In this issue of JAMA Internal Medicine, Fralick and colleagues1 create a straw man to demonstrate that observational treatment comparisons could be useful for expanding indications for medical products. The authors modeled the Ongoing Telmisartan Alone and in Combination with Ramipril Global End-point Trial (ONTARGET),2 which compared the angiotensin receptor antagonist telmisartan and the angiotensin-converting enzyme inhibitor ramipril for the treatment of hypertension. That trial,2 published in 2008, found that telmisartan was equally effective to ramipril, with fewer incidences of angioedema. Participants who received both drugs experienced more adverse events but no increase in benefits.
Califf RM. Comparison of Observational Data and the ONTARGET Results for Telmisartan Treatment of Hypertension: Bull’s-eye or Painting the Target Around the Arrow? JAMA Intern Med. 2018;178(1):63–65. doi:10.1001/jamainternmed.2017.5091
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