One mean to rule them all? The arithmetic mean based egg reduction rate can be misleading when estimating anthelminthic drug efficacy in clinical trials.
Animal and human helminth infections are highly prevalent around the world, with only few anthelminthic drugs available. The anthelminthic drug performance is expressed by the cure rate and the egg reduction rate. However, which kind of mean should be used to calculate the egg reduction rate remains...
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ftdoajarticles:oai:doaj.org/article:8df7a34c6a304a9d9e843e10df7ca631 2023-05-15T15:12:47+02:00 One mean to rule them all? The arithmetic mean based egg reduction rate can be misleading when estimating anthelminthic drug efficacy in clinical trials. Wendelin Moser Jennifer Keiser Benjamin Speich Somphou Sayasone Stefanie Knopp Jan Hattendorf 2020-04-01T00:00:00Z https://doi.org/10.1371/journal.pntd.0008185 https://doaj.org/article/8df7a34c6a304a9d9e843e10df7ca631 EN eng Public Library of Science (PLoS) https://doi.org/10.1371/journal.pntd.0008185 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0008185 https://doaj.org/article/8df7a34c6a304a9d9e843e10df7ca631 PLoS Neglected Tropical Diseases, Vol 14, Iss 4, p e0008185 (2020) Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 article 2020 ftdoajarticles https://doi.org/10.1371/journal.pntd.0008185 2022-12-31T07:46:40Z Animal and human helminth infections are highly prevalent around the world, with only few anthelminthic drugs available. The anthelminthic drug performance is expressed by the cure rate and the egg reduction rate. However, which kind of mean should be used to calculate the egg reduction rate remains a controversial issue. We visualized the distributions of egg counts of different helminth species in 7 randomized controlled trials and asked a panel of experts about their opinion on the egg burden and drug efficacy of two different treatments. Simultaneously, we calculated infection intensities and egg reduction rates using different types of means: arithmetic, geometric, trimmed, winsorized and Hölder means. Finally, we calculated the agreement between expert opinion and the different means. We generated 23 different trial arm pairs, which were judged by 49 experts. Among all investigated means, the arithmetic mean showed poorest performance with only 64% agreement with expert opinion (bootstrap confidence interval [CI]: 60-68). Highest agreement of 94% (CI: 86-96) was reached by the Hölder mean M0.2, followed by the geometric mean (91%, CI: 85-94). Winsorized and trimmed means showed a rather poor performance (e.g. winsorization with 0.1 cut-off showed 85% agreement, CI: 78-87), but they performed reasonably well after excluding treatment arms with a small number of patients. In clinical trials with moderate sample size, the currently recommended arithmetic mean does not necessarily rank anthelminthic efficacies in the same order as might be obtained from expert evaluation of the same data. Estimates based on the arithmetic mean should always be reported together with an estimate, which is more robust to outliers, e.g. the geometric mean. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic PLOS Neglected Tropical Diseases 14 4 e0008185 |
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Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
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ftdoajarticles |
language |
English |
topic |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
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Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 Wendelin Moser Jennifer Keiser Benjamin Speich Somphou Sayasone Stefanie Knopp Jan Hattendorf One mean to rule them all? The arithmetic mean based egg reduction rate can be misleading when estimating anthelminthic drug efficacy in clinical trials. |
topic_facet |
Arctic medicine. Tropical medicine RC955-962 Public aspects of medicine RA1-1270 |
description |
Animal and human helminth infections are highly prevalent around the world, with only few anthelminthic drugs available. The anthelminthic drug performance is expressed by the cure rate and the egg reduction rate. However, which kind of mean should be used to calculate the egg reduction rate remains a controversial issue. We visualized the distributions of egg counts of different helminth species in 7 randomized controlled trials and asked a panel of experts about their opinion on the egg burden and drug efficacy of two different treatments. Simultaneously, we calculated infection intensities and egg reduction rates using different types of means: arithmetic, geometric, trimmed, winsorized and Hölder means. Finally, we calculated the agreement between expert opinion and the different means. We generated 23 different trial arm pairs, which were judged by 49 experts. Among all investigated means, the arithmetic mean showed poorest performance with only 64% agreement with expert opinion (bootstrap confidence interval [CI]: 60-68). Highest agreement of 94% (CI: 86-96) was reached by the Hölder mean M0.2, followed by the geometric mean (91%, CI: 85-94). Winsorized and trimmed means showed a rather poor performance (e.g. winsorization with 0.1 cut-off showed 85% agreement, CI: 78-87), but they performed reasonably well after excluding treatment arms with a small number of patients. In clinical trials with moderate sample size, the currently recommended arithmetic mean does not necessarily rank anthelminthic efficacies in the same order as might be obtained from expert evaluation of the same data. Estimates based on the arithmetic mean should always be reported together with an estimate, which is more robust to outliers, e.g. the geometric mean. |
format |
Article in Journal/Newspaper |
author |
Wendelin Moser Jennifer Keiser Benjamin Speich Somphou Sayasone Stefanie Knopp Jan Hattendorf |
author_facet |
Wendelin Moser Jennifer Keiser Benjamin Speich Somphou Sayasone Stefanie Knopp Jan Hattendorf |
author_sort |
Wendelin Moser |
title |
One mean to rule them all? The arithmetic mean based egg reduction rate can be misleading when estimating anthelminthic drug efficacy in clinical trials. |
title_short |
One mean to rule them all? The arithmetic mean based egg reduction rate can be misleading when estimating anthelminthic drug efficacy in clinical trials. |
title_full |
One mean to rule them all? The arithmetic mean based egg reduction rate can be misleading when estimating anthelminthic drug efficacy in clinical trials. |
title_fullStr |
One mean to rule them all? The arithmetic mean based egg reduction rate can be misleading when estimating anthelminthic drug efficacy in clinical trials. |
title_full_unstemmed |
One mean to rule them all? The arithmetic mean based egg reduction rate can be misleading when estimating anthelminthic drug efficacy in clinical trials. |
title_sort |
one mean to rule them all? the arithmetic mean based egg reduction rate can be misleading when estimating anthelminthic drug efficacy in clinical trials. |
publisher |
Public Library of Science (PLoS) |
publishDate |
2020 |
url |
https://doi.org/10.1371/journal.pntd.0008185 https://doaj.org/article/8df7a34c6a304a9d9e843e10df7ca631 |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
PLoS Neglected Tropical Diseases, Vol 14, Iss 4, p e0008185 (2020) |
op_relation |
https://doi.org/10.1371/journal.pntd.0008185 https://doaj.org/toc/1935-2727 https://doaj.org/toc/1935-2735 1935-2727 1935-2735 doi:10.1371/journal.pntd.0008185 https://doaj.org/article/8df7a34c6a304a9d9e843e10df7ca631 |
op_doi |
https://doi.org/10.1371/journal.pntd.0008185 |
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PLOS Neglected Tropical Diseases |
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14 |
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4 |
container_start_page |
e0008185 |
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1766343419797438464 |