A dynamic treatment regimes (DTR) represents a statistical paradigm in precision medicine which aims to optimize patient outcomes by individualizing treatments. At its simplest, a DTR may require only a single decision to be made; this special case is called an individualized treatment rule (ITR) and is often used to maximize short-term rewards. Generalized dynamic weighted ordinary least squares (G-dWOLS), a DTR estimation method that offers theoretical advantages such as double robustness of parameter estimators in the decision rules, has been recently extended to accommodate categorical treatments. In this work G-dWOLS is applied to longitudinal data to estimate an optimal ITR. This novel method is demonstrated in simulations and is then applied to a population affected by HIV, whereby an ITR for the administration of Interleukin 7 (IL-7) is devised to maximize the duration where the CD4 load is above a healthy threshold (500 cells/μL) while preventing the administration of unnecessary injections.
LD is highly appreciative of the financial support from the Institute of Data Valorisation (IVADO), the Fonds de recherche du Québec—Nature et Technologies (FRQNT) and the Faculty of Medicine at McGill University. This work was conducted as part of LD’s dual degree MSc program at McGill University and the University of Bordeaux. EEMM is a Canada Research Chair (Tier 1) and acknowledges support from a Discovery Grant from the Natural Sciences and Engineering Research Council (NSERC) of Canada and a chercheur de merite career award from the Fonds de recherche du Québec—Santé (FRQS). We also thank the main investigators and supervisors of the INSPIRE trials: Jean-Pierre Routy, Irini Sereti, Margaret Fischl, Prudence Ive, Roberto F. Speck, Gianpiero D’Offizi, Salvatore Casari, Sharne Foulkes, Ven Natarajan, Thérèse Croughs, Jean-François Delfraissy, Guiseppe Tambussi, Yves Levy and Michael M. Lederman. The Digital Public Health Graduate Program is supported within the framework of the PIA3 (Investment for the future). Project reference 17-EURE-0019.
"Evaluating the use of generalized dynamic weighted ordinary least squares for individualized HIV treatment strategies." Ann. Appl. Stat. 17 (3) 2432 - 2451, September 2023. https://doi.org/10.1214/22-AOAS1726