Interpreting Indirect Treatment Comparisons and Network Meta-Analysis for Health-Care Decision Making: Report of the ISPOR Task Force on Indirect Treatment Comparisons Good Research Practices: Part 1

Mapi Values, Boston, MA, USA.
Value in Health (Impact Factor: 3.28). 06/2011; 14(4):417-28. DOI: 10.1016/j.jval.2011.04.002
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Evidence-based health-care decision making requires comparisons of all relevant competing interventions. In the absence of randomized, controlled trials involving a direct comparison of all treatments of interest, indirect treatment comparisons and network meta-analysis provide useful evidence for judiciously selecting the best choice(s) of treatment. Mixed treatment comparisons, a special case of network meta-analysis, combine direct and indirect evidence for particular pairwise comparisons, thereby synthesizing a greater share of the available evidence than a traditional meta-analysis. This report from the ISPOR Indirect Treatment Comparisons Good Research Practices Task Force provides guidance on the interpretation of indirect treatment comparisons and network meta-analysis to assist policymakers and health-care professionals in using its findings for decision making. We start with an overview of how networks of randomized, controlled trials allow multiple treatment comparisons of competing interventions. Next, an introduction to the synthesis of the available evidence with a focus on terminology, assumptions, validity, and statistical methods is provided, followed by advice on critically reviewing and interpreting an indirect treatment comparison or network meta-analysis to inform decision making. We finish with a discussion of what to do if there are no direct or indirect treatment comparisons of randomized, controlled trials possible and a health-care decision still needs to be made.

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    • "Interpretation guidelines are available for the readers of both traditional meta-analyses (Greenhalgh, 1997; Leucht, Kissling, & Davis, 2009; Oxman, Cook, & Guyatt, 1994) and network meta-analyses (Jansen et al., 2011; Mills et al., 2012). A structured approach to the appraisal of empirical evidence from meta-analyses (and from other studies) is oered by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system (GRADE Working Group, 2004; Guyatt et al., 2008), which has also been adapted to evidence from network-meta-analyses (Puhan et al., 2014; Salanti et al., 2014). "
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    ABSTRACT: In this chapter, an introductory overview on various evidence synthesis methods is given. A particular focus is set on the systematic reviews and meta-analyses of randomized controlled trials. Preparation, reporting, and interpretation of meta-analyses are addressed with a non-technical guidance to the most widespread statistical procedures and the underlying assumptions behind them. In addition to describing traditional evidence synthesis approaches contrasting two treatment options, the tools, challenges, and pitfalls of indirect and multiple treatment comparison (network) meta-analyses are discussed. A case study on antimanic drug treatments for acute mania in bipolar disorder is used throughout the chapter for illustration. Above the role of meta-analysis as a scientific method, its relevance and applicability in real-life treatment decision making is outlined. At last, current developments in the methodology of evidence synthesis methods in general are highlighted.
    The Bipolar Book: History, Neurobiology, and Treatment, Edited by Aysegul Yildiz, Pedro Ruiz, Charles Nemeroff, 08/2015: chapter 45: pages 649-672; Oxford University Press.
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    • "include both direct and indirect comparisons) [7], [8]. We used a stepwise approach [15], [16], first performing multiple pairwise meta-analyses of the direct comparisons of each of the combination treatments versus single DMARD followed by an indirect comparison of the pooled results of each of these meta-analyses. As the outcome measure (radiographic progression) was estimated at different time points (6–24 months) and as the maximum score of the different scoring systems (Sharp, Larsen) differed, we standardized the outcome measure by dividing the outcome with the SD, thus converting the outcome unit to the unitless standardized mean difference (SMD) [13]. "
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    ABSTRACT: Background Despite significant cost differences, the comparative effect of combination treatments of disease modifying anti-rheumatic drugs (DMARDs) with and without biologic agents has rarely been examined. Thus we performed a network meta-analysis on the effect of combination therapies on progression of radiographic joint erosions in patients with rheumatoid arthritis (RA). Methods and Findings The following combination drug therapies compared versus single DMARD were investigated: Double DMARD: 2 DMARDs (methotrexate, sulfasalazine, leflunomide, injectable gold, cyclosporine, chloroquine, azathioprin, penicillamin) or 1 DMARD plus low dose glucocorticoid (LDGC); triple DMARD: 3 DMARDs or 2 DMARDs plus LDGC; biologic combination: 1 DMARD plus biologic agent (tumor necrosis factor α inhibitor (TNFi) or abatacept or tocilizumab or CD20 inhibitor (CD20i)). Randomized controlled trials were identified in a search of electronic archives of biomedical literature and included in a star-shaped network meta-analysis and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement protocol. Effects are reported as standardized mean differences (SMD). The effects of data from 39 trials published in the period 1989–2012 were as follows: Double DMARD: −0.32 SMD (CI: −0.42, −0.22); triple DMARD: −0.46 SMD (CI: −0.60, −0.31); 1 DMARD plus TNFi: −0.30 SMD (CI: −0.36, −0.25); 1 DMARD plus abatacept: −0.20 SMD (CI: −0.33, −0.07); 1 DMARD plus tocilizumab: −0.34 SMD (CI: −0.48, −0.20); 1 DMARD plus CD20i: −0.32 SMD (CI: −0.40, −0.24). The indirect comparisons showed similar effects between combination treatments apart from triple DMARD being significantly better than abatacept plus methotrexate (−0.26 SMD (CI: −0.45, −0.07)) and TNFi plus methotrexate (−0.16 SMD (CI: −0.31, −0.01)). Conclusion Combination treatment of a biologic agent with 1 DMARD is not superior to 2–3 DMARDs including or excluding LDGC in preventing structural joint damage. Future randomized studies of biologic agents should be compared versus a combination of DMARDs.
    PLoS ONE 09/2014; 9(9-9):e106408-. DOI:10.1371/journal.pone.0106408 · 3.23 Impact Factor
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    • "Therefore, it is challenging for dentists to select the most appropriate medicaments, and the relative effectiveness of those treatments remains uncertain. Traditional meta-analysis undertakes pair-wise comparisons between treatments, but when the number of available treatments is large, pair-wise comparisons may be inefficient or not feasible [25] [26] [27] [28]. Network meta-analysis is a methodology for direct and indirect statistical comparisons between different treatments and had been used in dental research [25] [26] [29]. "
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    ABSTRACT: Objective Pulpotomy is a common procedure to treat asymptomatic reversible pulpitis in primary molars. The aim of this study is to undertake a systematic review and a network meta-analysis to compare the clinical and radiographic outcomes of different pulpotomy procedures in primary molars. Data: Three authors performed data extraction independently and in duplicate using data collection forms. Disagreements were resolved by discussion. Sources: An electronic literature search was performed within MEDLINE (via PubMed), ScienceDirect, Web of Science, Cochrane, and ClinicalKey databases until December 2012. Medications for pulpotomy including formocresol, ferric sulfate, calcium hydroxide, and mineral trioxide aggregate (MTA), and laser pulpotomy are compared using Bayesian network meta-analyses. The outcome is the odds ratio for clinical and radiographic failure including premature tooth loss at 12 and 24 months after treatments amongst different treatment procedures. >37 studies were included in the systematic review, and 22 of them in the final network meta-analyses. After 18-24 months, in terms of treatment failure, the odds ratio for calcium hydroxide vs formocresol was 1.94 [95% credible interval (CI): 1.11, 3.25]; 3.88 (95% CI: 1.37, 8.61) for lasers vs formocresol; 2.16 (95% CI: 1.12, 4.31) for calcium hydroxide vs ferric sulfate; 3.73 (95% CI: 1.27, 11.67) for lasers vs ferric sulfate; 0.47 (95% CI: 0.26, 0.83) for MTA vs calcium hydroxide; 3.76 (95% CI: 1.39, 10.08) for lasers vs MTA. Conclusions After 18-24 months, formocresol, ferric sulfate, and MTA showed significantly better clinical and radiographic outcomes than calcium hydroxide and laser therapies in primary molar pulpotomies. Clinical significance: The network meta-analyses showed that MTA is the first choice for primary molar pulpotomies. However, if treatment cost is an issue, especially when the treated primary molars are going to be replaced by permanent teeth, ferric sulfate may be the choice.
    Journal of dentistry 09/2014; 42(9). DOI:10.1016/j.jdent.2014.02.001 · 2.75 Impact Factor
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