[Skip to Content]
[Skip to Content Landing]
Comment & Response
March 2019

Finding Benefit in n-of-1 Trials

Author Affiliations
  • 1The University of Queensland, Brisbane, Queensland, Australia
  • 2Queensland University of Technology, Brisbane, Queensland, Australia
  • 3Tulane University, New Orleans, Louisiana
JAMA Intern Med. 2019;179(3):454-455. doi:10.1001/jamainternmed.2018.8382

To the Editor We read with interest the recent article by Kravitz and colleagues1 describing a randomized clinical trial comparing n-of-1 trials with standard care for treatment of chronic musculoskeletal pain.

The goal of the study was to establish the “benefits of participating in an n-of-1 trial, not to assess the superiority or inferiority of any particular treatment.”1(1369) However, there appears to be a disconnect between the study goal and the choice of outcomes, which were focused on pain interference scores across different treatment regimens. Therefore, the null results should be interpreted with respect to treatment efficacy, not design. The n-of-1 participants who demonstrated a better response to 1 of 2 treatments were likely to experience improved pain outcomes as a result of continuing to receive the superior treatment. However, there was a high proportion (>75%) of n-of-1 participants who had no treatment superiority, and this may explain the trial’s findings.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    ×