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Cohort studies: to what extent can they inform treatment guidelines?

Sabin, CA; (2010) Cohort studies: to what extent can they inform treatment guidelines? CURR OPIN INFECT DIS , 23 (1) 15 - 20. 10.1097/QCO.0b013e32833521b4.

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Abstract

Purpose of reviewThis review examines situations in which information from cohort studies has proved to be useful for the development of treatment guidelines.Recent findingsAlthough there are several reasons why randomized controlled trials (RCTs) are felt to provide the most robust evidence for treatment guidelines, they may suffer from insufficient duration of follow-up, inadequate power to consider differences in important adverse events and highly selected patient populations. Furthermore, as most RCTs are performed for licensing purposes, strategic treatment decisions often lack supportive evidence from RCTs. Although data from cohort studies may be used to complement information from RCTs, cohort studies themselves are susceptible to several biases (most notably confounding) which may limit their findings. However, in the HIV field, information from such studies has been influential in guiding decisions relating to when to start highly active antiretroviral therapy, what drugs to use in the initial highly active antiretroviral therapy regimen and when to switch highly active antiretroviral therapy should virological failure occur.SummaryGiven the biases that may be present, caution should be exercised when interpreting findings from cohort studies, particularly if comparisons are made of treatment strategies that involve some element of patient or clinician choice.

Type: Article
Title: Cohort studies: to what extent can they inform treatment guidelines?
DOI: 10.1097/QCO.0b013e32833521b4
Keywords: bias, cohort studies, confounding, treatment guidelines, ACTIVE ANTIRETROVIRAL THERAPY, HIV-INFECTED PATIENTS, HUMAN-IMMUNODEFICIENCY-VIRUS, REVERSE-TRANSCRIPTASE INHIBITORS, TERM VIROLOGICAL FAILURE, LOW-LEVEL VIREMIA, PROTEASE INHIBITOR, HIV-1-INFECTED PATIENTS, MYOCARDIAL-INFARCTION, NAIVE PATIENTS
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Pop Health Sciences > Institute for Global Health > Infection and Population Health
URI: http://discovery.ucl.ac.uk/id/eprint/110204
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