title: New insights on the relation between untreated and treated outcomes for a given therapy effect model is not necessarily linear.
abstract: OBJECTIVE
  A relation between the size of treatment efficacy and severity of the disease has been postulated and observed as linear for a few therapies. We have called this relation the effect model. Our objectives were to demonstrate that the relation is general and not necessarily linear.
  
  
  METHODS
  We extend the number of observed effect model. Then we established three numerical models of treatment activity corresponding to the three modes of action we have identified. Using these models, we simulated the relation.
  
  
  RESULTS
  Empirical evidence confirms the effect model and suggests that it may be linear over a short range of event frequency. However, it provides an incomplete understanding of the phenomenon because of the inescapable limitations of data from randomized clinical trials. Numerical modeling and simulation show that the real effect model is likely to be more complicated. It is probably linear only in rare instances. The effect model is general. It depends on factors related to the individual, disease and outcome.
  
  
  CONCLUSIONS
  Contrarily to common, assumption, since the effect model is often curvilinear, the relative risk cannot be granted as constant. The effect model should be taken into account when discovering and developing new therapies, when making, health care policy decisions or adjusting clinical decisions to the patient risk profile.
authors.affiliation: Institute for Theoretical Medicine and CNRS UMR5558, RTH Laennec School of Medicine, rue Guillaume Paradin, 69008 Lyon, France. jpb@upcl.univ-lyon1.fr
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Boissel
authors.forename: Michel
authors.initials: M
authors.lastname: Cucherat
authors.forename: Patrice
authors.initials: P
authors.lastname: Nony
authors.forename: Sylvie
authors.initials: S
authors.lastname: Chabaud
authors.forename: François
authors.initials: F
authors.lastname: Gueyffier
authors.forename: James M
authors.initials: JM
authors.lastname: Wright
authors.forename: Michel
authors.initials: M
authors.lastname: Lièvre
authors.forename: Alain
authors.initials: A
authors.lastname: Leizorovicz
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D006801:Humans; D015233:Models, Statistical; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists