THE RESTRICTED MEAN SURVIVAL TIME AS A TOOL FOR RANKING COMPARATIVE
OUTCOMES IN A NARRATIVE REVIEW THAT EVALUATES A NETWORK OF RANDOMISED
TRIALS: AN EXAMPLE BASED ON PCSK9 INHIBITORS
Abstract
Evolocumab and alirocumab have been approved based on a randomised
trial. We analysed the outcomes reported in the two trials to develop an
original framework of comparative assessment that uses the restricted
mean survival time (RMST). The objective was to show that, in the
context of a narrative review, the RMST can be an efficient though
simple tool to make indirect comparisons. For each cohort of patients
(13,784 patients given evolocumab, 9,462 given alirocumab, 23,242
controls; results expressed in months of event-free survival), we
determined the values of RMST with 95% confidence intervals [CI]
(evolocumab: 33.48, 95%CI: 33.45 to 33.50; alirocumab: 33.89, 95%CI:
36.86 to 33.92). These results, along with those of the control groups,
were analysed and interpreted narratively. A univariate statistics was
conducted; no network meta-analysis was done. The experience presented
herein indicates that a framework of evidence assessment focused on RMST
is a worthwhile option.