outcome considered the immortal time bias, with conflicting results. PubMed, Embase, Web of Science and Scopus were searched through 2 January 2020. Studies reporting the impact of IrAE on outcome in patients treated with antiprogrammed death receptor 1 or PD-L1 were included. Twenty nine articles were included. IrAEs were associated with improved outcomes with high heterogeneity. With a landmark approach, the association between IrAE and outcome remains significant but the effect size was smaller (hazard ratio 0.61 vs 0.41 for overall survival; p = 0.015; hazard ratio 0.66 vs 0.47 for progression-free survival, p = 0.029; odds ratio 2.59 vs 6.77 for overall response rate; p < 0.001), no significant heterogeneity. Our analysis suggests a confounding effect of immortal time bias and a real effect of IrAE on outcome.

journal_name

Immunotherapy

journal_title

Immunotherapy

authors

Dall'Olio FG,Rizzo A,Mollica V,Massucci M,Maggio I,Massari F

doi

10.2217/imt-2020-0179

subject

Has Abstract

pub_date

2021-02-01 00:00:00

pages

257-270

issue

3

eissn

1750-743X

issn

1750-7448

journal_volume

13

pub_type

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