Network meta-analysis of drugs
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1 / 2 Network meta-analysis of drugs Leo M.L. Stolk Nr 8 | 2020 (54) | Page 89-95 | New | doi: 10.35351/gebu.2020.8.15 | 18-08-2020 Tags network meta-analysis bias effect modifier drugs ranking consistency check statistical test The literature shows that the use of network meta-analysis is increasing. Unlike ordinary meta-analysis, network meta- analysis enables more than two drugs with the same indication to be compared, even if these drugs have never been directly compared. In addition, network analysis can rank drugs in order of efficacy. However, performing a network meta-analysis requires specific methodological knowledge, and evaluating the results is often more difficult than with meta-analyses. Sometimes it is even impossible to estimate their value because the statistical tests to check the quality are too limited or because the researchers provide insufficient information about the precise way they implemented the network meta-analysis and the exact way they checked the results. Ge-Bu Indication One advantage of network meta-analysis is the opportunity it provides to compare more than two drugs, even if these drugs have not been directly compared. The second advantage is the opportunity to rank drugs in order of efficacy. Performing a network meta-analysis is labour-intensive and requires specific methodological expertise. The results of network meta-analyses need to be interpreted with caution. For readers it can be complicated or even impossible to determine the quality of the usually lengthy papers. Network meta-analyses have to offer sufficient information about the implementation and statistical checks, such as checks on consistency, on factors that can influence the outcome (effect modifiers) and on bias in the enclosed studies. Literature references 1. Dekkers OM. Meta-analyse mogelijkheden en beperkingen. Gebu. 2012;46(8):85-92 2. Dekkers OM. Meta-analysis: Key features, potentials and misunderstandings. Res Pract Thromb Haemost. 2018;2(4):658-663. Published 2018 Oct 3. doi:10.1002/rth2.12153 3. Faltinsen EG, Storebø OJ, Jakobsen JC, Boesen K, Lange T, Gluud C. Network meta-analysis: the highest level of medical evidence?. BMJ Evid Based Med. 2018;23(2):56-59. doi:10.1136/bmjebm-2017-110887 4. Thorlund K, Mills EJ. Sample size and power considerations in network meta-analysis. Syst Rev. 2012;1:41. Published 2012 Sep 19. doi:10.1186/2046-4053-1-41 5. Al Wattar BH, Zamora J, Khan KS. Informing treatment decisions through meta-analysis: to network or not? Evid Based Med. 2017;22(1):12-15. doi:10.1136/ebmed-2016-110599 6. Rouse B, Cipriani A, Shi Q, Coleman AL, Dickersin K, Li T. Network Meta-analysis for Clinical Practice Guidelines: A Case Study on First-Line Medical Therapies for Primary Open-Angle Glaucoma. Ann Intern Med. 2016;164(10):674- 682. doi:10.7326/M15-2367
Transcript of Network meta-analysis of drugs
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Network meta-analysis of drugsLeo M.L. StolkNr 8 | 2020 (54) | Page 89-95 | New | doi: 10.35351/gebu.2020.8.15 | 18-08-2020
Tagsnetwork meta-analysis bias effect modifier drugs ranking consistency check statistical test
The literature shows that the use of network meta-analysis is increasing. Unlike ordinary meta-analysis, network meta-analysis enables more than two drugs with the same indication to be compared, even if these drugs have never beendirectly compared. In addition, network analysis can rank drugs in order of efficacy. However, performing a networkmeta-analysis requires specific methodological knowledge, and evaluating the results is often more difficult than withmeta-analyses. Sometimes it is even impossible to estimate their value because the statistical tests to check the qualityare too limited or because the researchers provide insufficient information about the precise way they implemented thenetwork meta-analysis and the exact way they checked the results.
Ge-Bu IndicationOne advantage of network meta-analysis is the opportunity it provides to compare morethan two drugs, even if these drugs have not been directly compared.The second advantage is the opportunity to rank drugs in order of efficacy. Performing a network meta-analysis is labour-intensive and requires specificmethodological expertise. The results of network meta-analyses need to be interpreted with caution. For readers itcan be complicated or even impossible to determine the quality of the usually lengthypapers.Network meta-analyses have to offer sufficient information about the implementationand statistical checks, such as checks on consistency, on factors that can influence theoutcome (effect modifiers) and on bias in the enclosed studies.
Literature references1. Dekkers OM. Meta-analyse mogelijkheden en beperkingen. Gebu. 2012;46(8):85-922. Dekkers OM. Meta-analysis: Key features, potentials and misunderstandings. Res Pract Thromb Haemost.
2018;2(4):658-663. Published 2018 Oct 3. doi:10.1002/rth2.121533. Faltinsen EG, Storebø OJ, Jakobsen JC, Boesen K, Lange T, Gluud C. Network meta-analysis: the highest level of
medical evidence?. BMJ Evid Based Med. 2018;23(2):56-59. doi:10.1136/bmjebm-2017-1108874. Thorlund K, Mills EJ. Sample size and power considerations in network meta-analysis. Syst Rev. 2012;1:41.
Published 2012 Sep 19. doi:10.1186/2046-4053-1-415. Al Wattar BH, Zamora J, Khan KS. Informing treatment decisions through meta-analysis: to network or not? Evid
Based Med. 2017;22(1):12-15. doi:10.1136/ebmed-2016-1105996. Rouse B, Cipriani A, Shi Q, Coleman AL, Dickersin K, Li T. Network Meta-analysis for Clinical Practice Guidelines: A
Case Study on First-Line Medical Therapies for Primary Open-Angle Glaucoma. Ann Intern Med. 2016;164(10):674-682. doi:10.7326/M15-2367
7. Rouse B, Chaimani A, Li T. Network meta-analysis: an introduction for clinicians. Intern Emerg Med.2017;12(1):103-111. doi:10.1007/s11739-016-1583-7
8. Dias S, Caldwell DM. Network meta-analysis explained. Arch Dis Child Fetal Neonatal Ed. 2019;104(1):F8-F12.doi:10.1136/archdischild-2018-315224
9. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook forSystematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane, 2019. Chapter 11 Chaimani A,Caldwell DM, Li T, Higgins JPT, Salanti G. Undertaking network meta-analyses. Via: https://training.cochrane.org/handbook/current Geraadpleegd op 24-05-2020
10. Hutton B, Salanti G, Caldwell DM, et al. The PRISMA extension statement for reporting of systematic reviewsincorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med.2015;162(11):777-784. doi:10.7326/M14-2385
11. Veroniki AA, Mavridis D, Higgins JP, Salanti G. Characteristics of a loop of evidence that affect detection andestimation of inconsistency: a simulation study. BMC Med Res Methodol. 2014;14:106. Published 2014 Sep 19.doi:10.1186/1471-2288-14-106
12. Kovic B, Zoratti MJ, Michalopoulos S, Silvestre C, Thorlund K, Thabane L. Deficiencies in addressing effectmodification in network meta-analyses: a meta-epidemiological survey. J Clin Epidemiol. 2017;88:47-56.doi:10.1016/j.jclinepi.2017.06.004
13. Nikolakopoulou A, Chaimani A, Veroniki AA, Vasiliadis HS, Schmid CH, Salanti G. Characteristics of networks ofinterventions: a description of a database of 186 published networks. PLoS One. 2014;9(1):e86754. Published2014 Jan 22. doi:10.1371/journal.pone.0086754
14. Tonin FS, Borba HH, Leonart LP, et al. Methodological quality assessment of network meta-analysis of druginterventions: implications from a systematic review. Int J Epidemiol. 2019;48(2):620-632. doi:10.1093/ije/dyy197
15. Cipriani A, Higgins JP, Geddes JR, Salanti G. Conceptual and technical challenges in network meta-analysis. AnnIntern Med. 2013;159(2):130-137. doi:10.7326/0003-4819-159-2-201307160-00008
16. Mills EJ, Ioannidis JP, Thorlund K, Schünemann HJ, Puhan MA, Guyatt GH. How to use an article reporting amultiple treatment comparison meta-analysis. JAMA. 2012;308(12):1246-1253. doi:10.1001/2012.jama.11228
17. Chaimani A, Salanti G, Leucht S, Geddes JR, Cipriani A. Common pitfalls and mistakes in the set-up, analysis andinterpretation of results in network meta-analysis: what clinicians should look for in a published article. EvidBased Ment Health. 2017;20(3):88-94. doi:10.1136/eb-2017-102753
18. Huhn M, Nikolakopoulou A, Schneider-Thoma J, et al. Comparative efficacy and tolerability of 32 oralantipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review andnetwork meta-analysis [published correction appears in Lancet. 2019 Sep 14;394(10202):918]. Lancet.2019;394(10202):939-951. doi:10.1016/S0140-6736(19)31135-3
19. National Institute for Health Research. International Prospective Register of systematic reviews. Via: https://www2.le.ac.uk/library/find/databases/p/Prospero Geraadpleegd op 24-07-2020
20. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews andmeta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006-1012.doi:10.1016/j.jclinepi.2009.06.005
AuthorsStolk, dr
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