[Critical analysis of individual data in meta-analysis. Apropos of an experience in the domain of drug treatment in arterial hypertension].
Reliable syntheses are more and more needed by physicians. In the therapeutic field, this need is illustrated by the growing number of syntheses using meta-analysis tools. Some of these syntheses are based on individual patient data, and this offers three kinds of advantages: the favourable consequences of a collaborative approach, the enhancement of data reliability, and a more complete extraction of useful information thanks to wider analysis potential. Most often, achieving the first two advantages does not require the individual patient data to be available, and a wider analysis potential seems to be the major rationale of such an approach. For instance, the assessment of the variation of treatment effect with along time is more accurate, but may also raise doubts about the validity of some hypotheses, for example, those underlying classical analysis techniques, or at the basis of even acknowledged pathophysiological theory. Ultimately, the concepts of identifying responders (here defined in terms of quantity or quality of life) and identifying the therapy target population are concretely applied in a way that will affect classical medical practice. Tomorrow, drugs will not be prescribed to a hypertensive individual because of the blood pressure level, but considering the size of the predicted therapeutic benefit.
Gueyffier
F
F
Service de Pharmacologie Clinique, Lyon, France.
Boissel
J P
JP
D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007400:Interprofessional Relations; D015201:Meta-Analysis as Topic; D018579:Patient Selection; D015203:Reproducibility of Results