Skip Navigation

This Article
Right arrow Full Text Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (1)
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by WALLEY, T.
Right arrow Articles by DICKSON, R.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by WALLEY, T.
Right arrow Articles by DICKSON, R.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

Q J Med 2003; 96: 155-160
© 2003 Association of Physicians

Commentary

Superiority and equivalence in thrombolytic drugs: an interpretation

T. WALLEY, Y. DUNDAR, R. HILL and R. DICKSON

From the Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK

The first 150 words of the full text of this article appear below.


   Introduction
 
Streptokinase and alteplase both reduce mortality from acute myocardial infarction. Newer thrombolytic drugs (reteplase and tenecteplase) have putative advantages, such as ease of delivery and better fibrin specificity, although they are more expensive. A systematic review and meta-analysis identified the clinical efficacy and adverse effects of these drugs.1 But this can only compare drugs where there are direct trial comparisons. Inevitably, we need to make indirect comparisons also, as well as to interpret the results of the direct comparisons. We present an interpretation and consider its strengths and weaknesses.


   Equivalence and superiority in clinical trials
 
Broadly, ‘superiority studies’, where one drug is thought likely to be better than another, assume a null hypothesis that there is no difference, which may then be disproved. Such studies are usually analysed by intention to treat (ITT, i.e. to analyse all patients according to their initial randomized allocation, and not whether they ever received the therapy or changed at some . . . [Full Text of this Article]


   Analysing equivalence trials
 

   Direct comparisons between drugs
 
Alteplase and streptokinase
Alteplase and reteplase
Reteplase and streptokinase
Alteplase and tenecteplase

   Indirect comparisons
 
Streptokinase vs. tenecteplase
Reteplase vs. tenecteplase

   Bleeding and adverse events
 

   Discussion
 

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?