Après une décennie de « buzz » : quelle pertinence pour le concept de modèle d’affaires en stratégie?

Une dizaine d’années après la renaissance manifeste de l’intérêt des praticiens, puis des chercheurs, pour le concept de modèle d’affaires (business model), la question de sa pertinence au regard des concepts et des outils existants en stratégie persiste. Concept polysémique? Concept « valise »? Concept utile? Concept durable? Autant de questions qui, au-delà de la popularité du concept, nous invitent à porter un regard à la fois critique et constructif sur le modèle d’affaires dans le champ du management stratégique.Alors que notre pratique d’enseignement de la stratégie et d’accompagnement de projets d’innovation nous amenait à questionner la pertinence du concept/outil du modèle d’affaires, il nous sembla qu’un tour de table s’imposait pour tenter de répondre aux questions soulevées. Ce tour de table s’est tenu le 8 juin 2011 lors de la XXe conférence de l’Association Internationale de Management Stratégique (AIMS) à Nantes. Ce petit ouvrage a pour but de faire partager au lecteur l’intégralité des propos échangés ce jour-là

Evaluation of Study and Patient Characteristics of Clinical Studies in Primary Progressive Multiple Sclerosis: A Systematic Review

<div><p>Background</p><p>So far, clinical studies in primary progressive MS (PPMS) have failed to meet their primary efficacy endpoints. To some extent this might be attributable to the choice of assessments or to the selection of the study population.</p><p>Objective</p><p>The aim of this study was to identify outcome influencing factors by analyzing the design and methods of previous randomized studies in PPMS patients without restriction to intervention or comparator.</p><p>Methods</p><p>A systematic literature search was conducted in MEDLINE, EMBASE, BIOSIS and the COCHRANE Central Register of Controlled Trials (inception to February 2015). Keywords included PPMS, primary progressive multiple sclerosis and chronic progressive multiple sclerosis. Randomized, controlled trials of at least one year’s duration were selected if they included only patients with PPMS or if they reported sufficient PPMS subgroup data. No restrictions with respect to intervention or comparator were applied. Study quality was assessed by a biometrics expert. Relevant baseline characteristics and outcomes were extracted and compared.</p><p>Results</p><p>Of 52 PPMS studies identified, four were selected. Inclusion criteria were notably different among studies with respect to both the definition of PPMS and the requirements for the presence of disability progression at enrolment. Differences between the study populations included the baseline lesion load, pretreatment status and disease duration. The rate of disease progression may also be an important factor, as all but one of the studies included a large proportion of patients with a low progression rate. In addition, the endpoints specified could not detect progression adequately.</p><p>Conclusion</p><p>Optimal PPMS study methods involve appropriate patient selection, especially regarding the PPMS phenotype and progression rate. Functional composite endpoints might be more sensitive than single endpoints in capturing progression.</p></div

Disability Progression.

<p>CDP: Clinical disability progression; CI: Confidence-interval; n/a: not available.</p><p>^a: no group-specific data available</p><p>Definition of clinical disability progression: PROMiSe: sustained EDSS increase of ≥1.0 point in patients with a EDSS score at baseline of 3.0 to 5.0, or a sustained EDSS increase of ≥0.5 in patients with a baseline EDSS score of 5.5 to 6.5. OLYMPUS: sustained EDSS increase of ≥1.0 point in patients with a EDSS score at baseline of 2.0 to 5.5 points (inclusive), or a sustained EDSS increase of ≥0.5 point in patients with a baseline EDSS score of >5.5 points. Poehlau: sustained EDSS increase of ≥1.0 point in patients with a EDSS score at baseline of ≤5.0, or a sustained EDSS increase by ≥0.5 points, in patients with an EDSS score at baseline of >5.0. Leary: sustained EDSS increase of ≥1.0 point for patients with a baseline EDSS score ≤5.0, or a sustained EDSS increase of ≥0.5 point for patients with a baseline EDSS of ≥5.5.</p><p>Disability Progression.</p

Median change from baseline in T25W in the OLYMPUS study (reported by Hawker et al. as z-score; the Z-score is calculated by subtracting the baseline mean from each individual test result and then dividing by the standard deviation of the baseline values to obtain a standardized score for each individual); * p<0.05 compared to placebo.

<p>Median change from baseline in T25W in the OLYMPUS study (reported by Hawker et al. as z-score; the Z-score is calculated by subtracting the baseline mean from each individual test result and then dividing by the standard deviation of the baseline values to obtain a standardized score for each individual); * p<0.05 compared to placebo.</p

PRISMA Flow-chart

<p>(From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097).</p

Results from the timed 10-meter walk in the study by Leary et al. (median time in seconds).

<p>Results from the timed 10-meter walk in the study by Leary et al. (median time in seconds).</p

Published results—Baseline characteristics.

<p>GA: Glatiramer acetate; IVIg: intravenous immunoglobulin; IFN: Interferon; n/a: not available; yrs: years</p><p>^a: the publication does not name, whether duration since diagnosis or since first symptom is reported. It is assumed, that the value refers to the duration since first symptom.</p><p>Published results—Baseline characteristics.</p