%0 Journal Article
%T Therapeutic Success Is Misclassified When Biomarkers Improve but the Medication Work Required from Patients Becomes Unsustainable
%A Nina Larsen
%A Ahmed Mansour
%A Julia Fischer
%J Annals of Pharmacy Practice and Pharmacotherapy
%@ 3062-4436
%D 2024
%V 4
%N 2
%R 10.51847/xB0VMtRha0
%P 114-124
%X To develop a methodological approach for classifying treatment outcomes when biological or clinical markers improve while the work required to sustain treatment becomes difficult, disruptive, or unacceptable to patients. A construct-explicit methodological synthesis was undertaken across literature addressing treatment burden, patient work, patient-reported outcomes, medication adherence and persistence, surrogate endpoints, functional outcomes, patient preferences, and value assessment. Biological response, symptom or functional response, treatment workload, experienced treatment burden, persistence feasibility, and patient-valued benefit were treated as analytically distinct constructs. Rules were specified for recognizing discordance among these domains and for preventing adherence, biomarker change, or treatment-burden scores from being used as interchangeable proxies. No patient-level dataset was created, no empirical threshold was estimated, and no composite score was derived. Biological improvement can coexist with high treatment workload, reduced capacity to sustain treatment, limited functional improvement, or unfavorable patient evaluation. Conversely, demanding treatment can remain sustainable when its benefits are substantial, the workload is bounded or supported, and the patient considers the trade-off worthwhile. Observed adherence or persistence does not establish low treatment burden, and nonpersistence does not establish that burden caused discontinuation. Biomarker improvement represents biological response unless direct patient-important evidence or an adequately justified surrogate relationship supports broader inference. Sustainable treatment success is therefore better treated as a multidomain interpretation than as a synonym for favorable biological response. Health-outcome assessment can misclassify treatment success when biological improvement is recorded without examining the work required to produce and maintain it. Biological response, treatment-work sustainability, patient-important outcomes, and persistence should be measured separately before preference-sensitive weighting or value assessment. The proposed approach is a testable methodological specification rather than a validated scoring instrument.
%U https://galaxypub.co/article/therapeutic-success-is-misclassified-when-biomarkers-improve-but-the-medication-work-required-from-p-0jj4zpgrjibfjmb