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Kokaliaris C, Evans R, Hawkins N, Mahajan A, Scott DA, Sutherland CS, Nam J, Sajeev G. Long-Term Comparative Efficacy and Safety of Risdiplam and Nusinersen in Children with Type 1 Spinal Muscular Atrophy. Adv Ther 2024; 41:2414-2434. [PMID: 38705943 PMCID: PMC11133132 DOI: 10.1007/s12325-024-02845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/13/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Spinal muscular atrophy (SMA) is a severe genetic neuromuscular disease characterized by a loss of motor neurons and progressive muscle weakness. Children with untreated type 1 SMA never sit independently and require increasing levels of ventilatory support as the disease progresses. Without intervention, and lacking ventilatory support, death typically occurs before the age of 2 years. There are currently no head-to-head trials comparing available treatments in SMA. Indirect treatment comparisons are therefore needed to provide information on the relative efficacy and safety of SMA treatments for healthcare decision-making. METHODS The long-term efficacy and safety of risdiplam versus nusinersen in children with type 1 SMA was evaluated using indirect treatment comparison methodology to adjust for differences between population baseline characteristics, to reduce any potential bias in the comparative analysis. An unanchored matching-adjusted indirect comparison was conducted using risdiplam data from 58 children in FIREFISH (NCT02913482) and published aggregate nusinersen data from 81 children obtained from the ENDEAR (NCT02193074) and SHINE (NCT02594124) clinical trials with at least 36 months of follow-up. RESULTS Children with type 1 SMA treated with risdiplam had a 78% reduction in the rate of death, an 81% reduction in the rate of death or permanent ventilation, and a 57% reduction in the rate of serious adverse events compared with children treated with nusinersen. Children treated with risdiplam also had a 45% higher rate of achieving a Hammersmith Infant Neurological Examination, Module 2 motor milestone response and a 186% higher rate of achieving a ≥ 4-point improvement in Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders compared with children treated with nusinersen. CONCLUSION Long-term data supported risdiplam as a superior alternative to nusinersen in children with type 1 SMA. Video abstract available for this article. Video abstract (MP4 184542 KB).
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Affiliation(s)
| | | | - Neil Hawkins
- Visible Analytics, Oxford, UK
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | | | | | | | - Julian Nam
- F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, 4070, Basel, Switzerland
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Leininger BD, Johnson PJ, Bronfort G, Kuntz KM, Enns E, Hodges JS, Evans R. How well do participants in clinical trials represent the U.S. population with chronic neck or back pain? BMC Musculoskelet Disord 2024; 25:414. [PMID: 38802802 PMCID: PMC11129496 DOI: 10.1186/s12891-024-07524-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 05/14/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Randomized clinical trials (RCTs) are the gold standard for assessing treatment effectiveness; however, they have been criticized for generalizability issues such as how well trial participants represent those who receive the treatments in clinical practice. We assessed the representativeness of participants from eight RCTs for chronic spine pain in the U.S., which were used for an individual participant data meta-analysis on the cost-effectiveness of spinal manipulation for spine pain. In these clinical trials, spinal manipulation was performed by chiropractors. METHODS We conducted a retrospective secondary analysis of RCT data to compare trial participants' socio-demographic characteristics, clinical features, and health outcomes to a representative sample of (a) U.S. adults with chronic spine pain and (b) U.S. adults with chronic spine pain receiving chiropractic care, using secondary data from the National Health Interview Survey (NHIS) and Medical Expenditure Panel Survey (MEPS). We assessed differences between trial and U.S. spine populations using independent t-tests for means and z-tests for proportions, accounting for the complex multi-stage survey design of the NHIS and MEPS. RESULTS We found the clinical trials had an under-representation of individuals from health disparity populations with lower percentages of racial and ethnic minority groups (Black/African American 7% lower, Hispanic 8% lower), less educated (No high school degree 19% lower, high school degree 11% lower), and unemployed adults (25% lower) with worse health outcomes (physical health scores 2.5 lower and mental health scores 5.3 lower using the SF-12/36) relative to the U.S. population with spine pain. While the odds of chiropractic use in the U.S. are lower for individuals from health disparity populations, the trials also under-represented these populations relative to U.S. adults with chronic spine pain who visit a chiropractor. CONCLUSIONS Health disparity populations are not well represented in spine pain clinical trials. Embracing key community-based approaches, which have shown promise for increasing participation of underserved communities, is needed.
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Affiliation(s)
- Brent D Leininger
- Integrative Health and Wellbeing Research Program Earl E. Bakken Center for Spirituality & Healing, University of Minnesota, Mayo Memorial Building C504, 420 Delaware Street, Minneapolis, MN, 55414, USA.
| | - Pamela Jo Johnson
- Department of Public Health, North Dakota State University, 640R Aldevron Tower, 1455 14th Ave N, Fargo, ND, 58102, USA
| | - Gert Bronfort
- Integrative Health and Wellbeing Research Program Earl E. Bakken Center for Spirituality & Healing, University of Minnesota, Mayo Memorial Building C504, 420 Delaware Street, Minneapolis, MN, 55414, USA
| | - Karen M Kuntz
- Division of Health Policy & Management School of Public Health, University of Minnesota, 420 Delaware St SE, MMC 729 Mayo, Minneapolis, MN, 55455, USA
| | - Eva Enns
- Division of Health Policy & Management School of Public Health, University of Minnesota, 420 Delaware St SE, MMC 729 Mayo, Minneapolis, MN, 55455, USA
| | - James S Hodges
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE, Room 200 University Office Plaza, Minneapolis, MN, 55414, USA
| | - Roni Evans
- Integrative Health and Wellbeing Research Program Earl E. Bakken Center for Spirituality & Healing, University of Minnesota, Mayo Memorial Building C504, 420 Delaware Street, Minneapolis, MN, 55414, USA
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Zhang I, Jansen JP, Yungher BJ, Kielhorn A, Yee KS. Commentary: Efficacy and safety of the innovative monoclonal antibodies in adults with generalized myasthenia gravis: a Bayesian network analysis. Front Immunol 2024; 15:1403802. [PMID: 38827748 PMCID: PMC11141541 DOI: 10.3389/fimmu.2024.1403802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/12/2024] [Indexed: 06/04/2024] Open
Affiliation(s)
- Ina Zhang
- Evidence Synthesis and Decision Modeling, PRECISIONheor, Oakland, CA, United States
| | - Jeroen P. Jansen
- Evidence Synthesis and Decision Modeling, PRECISIONheor, Oakland, CA, United States
| | | | - Adrian Kielhorn
- Alexion, AstraZeneca Rare Disease, Boston, MA, United States
| | - Karen S. Yee
- Alexion, AstraZeneca Rare Disease, Boston, MA, United States
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Spineli LM, Kalyvas C, Yepes-Nuñez JJ, García-Sierra AM, Rivera-Pinzón DC, Seide SE, Papadimitropoulou K. Low awareness of the transitivity assumption in complex networks of interventions: a systematic survey from 721 network meta-analyses. BMC Med 2024; 22:112. [PMID: 38475826 DOI: 10.1186/s12916-024-03322-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The transitivity assumption is the cornerstone of network meta-analysis (NMA). Violating transitivity compromises the credibility of the indirect estimates and, by extent, the estimated treatment effects of the comparisons in the network. The present study offers comprehensive empirical evidence on the completeness of reporting and evaluating transitivity in systematic reviews with multiple interventions. METHODS We screened the datasets of two previous empirical studies, resulting in 361 systematic reviews with NMA published between January 2011 and April 2015. We updated our evidence base with an additional 360 systematic reviews with NMA published between 2016 and 2021, employing a pragmatic approach. We devised assessment criteria for reporting and evaluating transitivity using relevant methodological literature and compared their reporting frequency before and after the PRISMA-NMA statement. RESULTS Systematic reviews published after PRISMA-NMA were more likely to provide a protocol (odds ratio (OR): 3.94, 95% CI: 2.79-5.64), pre-plan the transitivity evaluation (OR: 3.01, 95% CI: 1.54-6.23), and report the evaluation and results (OR: 2.10, 95% CI: 1.55-2.86) than those before PRISMA-NMA. However, systematic reviews after PRISMA-NMA were less likely to define transitivity (OR: 0.57, 95% CI: 0.42-0.79) and discuss the implications of transitivity (OR: 0.48, 95% CI: 0.27-0.85) than those published before PRISMA-NMA. Most systematic reviews evaluated transitivity statistically than conceptually (40% versus 12% before PRISMA-NMA, and 54% versus 11% after PRISMA-NMA), with consistency evaluation being the most preferred (34% before versus 47% after PRISMA-NMA). One in five reviews inferred the plausibility of the transitivity (22% before versus 18% after PRISMA-NMA), followed by 11% of reviews that found it difficult to judge transitivity due to insufficient data. In justifying their conclusions, reviews considered mostly the comparability of the trials (24% before versus 30% after PRISMA-NMA), followed by the consistency evaluation (23% before versus 16% after PRISMA-NMA). CONCLUSIONS Overall, there has been a slight improvement in reporting and evaluating transitivity since releasing PRISMA-NMA, particularly in items related to the systematic review report. Nevertheless, there has been limited attention to pre-planning the transitivity evaluation and low awareness of the conceptual evaluation methods that align with the nature of the assumption.
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Affiliation(s)
- Loukia M Spineli
- Midwifery Research and Education Unit (OE 9210), Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Chrysostomos Kalyvas
- Biostatistics and Research Decision Sciences, MSD Europe Inc., Brussels, Belgium
| | - Juan Jose Yepes-Nuñez
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
- Pulmonology Service, Internal Medicine Section, Fundación Santa Fe de Bogotá University Hospital, Bogotá, Colombia
| | - Andrés Mauricio García-Sierra
- School of Medicine, Universidad de los Andes, Bogotá, Colombia
- School of Global Health Management and Informatics, University of Central Florida, Orlando, USA
| | | | - Svenja E Seide
- Institute of Medical Biometry, University Hospital Heidelberg, Heidelberg, Germany
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Bartoszko JJ, Gutiérrez García M, Díaz Martínez JP, Yegorov S, Brignardello-Petersen R, Mertz D, Thabane L, Loeb M. Conduct and reporting of multivariate network meta-analyses: a scoping review. J Clin Epidemiol 2024; 166:111238. [PMID: 38081440 DOI: 10.1016/j.jclinepi.2023.111238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Combining multivariate and network meta-analysis methods simultaneously in a multivariate network meta-analysis (MVNMA) provides the methodological framework to analyze the largest amount of evidence relevant to decision-makers (i.e., from indirect evidence and correlated outcomes). The objectives of this scoping review were to summarize the characteristics of MVNMAs published in the health sciences literature and map the methodological guidance available for MVNMA. STUDY DESIGN AND SETTING We searched MEDLINE, Embase, and the Cumulative Index to Nursing and Allied Health Literature from inception to 28 August 2023, along with citations of included studies, for quantitative evidence syntheses that applied MVNMA and articles addressing MVNMA methods. Pairs of reviewers independently screened potentially eligible studies. Collected data included bibliographic, methodological, and analytical characteristics of included studies. We reported results as total numbers, frequencies, and percentages for categorical variables and medians and interquartile ranges for continuous variables that were not normally distributed. RESULTS After screening 1,075 titles and abstracts, and 112 full texts, we included 38 unique studies, of which, 10 were quantitative evidence syntheses that applied MVNMA and 28 were articles addressing MVNMA methods. Among the 10 MVNMAs, the first was published in 2013, four used studies identified from already published systematic reviews, and eight addressed pharmacological interventions, which were the most common interventions. They evaluated interventions for metastatic melanoma, colorectal cancer, prostate cancer, oral hygiene, disruptive behavior disorders, rheumatoid arthritis, narcolepsy, type 2 diabetes, and overactive bladder syndrome. Five MVNMAs analyzed two outcomes simultaneously, and four MVNMAs analyzed three outcomes simultaneously. Among the articles addressing MVNMA methods, the first was published in 2007 and the majority provided methodological frameworks for conducting MVNMAs (26/28, 93%). One study proposed criteria to standardize reporting of MVNMAs and two proposed items relevant to the quality assessment of MVNMAs. Study authors used data from 18 different illnesses to provide illustrative examples within their methodological guidance. CONCLUSIONS The application of MVNMA in the health sciences literature is uncommon. Many methodological frameworks are published; however, standardization and specific criteria to guide reporting and quality assessment are lacking. This overview of the current landscape may help inform future conduct of MVNMAs and research on MVNMA methods.
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Affiliation(s)
- Jessica J Bartoszko
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada.
| | - Mayra Gutiérrez García
- Faculty of Science, National Autonomous University of Mexico, University City, Coyoacán, Mexico City 04510, Mexico
| | - Juan Pablo Díaz Martínez
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada
| | - Sergey Yegorov
- Institute for Infectious Disease Research, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada; Department of Biochemistry and Biomedical Sciences, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada
| | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada
| | - Dominik Mertz
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada; Institute for Infectious Disease Research, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada; Department of Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada; Department of Pathology and Molecular Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada; Departments of Anesthesia and Pediatrics, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada; Biostatistics Unit, St. Joseph's Healthcare Hamilton, 50 Charlton Ave E, Hamilton, Ontario L8N 4A6, Canada; Faculty of Health Sciences, University of Johannesburg, 5 Kingsway Ave, Rossmore, Johannesburg 2092, South Africa
| | - Mark Loeb
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada; Institute for Infectious Disease Research, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada; Department of Pathology and Molecular Medicine, McMaster University, 1280 Main St W, Hamilton, Ontario L8S 4L8, Canada
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Lunny C, Veroniki AA, Higgins JPT, Dias S, Hutton B, Wright JM, White IR, Whiting P, Tricco AC. Methodological review of NMA bias concepts provides groundwork for the development of a list of concepts for potential inclusion in a new risk of bias tool for network meta-analysis (RoB NMA Tool). Syst Rev 2024; 13:25. [PMID: 38217041 PMCID: PMC10785511 DOI: 10.1186/s13643-023-02388-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 11/10/2023] [Indexed: 01/14/2024] Open
Abstract
INTRODUCTION Network meta-analyses (NMAs) have gained popularity and grown in number due to their ability to provide estimates of the comparative effectiveness of multiple treatments for the same condition. The aim of this study is to conduct a methodological review to compile a preliminary list of concepts related to bias in NMAs. METHODS AND ANALYSIS We included papers that present items related to bias, reporting or methodological quality, papers assessing the quality of NMAs, or method papers. We searched MEDLINE, the Cochrane Library and unpublished literature (up to July 2020). We extracted items related to bias in NMAs. An item was excluded if it related to general systematic review quality or bias and was included in currently available tools such as ROBIS or AMSTAR 2. We reworded items, typically structured as questions, into concepts (i.e. general notions). RESULTS One hundred eighty-one articles were assessed in full text and 58 were included. Of these articles, 12 were tools, checklists or journal standards; 13 were guidance documents for NMAs; 27 were studies related to bias or NMA methods; and 6 were papers assessing the quality of NMAs. These studies yielded 99 items of which the majority related to general systematic review quality and biases and were therefore excluded. The 22 items we included were reworded into concepts specific to bias in NMAs. CONCLUSIONS A list of 22 concepts was included. This list is not intended to be used to assess biases in NMAs, but to inform the development of items to be included in our tool.
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Affiliation(s)
- Carole Lunny
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada.
- Cochrane Hypertension Review Group, the Therapeutics Initiative, University of British Columbia, Vancouver, Canada.
| | - Areti-Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada
| | - Julian P T Higgins
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Brian Hutton
- Ottawa Hospital Research Institute, Ottawa, Canada
- Ottawa University, School of Epidemiology and Public Health, Ottawa, Canada
| | - James M Wright
- Cochrane Hypertension Review Group, the Therapeutics Initiative, University of British Columbia, Vancouver, Canada
| | | | - Penny Whiting
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 209 Victoria Street, East Building, Toronto, ON, M5B 1T8, Canada
- Dalla Lana School of Public Health & Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Canada
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Valenzuela-López L, Moreno-Verdú M, Cuenca-Zaldívar JN, Romero JP. Effects of Hand Motor Interventions on Cognitive Outcomes Post-stroke: A Systematic Review and Bayesian Network Meta-analysis. Arch Phys Med Rehabil 2024:S0003-9993(24)00029-7. [PMID: 38211761 DOI: 10.1016/j.apmr.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 11/29/2023] [Accepted: 12/14/2023] [Indexed: 01/13/2024]
Abstract
OBJECTIVE To synthetize the evidence on the effects of hand rehabilitation (RHB) interventions on cognition post-stroke and compare their efficacy. DATA SOURCES PubMed, Embase, Cochrane, Scopus, Web of Science, and CINAHL were searched from inception to November 2022. DATA SELECTION Randomized controlled trials conducted in adults with stroke where the effects of hand motor interventions on any cognitive domains were assessed. DATA EXTRACTION Data were extracted by 2 independent reviewers. A Bayesian Network Meta-analysis (NMA) was applied for measures with enough studies and comparisons. Risk of bias was assessed with the Cochrane Risk of Bias tool. DATA SYNTHESIS Fifteen studies were included in qualitative synthesis, and 11 in NMA. Virtual reality (VR) (n=7), robot-assisted (n=5), or handgrip strength (n=3) training were the experimental interventions and conventional RHB (n=14) control intervention. Two separate NMA were performed with MoCA (n=480 participants) and MMSE (n=350 participants) as outcome measures. Both coincided that the most probable best interventions were robot-assisted and strength training, according to SUCRA and rankogram, followed by conventional RHB and VR training. No significant differences between any of the treatments were found in the MoCA network, but in the MMSE, robot-assisted and strength training were significantly better than conventional RHB and VR. No significant differences between robot-assisted and strength training were found nor between conventional RHB and VR. CONCLUSIONS Motor interventions can improve MoCA/MMSE scores post-stroke. Most probable best interventions were robot-assisted and strength training. Limited literature assessing domain-specific cognitive effects was found.
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Affiliation(s)
- Laura Valenzuela-López
- Faculty of Experimental Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain; Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain
| | - Marcos Moreno-Verdú
- Faculty of Experimental Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain; Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain.
| | - Juan Nicolás Cuenca-Zaldívar
- Research Group in Physiotherapy and Pain, Department of Nursing and Physiotherapy, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Spain; Research Group in Nursing and Health Care, Puerta de Hierro Health Research Institute - Segovia de Arana (IDIPHISA), Madrid, Spain; Physical Therapy Unit. Primary Health Care Center "El Abajón", Madrid, Spain; Interdisciplinary Group on Musculoskeletal Disorders, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain
| | - Juan Pablo Romero
- Faculty of Experimental Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain; Brain Injury and Movement Disorders Neurorehabilitation Group (GINDAT), Institute of Life Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Spain; Brain Damage Unit, Beata María Ana Hospital, Madrid, Spain
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Wang P, Zhang Y, Xu W, He J, Peng L, Feng Y, Xu P, Chong W, Hai Y, Jia L, Fang F. Efficacy and Safety of Once-Weekly Insulin Regimes on Glycemic Control for Type 2 Diabetes: A Systematic Review and Network Meta-analysis. Diabetol Metab Syndr 2024; 16:3. [PMID: 38172995 PMCID: PMC10763463 DOI: 10.1186/s13098-023-01240-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Randomized controlled trials have found that once-weekly insulin resulted in greater glycemic control compared to once-daily insulin in patients with type 2 diabetes. However, no direct comparisons have been made between different types of once-weekly insulin thus far. This systematic review and network meta-analysis aimed to evaluate the effect of the two most advanced once-weekly insulin analogues, namely insulin icodec and insulin Fc, in patients with type 2 diabetes. METHODS We conducted a thorough search in the databases PubMed, Embase, and the Cochrane Central Register of Controlled Trials. The search included articles published from the beginning to October 10, 2023, with no language limitations. Our aim was to conduct a systematic review of randomized controlled trials that investigated the effectiveness and safety of once-weekly insulin in individuals with type 2 diabetes. Our primary outcome was to evaluate excellent glycemic control, defined as patients achieving glycated hemoglobin levels below 7%. RESULTS We identified a total of 7 trials involving 2829 patients. The results showed that once-weekly insulin icodec is more effective than once-weekly insulin Fc (RR 1.59 [95% CI 1.08-2.38]), once-daily degludec (RR 1.43 [95% CI 1.14-1.83]), and once-daily glargine (RR 1.15 [95% CI 1.00-1.41]). Moreover, the incidence of severe hypoglycemia was lower with once-weekly insulin icodec compared to once-daily degludec (RR 0.00016 [95% CI 0 to 0.41]). However, no significant difference in the incidence of severe hypoglycemia was observed between once-weekly insulin icodec and once-daily glargine (RR 0.39 [95% CI 0.03 to 4.83]). CONCLUSIONS In patients with type 2 diabetes, once-weekly insulin icodec achieved superior glycemic control compared to once-weekly insulin Fc, with no significant difference in the occurrence of hypoglycemia. The ranking probability results have shown that one weekly icodec seems to be the preferred option in patients with type 2 diabetes. TRIAL REGISTRATION PROSPERO Identifier: CRD42023470894.
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Affiliation(s)
- Peng Wang
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yu Zhang
- Center for Evidence-based Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Wenhao Xu
- Center for Evidence-based Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Jialing He
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Liyuan Peng
- Department of critical care medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Yuning Feng
- Center for Evidence-based Medicine, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China
| | - Ping Xu
- Sichuan University Library, Chengdu, Sichuan, China
| | - Weelic Chong
- Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Yang Hai
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Lu Jia
- Department of Surgical Intensive care medicine, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Fang Fang
- West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Macabeo B, Rotrou T, Millier A, François C, Laramée P. The Acceptance of Indirect Treatment Comparison Methods in Oncology by Health Technology Assessment Agencies in England, France, Germany, Italy, and Spain. PHARMACOECONOMICS - OPEN 2024; 8:5-18. [PMID: 38097828 PMCID: PMC10781913 DOI: 10.1007/s41669-023-00455-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Randomized controlled trials (RCTs) are the gold standard when comparing treatment effectiveness, and Health Technology Assessment (HTA) agencies state a clear preference for such direct comparisons. When these are not available, an indirect treatment comparison (ITC) is an alternative option. The objective of this study was to assess the acceptance of ITC methods by HTA agencies across England, France, Germany, Italy, and Spain, using oncology cases for a homogeneous sample of HTA evaluations. METHODS The study was conducted on the PrismAccess database in May 2021 to retrieve HTA evaluation reports for oncology treatments for solid tumors, in which an ITC was presented. The analysis was restricted to HTA evaluation reports published between April 2018 and April 2021 in England, France, Germany, Italy, and Spain. Identified HTA evaluation reports were screened and reviewed by two independent reviewers. For each ITC presented, the methodology and its acceptance by the HTA agency were analyzed. RESULTS Five hundred and forty-three HTA evaluation reports were identified, of which 120 (22%) presented an ITC. This proportion was the highest in England (51%) and lowest in France (6%). The overall acceptance rate of ITC methods was 30%, with the highest in England (47%) and lowest in France (0%). Network meta-analysis (NMA; 23%) was the most commonly used ITC technique, with a 39% acceptance rate overall, followed by Bucher ITC (19%; 43% acceptance rate) and matching-adjusted indirect comparison (13%; 33% acceptance rate). The most common criticisms of the ITC methods from HTA agencies related to data limitations (heterogeneity and lack of data; 48% and 43%, respectively) and the statistical methods used (41%). CONCLUSIONS The generally low acceptance rate of ITC methods by HTA agencies in oncology suggests that, whilst in the absence of a direct comparison ITCs may provide relevant evidence, this evidence is not widely considered sufficient for the purpose of HTA evaluations. The perception of ITC methods for the purpose of HTA evaluations varies substantially between countries. There is a need for further clarity on the properties of ITC techniques and the assessment of their results as ITC methods continue to evolve quickly and further techniques may become available in the future.
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Affiliation(s)
- Bérengère Macabeo
- Faculté des sciences Médicales et Paramédicales, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France.
- Pierre Fabre Laboratories, Paris, France.
| | | | | | - Clément François
- Faculté des sciences Médicales et Paramédicales, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
| | - Philippe Laramée
- Faculté des sciences Médicales et Paramédicales, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005, Marseille, France
- Pierre Fabre Laboratories, Paris, France
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10
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Yang J, Lei S. Efficacy and safety of sublingual versus subcutaneous immunotherapy in children with allergic rhinitis: a systematic review and meta-analysis. Front Immunol 2023; 14:1274241. [PMID: 38162647 PMCID: PMC10757840 DOI: 10.3389/fimmu.2023.1274241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024] Open
Abstract
Aim To systematically compare the efficacy and safety of subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) in children with allergic rhinitis (AR). Methods PubMed, Embase, Cochrane Library, and Web of Science were searched from inception to March 2, 2023. Outcomes included symptom scores (SSs), medication scores (MSs), symptom and medication scores (SMSs), new sensitizations, development of asthma, improvement, and treatment-related adverse events (TRAEs). The quality of the included studies was assessed by the modified Jadad scale and Newcastle-Ottawa scale (NOS). Meta-regression was carried out to explore the source of heterogeneity. Subgroup analysis was further conducted in terms of study design [randomized controlled trials (RCTs), cohort studies], allergen [house dust mites (HDMs), grass pollen], treatment duration (≥ 24, 12-23 or < 12 months), allergen immunotherapy (AIT) modality (drops or tablets), and AIT protocol [continuous, pre-seasonal, co-seasonal, or after the grass pollen season (GPS)]. Sensitivity analysis was conducted for all outcomes. A Bayesian framework and a Monte Carlo Markov Chain (MCMC) model were developed for indirect comparison. Results Totally 50 studies with 10813 AR children were included, with 4122 treated with SLIT, 1852 treated with SCIT, and 4839 treated with non-SLIT or non-SCIT therapy. For direct comparison, the SLIT group had a similar SS to the SCIT group [pooled standardized mean difference (SMD): 0.41, 95% confidence interval (CI): -0.46, 1.28, P = 0.353]. Comparable MSs were observed in the SLIT and SCIT groups (pooled SMD: 0.82, 95%CI: -0.88, 2.53, P = 0.344). For indirect comparison, no significant differences were found in SSs (pooled SMD: 1.20, 95% credibility interval (CrI): -1.70, 4.10), MSs (pooled SMD: 0.57, 95%CrI: -1.20, 2.30), SMSs (pooled SMD: 1.80, 95%CrI: -0.005, 3.60), new sensitizations [pooled relative risk (RR): 0.34, 95%CrI: 0.03, 3.58], and development of asthma (pooled RR: 0.68, 95%CrI: 0.01, 26.33) between the SLIT and SCIT groups; the SLIT group illustrated a significantly lower incidence of TRAEs than the SCIT group (pooled RR: 0.17, 95%CrI: 0.11, 0.26). Conclusion Considering both efficacy and safety, SLIT might be a more favorable AIT than SCIT in the treatment of pediatric AR, which may serve as a decision-making reference for clinicians. Systematic review registration PROSPERO (CRD42023460693).
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Affiliation(s)
| | - Sihong Lei
- The Department of Otolaryngology-Head and Neck Surgery, Nanchong Central Hospital, Second Clinical Medical College of North Sichuan Medical College, Nanchong, Sichuan, China
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11
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Calzetta L, Rogliani P. Bayesian or frequentist: there is no question when comparing single-inhaler triple therapies via network meta-analysis. Focus on fluticasone furoate/umeclidinium/vilanterol fixed-dose combination in chronic obstructive pulmonary disease. Expert Rev Respir Med 2023; 17:1273-1283. [PMID: 38318884 DOI: 10.1080/17476348.2024.2316167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/05/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVES Single-inhaler triple therapies (SITTs) have never been directly compared in randomized controlled trials (RCTs) in chronic obstructive pulmonary disease (COPD). Cochrane recommends the Bayesian approach for indirect comparisons but a frequentist network meta-analysis (NMA) reported superiority of fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) over other SITT. We assessed the most appropriate inference method for NMA characterized by between-study heterogeneity on SITT in COPD. METHODS Bayesian and frequentist NMA were performed on RCTs investigating the effect of SITT on exacerbations and trough forced expiratory volume in the 1st second (FEV1) in COPD. RESULTS The included RCTs (ETHOS, FULFIL, IMPACT, KRONOS 200812) reported significant between-study heterogeneity (I2 > 99%, p < 0.001). The Bayesian random-effect NMA provided unbiased evidence that FF/UMEC/VI was not superior to other SITT on exacerbations and trough FEV1. The frequentist fixed-effect NMA indicated that FF/UMEC/VI was significantly (p < 0.05) more effective than other SITT, although results were affected by dispersion, asymmetry, and significant risk of bias. Frequentist random-effect NMA provided effect estimates rather similar but not equal to those of Bayesian approach. CONCLUSION Indirect comparison should be performed via Bayesian approach instead of frequentist inference with a fixed-effect model. Claiming the superiority of a specific medication over other therapies should be confirmed by findings originating from well-designed RCTs.
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Affiliation(s)
- Luigino Calzetta
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paola Rogliani
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
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12
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Yang TL, Lin C, Ho CL, Huang TC, Wu YY, Jhou HJ, Chen PH, Lee CH. Progression-Free Survival Efficacy in Refractory/Relapsed Multiple Myeloma among Elderly Patients: A Systematic Review. Life (Basel) 2023; 13:2259. [PMID: 38137860 PMCID: PMC10744445 DOI: 10.3390/life13122259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/19/2023] [Accepted: 11/25/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Over the last decade, many studies have assessed the efficacy of treatments for refractory/relapsed multiple myeloma (R/R MM). While combination therapies show greater efficacy than traditional methods, limited research has targeted elderly patients who might be less resilient to treatments. Our study aimed to evaluate treatment efficacy for these elderly patients. METHODS We carried out a comprehensive review of the literature using a systematic approach. Initially, 4966 citations were retrieved and subsequently narrowed down to 13 eligible randomized controlled trials (RCTs) through our systematic review process from databases like Embase, PubMed, and Cochrane Library from 1 January 2000 to 31 December 2022. Evidence was collated through a frequentist network meta-analysis, using the hazard ratio (HR) for evaluation. RESULTS Combined therapy of daratumumab, lenalidomide, and dexamethasone (DaraLenDex) was the preferred treatment for R/R MM elderly patients. Its strengths included an HR for progression-free survival (0.15; 95% CI: 0.09-0.25) and a 96% P-score. CONCLUSIONS Our analysis suggests that, pending more comprehensive RCTs, DaraLenDex is the treatment with the highest efficacy for R/R MM in elderly patients.
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Affiliation(s)
- Tung-Lung Yang
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (T.-L.Y.)
| | - Chin Lin
- School of Public Health, National Defense Medical Center, Taipei 114, Taiwan
- Department of Research and Development, National Defense Medical Center, Taipei 114, Taiwan
| | - Ching-Liang Ho
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (T.-L.Y.)
| | - Tzu-Chuan Huang
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (T.-L.Y.)
| | - Yi-Ying Wu
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (T.-L.Y.)
| | - Hong-Jie Jhou
- Department of Neurology, Changhua Christian Hospital, Changhua 500, Taiwan;
| | - Po-Huang Chen
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (T.-L.Y.)
| | - Cho-Hao Lee
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan; (T.-L.Y.)
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13
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Cassidy O, Harte M, Trela-Larsen L, Walsh C, White A, McCullagh L, Leahy J. A Comparison of Relative-Efficacy Estimate(S) Derived From Both Matching-Adjusted Indirect Comparisons and Standard Anchored Indirect Treatment Comparisons: A Review of Matching-Adjusted Indirect Comparisons. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:1665-1674. [PMID: 37460009 DOI: 10.1016/j.jval.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 06/06/2023] [Accepted: 07/07/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVES We present an empirical comparison of relative-efficacy estimate(s) from matching-adjusted indirect comparisons (MAICs) with estimates from corresponding standard anchored indirect treatment comparisons. METHODS A total of 80 comparisons were identified from 17 publications through a systematic rapid review. A standardized metric that used reported relative treatment efficacy estimates and their associated uncertainty was used to compare the methods across different treatment indications and outcome measures. RESULTS On aggregate, MAICs presented for connected networks tended to report a more favorable relative-efficacy estimate for the treatment for which individual-level patient data were available relative to the reported indirect treatment comparison estimate. CONCLUSIONS Although we recognize the importance of MAIC and other population adjustment methods in certain situations, we recommend that results from these analyses are interpreted with caution. Researchers and analysts should carefully consider if MAICs are appropriate where presented and whether MAICs would have added value where omitted.
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Affiliation(s)
- Owen Cassidy
- National Centre for Pharmacoeconomics Ireland, St. James's Hospital, Dublin, Ireland; Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - Marie Harte
- National Centre for Pharmacoeconomics Ireland, St. James's Hospital, Dublin, Ireland; Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - Lea Trela-Larsen
- National Centre for Pharmacoeconomics Ireland, St. James's Hospital, Dublin, Ireland; Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - Cathal Walsh
- Health Research Institute and MACSI, Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Arthur White
- Department of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
| | - Laura McCullagh
- National Centre for Pharmacoeconomics Ireland, St. James's Hospital, Dublin, Ireland; Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland
| | - Joy Leahy
- National Centre for Pharmacoeconomics Ireland, St. James's Hospital, Dublin, Ireland; Department of Pharmacology and Therapeutics, Trinity College Dublin, Dublin, Ireland.
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14
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Watt J, Hofmeister M, Del Giovane C, Turner R, Tricco AC, Mavridis D, Straus S, Veroniki AA. Implementing hierarchical network meta-analysis incorporating exchangeable dose effects compared to standard hierarchical network meta-analysis. BMJ Evid Based Med 2023; 28:332-336. [PMID: 37076267 DOI: 10.1136/bmjebm-2022-112136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2023] [Indexed: 04/21/2023]
Affiliation(s)
- Jennifer Watt
- Knowledge Translation Program, St. Michael's Hospital, Toronto, Ontario, Canada
- Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Mark Hofmeister
- O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of Medical and Surgical Sciences for Children and Adults, University-Hospital of Modena and Reggio Emilia, Modena, Italy
| | - Rebecca Turner
- MRC Clinical Trials Unit, University College London, London, UK
| | - Andrea C Tricco
- Knowledge Translation Program, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Dimitris Mavridis
- Department of Primary Education, University of Ioannina, Ioannina, Greece
| | - Sharon Straus
- Knowledge Translation Program, St. Michael's Hospital, Toronto, Ontario, Canada
- Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Areti Angeliki Veroniki
- Knowledge Translation Program, St. Michael's Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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15
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Krawczyk K, Śladowska K, Holko P, Kawalec P. Comparative safety of tyrosine kinase inhibitors in the treatment of metastatic renal cell carcinoma: a systematic review and network meta-analysis. Front Pharmacol 2023; 14:1223929. [PMID: 37745049 PMCID: PMC10512702 DOI: 10.3389/fphar.2023.1223929] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/11/2023] [Indexed: 09/26/2023] Open
Abstract
Objective: This study aimed to compare the safety profile of tyrosine kinase inhibitors (TKIs) approved for use as monotherapy or combination therapy for the first-line treatment of adult patients with metastatic clear cell renal cell carcinoma (RCC). Methods: A systematic review with frequentist network meta-analysis (NMA) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included randomized controlled trials (RCTs) investigating the use of: cabozantinib, pazopanib, sorafenib, sunitinib, tivozanib, cabozantinib + nivolumab, lenvatinib + pembrolizumab, axitinib + avelumab, and axitinib + pembrolizumab in previously untreated adult patients with metastatic clear cell RCC. Eligible studies were identified by two reviewers in MEDLINE (via PubMed), EMBASE, and Cochrane Library. The risk of bias for RCTs was assessed using the Cochrane Collaboration tool. The P score was used to determine the treatment ranking. The mean probability of an event along with the relative measures of the NMA was considered with the treatment rankings. Results: A total of 13 RCTs were included in the systematic review and NMA. Sorafenib and tivozanib used as monotherapy were the best treatment options. Sorafenib achieved the highest P score for treatment discontinuation due to adverse events (AEs), fatigue, nausea, vomiting of any grade, and hypertension of any grade or grade ≥3. Tivozanib achieved the highest P score for AEs, grade ≥3 AEs, dose modifications due to AEs, and grade ≥3 diarrhea. Sunitinib was the best treatment option in terms of diarrhea and dysphonia of any grade, while cabozantinib, pazopanib, and axitinib + pembrolizumab-in terms of grade ≥3 fatigue, nausea, and vomiting. TKIs used in combination were shown to have a poorer safety profile than those used as monotherapy. Lenvatinib + pembrolizumab was considered the worst option in terms of any AEs, grade ≥3 AEs, treatment discontinuation due to AEs, dose modifications due to AEs, fatigue of any grade, nausea, vomiting, and grade ≥3 nausea. Axitinib + avelumab was the worst treatment option in terms of dysphonia, grade ≥3 diarrhea, and hypertension, while cabozantinib + nivolumab was the worst option in terms of grade ≥3 vomiting. Interestingly, among the other safety endpoints, cabozantinib monotherapy had the lowest P score for diarrhea and hypertension of any grade. Conclusion: The general safety profile, including common AEs, is better when TKIs are used as monotherapy vs. in combination with immunological agents. To confirm these findings, further research is needed, including large RCTs.
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Affiliation(s)
- Kinga Krawczyk
- Faculty of Health Sciences, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Śladowska
- Department of Nutrition and Drug Research, Faculty of Health Sciences, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Przemysław Holko
- Department of Nutrition and Drug Research, Faculty of Health Sciences, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Kawalec
- Department of Nutrition and Drug Research, Faculty of Health Sciences, Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
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16
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Otten TM, Grimm SE, Ramaekers B, Joore MA. Comprehensive Review of Methods to Assess Uncertainty in Health Economic Evaluations. PHARMACOECONOMICS 2023; 41:619-632. [PMID: 36943674 PMCID: PMC10163110 DOI: 10.1007/s40273-023-01242-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 05/06/2023]
Abstract
Uncertainty assessment is a cornerstone in model-based health economic evaluations (HEEs) that inform reimbursement decisions. No comprehensive overview of available uncertainty assessment methods currently exists. We aimed to review methods for uncertainty assessment for use in model-based HEEs, by conducting a snowballing review. We categorised all methods according to their stage of use relating to uncertainty assessment (identification, analysis, communication). Additionally, we classified identification methods according to sources of uncertainty, and subdivided analysis and communication methods according to their purpose. The review identified a total of 80 uncertainty methods: 30 identification, 28 analysis, and 22 communication methods. Uncertainty identification methods exist to address uncertainty from different sources. Most identification methods were developed with the objective to assess related concepts such as validity, model quality, and relevance. Almost all uncertainty analysis and communication methods required uncertainty to be quantified and inclusion of uncertainties in probabilistic analysis. Our review can help analysts and decision makers in selecting uncertainty assessment methods according to their aim and purpose of the assessment. We noted a need for further clarification of terminology and guidance on the use of (combinations of) methods to identify uncertainty and related concepts such as validity and quality. A key finding is that uncertainty assessment relies heavily on quantification, which may necessitate increased use of expert elicitation and/or the development of methods to assess unquantified uncertainty.
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Affiliation(s)
- Thomas Michael Otten
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), P. Debyelaan 25, Oxford Building, PO Box 5800a, Maastricht, Limburg, The Netherlands.
| | - Sabine E Grimm
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), P. Debyelaan 25, Oxford Building, PO Box 5800a, Maastricht, Limburg, The Netherlands
| | - Bram Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), P. Debyelaan 25, Oxford Building, PO Box 5800a, Maastricht, Limburg, The Netherlands
| | - Manuela A Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), P. Debyelaan 25, Oxford Building, PO Box 5800a, Maastricht, Limburg, The Netherlands
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17
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Frank RA, Salameh JP, Islam N, Yang B, Murad MH, Mustafa R, Leeflang M, Bossuyt PM, Takwoingi Y, Whiting P, Dawit H, Kang SK, Ebrahimzadeh S, Levis B, Hutton B, McInnes MDF. How to Critically Appraise and Interpret Systematic Reviews and Meta-Analyses of Diagnostic Accuracy: A User Guide. Radiology 2023; 307:e221437. [PMID: 36916896 PMCID: PMC10140638 DOI: 10.1148/radiol.221437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 03/16/2023]
Abstract
Systematic reviews of diagnostic accuracy studies can provide the best available evidence to inform decisions regarding the use of a diagnostic test. In this guide, the authors provide a practical approach for clinicians to appraise diagnostic accuracy systematic reviews and apply their results to patient care. The first step is to identify an appropriate systematic review with a research question matching the clinical scenario. The user should evaluate the rigor of the review methods to evaluate its credibility (Did the review use clearly defined eligibility criteria, a comprehensive search strategy, structured data collection, risk of bias and applicability appraisal, and appropriate meta-analysis methods?). If the review is credible, the next step is to decide whether the diagnostic performance is adequate for clinical use (Do sensitivity and specificity estimates exceed the threshold that makes them useful in clinical practice? Are these estimates sufficiently precise? Is variability in the estimates of diagnostic accuracy across studies explained?). Diagnostic accuracy systematic reviews that are judged to be credible and provide diagnostic accuracy estimates with sufficient certainty and relevance are the most useful to inform patient care. This review discusses comparative, noncomparative, and emerging approaches to systematic reviews of diagnostic accuracy using a clinical scenario and examples based on recent publications.
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Affiliation(s)
| | | | - Nayaar Islam
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Bada Yang
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Mohammad Hassan Murad
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Reem Mustafa
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Mariska Leeflang
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Patrick M. Bossuyt
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Yemisi Takwoingi
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Penny Whiting
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Haben Dawit
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Stella K. Kang
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Sanam Ebrahimzadeh
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Brooke Levis
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Brian Hutton
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
| | - Matthew D. F. McInnes
- From the Department of Radiology, University of Ottawa, The Ottawa
Hospital Civic Campus, 1053 Carling Ave, Room c159, Ottawa, ON, Canada K1Y 4E9
(R.A.F., M.D.F.M.); Faculty of Health Sciences, Queen’s University,
Kingston, Ontario, Canada (J.P.S.); Clinical Epidemiology Program, Ottawa
Hospital Research Institute, University of Ottawa, Ottawa, Canada (N.I., M.H.M.,
H.D., S.E., B.H.); Julius Center for Health Sciences and Primary Care,
University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
(B.Y.); Evidence-Based Practice Center, Mayo Clinic, Rochester, Minn (M.H.M.);
Department of Medicine, Division of Nephrology and Hypertension, University of
Kansas Medical Center, Kansas City, Mo (R.M.); Department of Epidemiology and
Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
(M.L., P.M.B.); Amsterdam Public Health, Amsterdam, the Netherlands (P.M.B.);
Institute of Applied Health Research, University of Birmingham, Birmingham, UK
(Y.T.); NIHR Birmingham Biomedical Research Centre, University Hospitals
Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
(Y.T.); Population Health Sciences, Bristol Medical School, University of
Bristol, Bristol, UK (P.W.); Department of Radiology, NYU Langone Health, New
York, NY (S.K.K.); and Centre for Clinical Epidemiology, Lady Davis Institute
for Medical Research, Jewish General Hospital, Montréal, Canada
(B.L.)
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18
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Marshall J, Sharma A, Darken P, Ouwens M, Singh B, Tansey-Dwyer D. Letter to the Editor Regarding "Fluticasone Furoate/Umeclidinium/Vilanterol (FF/UMEC/VI) Triple Therapy Compared with Other Therapies for the Treatment of COPD: A Network Meta-Analysis". Adv Ther 2023; 40:2549-2555. [PMID: 37004641 PMCID: PMC10129921 DOI: 10.1007/s12325-023-02491-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/09/2023] [Indexed: 04/04/2023]
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19
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Lackey LG, Ng X, Veldwijk J, Thokala P, Levitan B, Payne K, Ho M, Tervonen T. Illustrating Emerging Good Practices for Quantitative Benefit-Risk Assessment: A Hypothetical Case Study of Systemic Biologic Treatments for Plaque Psoriasis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:519-527. [PMID: 36764517 DOI: 10.1016/j.jval.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Quantitative benefit-risk assessment (qBRA) is a structured process to evaluate the benefit-risk balance of treatment options to support decision making. The ISPOR qBRA Task Force was recently established to provide recommendations for the design, conduct, and reporting of qBRA. This report presents a hypothetical case study illustrating how to apply the Task Force's recommendations toward a qBRA to inform the benefit-risk assessment of brodalumab at the time of initial marketing approval. The qBRA evaluated 2 dosing regimens of brodalumab (210 mg or 140 mg twice weekly) compared with weight-based dosing of ustekinumab and placebo. METHODS We followed the 5 steps recommended by the Task Force. Attributes included treatment response (≥75% improvement in Psoriasis Area and Severity Index), suicidal ideation and behavior, and infections. Performance data were drawn from pivotal clinical trials of brodalumab. The qBRA used multicriteria decision analysis and preference weights from a hypothetical discrete choice experiment. Sensitivity analyses examined the robustness of benefit-risk ranking to uncertainty in clinical effect and preference estimates, consideration of a subgroup (nail psoriasis), and the maintenance phase of treatment (52 weeks instead of 12). RESULTS Results from this hypothetical qBRA suggest that brodalumab 210 mg had a more favorable benefit-risk profile compared with ustekinumab and placebo. Ranking of brodalumab compared with ustekinumab was dependent on brodalumab's dose. Sensitivity analyses demonstrated robustness of benefit-risk ranking to uncertainty in clinical effect and preference estimates, as well as choice of attributes and length of follow-up. CONCLUSION This case study demonstrates how to implement the ISPOR Task Force's good practice recommendations on qBRA.
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Affiliation(s)
- Leila G Lackey
- Decision Support and Analysis Staff, Office of Program and Strategic Analysis, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA.
| | - Xinyi Ng
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | - Jorien Veldwijk
- Erasmus School of Health Policy and Management & Erasmus Choice Modelling Center, Rotterdam, The Netherlands
| | - Praveen Thokala
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | | | - Katherine Payne
- Manchester Centre for Health Economics, School of Health Sciences, The University of Manchester, Manchester, England, UK
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20
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Han B, Tang D, Lv X, Li S, Fan J, Xu X, Zhang J, Xu S, Ye W, Huang Z, Zhan L, Lv X. Comparative efficacy and safety of combination therapy with infliximab for Crohn's disease: a systematic review and network meta-analysis. Int J Colorectal Dis 2023; 38:82. [PMID: 36971914 DOI: 10.1007/s00384-023-04378-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE There is not enough information to position medications for the treatment of Crohn's disease (CD). Therefore, using a network meta-analysis and systematic review, we evaluated the efficacy and safety of combination therapy and infliximab (IFX) monotherapy in CD patients. METHODS We identified randomized controlled trials (RCTs) in CD patients who were given IFX-containing combination therapy versus IFX monotherapy. Induction and maintenance of clinical remission were the efficacy outcomes, while adverse events were the safety outcomes. The surface under cumulative ranking (SUCRA) probabilities was used to assess ranking in the network meta-analysis. RESULTS In total, 15 RCTs with 1586 CD patients were included in this study. There was no statistical difference between different combination therapies in induction and maintenance of remission. In terms of inducing clinical remission, IFX + EN (SUCRA: 0.91) ranked highest; in terms of maintaining clinical remission, IFX + AZA (SUCRA: 0.85) ranked highest. There was no treatment that was significantly safer than the others. In terms of any adverse events, serious adverse events, serious infections, and infusion/injection-site reactions, IFX + AZA (SUCRA: 0.36, 0.12, 0.19, and 0.24) was ranked lowest for all risks; while IFX + MTX (SUCRA: 0.34, 0.06, 0.13, 0.08, 0.34, and 0.08) was rated lowest for risk of abdominal pain, arthralgia, headache, nausea, pyrexia, and upper respiratory tract infection. CONCLUSION Indirect comparisons suggested that efficacy and safety of different combination treatments are comparable in CD patients. For maintenance therapies, IFX + AZA was ranked highest for clinical remission and lowest for adverse events. Further head-to-head trials are required.
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Affiliation(s)
- Bing Han
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Daiyuan Tang
- Postgraduate College, Kunming Medical University, Kunming, China
| | - Xiaodan Lv
- Department of Clinical Experimental Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shiquan Li
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Junhua Fan
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xiaofang Xu
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jiatong Zhang
- Postgraduate College, Guangxi Medical University, Nanning, China
| | - Shang Xu
- Postgraduate College, Guangxi Medical University, Nanning, China
| | - Weizheng Ye
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ziqian Huang
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lingling Zhan
- Postgraduate College, Kunming Medical University, Kunming, China
| | - Xiaoping Lv
- Department of Gastroenterology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
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21
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Nagendrababu V, Narasimhan S, Faggion CM, Dharmarajan L, Jacob PS, Gopinath VK, Dummer PMH. Reporting quality of systematic reviews with network meta-analyses in Endodontics. Clin Oral Investig 2023:10.1007/s00784-023-04948-w. [PMID: 36914841 DOI: 10.1007/s00784-023-04948-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 03/07/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES To evaluate the reporting quality of systematic reviews with network meta-analyses (NMAs) in Endodontics using the the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) for NMA checklist. METHODS The current investigation extends a recently published study in the International Endodontic Journal (Nagendrababu V, Faggion Jr CM, Pulikkotil SJ, Alatta A, Dummer PM Methodological assessment and overall confidence in the results of systematic reviews with network meta-analyses in Endodontics. International Endodontic Journal 2022;55:393-404) that assessed the methodological quality of systematic reviews with NMAs in Endodontics using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) tool. In the present study, the PRISMA for NMA checklist with 32 items was used to assess the reporting quality of the systematic reviews with NMAs (n = 12). Two independent assessors assigned '1' when an item was completely addressed, '0.5' when it was partially addressed, and '0' when it was not addressed. Disagreements were resolved through reviewer discussion until consensus was reached. If conflicts persisted, a third reviewer made the final decision. The PRISMA for NMA scores were shared with the relevant authors of the individual reviews to reduce the likelihood of misinterpretation and verify the scores assigned. The results for each individual item of the PRISMA-NMA items were calculated by summing the individual scores awarded; the maximum score for each item was 12. RESULTS All the systematic reviews with NMAs adequately reported the following items: Title, Introduction section (Objectives), Methods section (Eligibility criteria and Information sources), Results section (Study selection, Study characteristics and Risk of bias within studies), and Discussion section (Summary of evidence). The items that were reported least often were the "geometry of the network" and "the summary of network geometry" with only 2 manuscripts (17%) including these items. CONCLUSION A number of the items in the PRISMA-NMA checklist were adequately addressed in the NMAs; however, none adequately reported all the PRISMA-NMA items. The inadequacies of published NMAs that have been identified should be taken into consideration by authors of NMAs in Endodontics and by editors when managing the peer review process. In future, researchers who are writing systematic reviews with NMAs should comply with the PRISMA-NMA checklist. CLINICAL RELEVANCE None of the included systematic reviews with NMA adequately reported all the PRISMA-NMA items. Inadequate reporting of a systematic review with NMA increases the possibility that it will provide invalid results. Therefore, authors should follow the PRISMA-NMA guidelines when reporting systematic reviews with NMA in Endodontics.
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Affiliation(s)
- Venkateshbabu Nagendrababu
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE.
| | | | - Clovis M Faggion
- Faculty of Dentistry, Department of Periodontology and Operative Dentistry, University Hospital Münster, Münster, Germany
| | | | | | - Vellore Kannan Gopinath
- Department of Preventive and Restorative Dentistry, College of Dental Medicine, University of Sharjah, Sharjah, UAE
| | - Paul M H Dummer
- School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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22
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Methods to appraise available evidence and adequacy of data from a systematic literature review to conduct a robust network meta-analysis of treatment options for patients with hospital-acquired or ventilator-associated bacterial pneumonia. PLoS One 2023; 18:e0279844. [PMID: 36598902 DOI: 10.1371/journal.pone.0279844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 12/15/2022] [Indexed: 01/05/2023] Open
Abstract
We aimed to determine if available evidence from a previously conducted systematic literature review was sufficient to conduct a robust network meta-analysis (NMA) using the International Society for Pharmacoeconomics and Outcomes Research Good Practice Task Force NMA study questionnaire to evaluate suitability, relevance, and credibility of available randomized-controlled trials (RCT) of antibacterial therapies for treatment of patients with hospital-acquired or ventilator-associated bacterial pneumonia (HABP/VABP). We assessed feasibility and reliability of an NMA for a connected network of RCTs, and then relevance and credibility of the connected network for informing decision-making. This previously conducted systematic literature review using Cochrane dual-reviewer methodology, Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and PICOTS (population, interventions, comparators, outcomes, timing, and setting) criteria identified 25 citations between 2001 and 2018; 18 were unique RCTs. Trial design characteristics, outcome definitions, assessment time points, and analyses populations varied across studies. Using "clinical response," an efficacy end point to health technology assessment agencies, we assessed potential network credibility, which collapsed from the overall data set to four studies and five interventions. This did not include closed loop(s) needed to assess consistency. Of the studies reporting clinical response, >70% of patients were ventilated at baseline with mean Acute Physiologic Assessment and Chronic Health Evaluation II scores from 14.7 to 17.5. Pseudomonas aeruginosa (range, 18.4-64.1%) and Klebsiella spp. (range, 1.6-49%) were the most common causative pathogens. We identified relevant RCTs for most standard-of-care agents approved for HABP/VABP, which provided a comprehensive evidence base. In summary, our appraisal of available evidence for the clinical response outcome among adult patients with HABP/VABP does not support the conduct of a scientifically robust and clinically meaningful NMA. Although this data is vital to registration, there are significant limitations in these trials for health technology assessments, payor decisions, guidelines, and protocol decisions.
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23
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Remiro‐Azócar A. Some considerations on target estimands for health technology assessment. Stat Med 2022; 41:5592-5596. [PMID: 36385477 PMCID: PMC9828791 DOI: 10.1002/sim.9566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/18/2022]
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24
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Peñarrocha‐Oltra S, Soto‐Peñaloza R, Alonso‐Arroyo A, Vidal‐Infer A, Pascual‐Segarra J. Laser-based refractive surgery techniques to treat myopia in adults. An overview of systematic reviews and meta-analyses. Acta Ophthalmol 2022; 100:878-893. [PMID: 35535010 PMCID: PMC9790262 DOI: 10.1111/aos.15160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 03/22/2022] [Accepted: 04/18/2022] [Indexed: 12/30/2022]
Abstract
Systematic reviews (SRs) and meta-analyses (MAs) are of great importance for basing clinical decisions. However, misleading interpretations may result when informed decisions rest on biased review papers with methodological issues. To evaluate which treatment is optimal, an overview was made of SRs and MAs to establish the quality and certainty of meta-evidence published on the efficacy of laser-based refractive surgery techniques for treating myopia in adults. A search was made in five databases and was updated using Really Simple Syndication (RSS) feed appliances up to April 2021; SRs with or without MAs were included. Methodological quality was appraised using the AMSTAR-2 tool. The best available reviews were summarized using the GRADE approach. The corrected covered area (CCA) was used to determine the degree of over-representation of publications. The risk of bias of the primary studies was disclosed visually. Thirty-six studies published between 2003 and 2021 were included. Twenty SRs (56%) were conducted in China. The most studied comparisons were SMILE versus FS-LASIK (19%) and FS-LASIK versus MM-LASIK (11%). Of the 251 overlapping index publications, 165 were unique (CCA = 0.015%), representing a negligible risk of skewed reporting. The AMSTAR-2 tool showed most SRs to have critically low or low quality. Nine reviews presented moderate quality. The GRADE approach of the 41 a priori outcomes evidenced critically low and low certainty of evidence. Only the spherical equivalent refraction changes at 12 months between LASEK and PRK showed moderate certainty of evidence, favouring PRK (mean difference 0.06, 95%CI [-0.02 to 0.14], I2 = 0%; p ≥ 0.05). Index trials among less biased reviews are prone to selection, performance and reporting bias. The appraised techniques exhibit comparable results in terms of efficacy. There is moderate certainty of evidence in favour of the use of PRK over LASEK in terms of the spherical equivalent refraction error changes at 1 year of follow-up. Most appraised SRs presented methodological flaws in critical domains, resulting in a low to critically low certainty of evidence after GRADE appraisal. Therefore, investigators need to study and compare the different laser-based refractive techniques to provide better evidence-based medicine. Further well-designed, high-quality clinical trials and SRs are needed to reappraise the current findings.
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Affiliation(s)
- Sonia Peñarrocha‐Oltra
- Hospital Lluís AlcanyísXàtivaSpain,Faculty of Medicine and DentistryUniversity of ValenciaValenciaSpain
| | | | - Adolfo Alonso‐Arroyo
- UISYS. Department of History of Science and Information ScienceSchool of Medicine and Dentistry, University of ValenciaValenciaSpain
| | - Antonio Vidal‐Infer
- UISYS. Department of History of Science and Information ScienceSchool of Medicine and Dentistry, University of ValenciaValenciaSpain
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Zhang A, Han F, Piao C. Comparative effectiveness of acupuncture and pharmacological interventions in treating diabetic stroke: A protocol for a systematic review and network meta-analysis. Medicine (Baltimore) 2022; 101:e31823. [PMID: 36401496 PMCID: PMC9678551 DOI: 10.1097/md.0000000000031823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND There is a close and causative correlation between stroke and diabetes, and the complication of the 2 diseases seriously harms human health and currently becomes a topic of clinical importance. To date, the common methods of treating diabetic stroke include acupuncture and pharmacological interventions. However, there is no high-quality or direct evidence of their comparative effectiveness. This review aims to provide a network meta-analysis to compare the efficacy of acupuncture and pharmacological interventions in treating diabetic stroke. METHODS Databases such as PubMed, Cochrane Central Register of Controlled Trials, EMBASE, China National Knowledge Infrastructure, China Biology Medicine Disc will be searched for relevant randomized controlled trials to obtain literatures on the treatment of diabetic stroke, and clinical randomized controlled trials will be screened out from their inception to December 30, 2022. The participant intervention comparator outcomes of this study are as flowing: P, patients with diabetic stroke; I, acupuncture and pharmacological interventions; C, no treatment, pharmacological placebo, or sham acupuncture groups; O, primary outcome will be blood glucose levels, glycosylated hemoglobin levels, and the rate of stroke recurrence; secondary outcomes will include fasting and post-load blood glucose levels, cholesterol, triglycerides, and quality of life scale scores. Cochrane Risk of Bias Tool will be used in assessing literature's quality. Review Manager software 5.3 and Stata 15.1 will be used in data analysis. RESULT This systematic review and network meta-analysis will provide evidence of the efficacy of different therapeutic methods in treating diabetic stroke, to show which forms of therapy are more commonly used with higher effectiveness. CONCLUSION The results will systematically provide suggestions for medical practitioners to choose the effective, time-saving and economical therapeutic strategy for diabetic stroke.
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Affiliation(s)
- Ao Zhang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Fangda Han
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Chunli Piao
- Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, China
- * Correspondence: Chunli Piao, Shenzhen Hospital of Guangzhou University of Chinese Medicine, Shenzhen, Guangdong 518000, China (e-mail: )
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Pan Z, Huang S, Ma T, Yuan R, Wang M, Luo R, Yu M, Li W, Zhang A, Wu J. Comparative effectiveness of external therapies of traditional Chinese medicine and surgical treatments in pain management of postherpetic neuralgia: A protocol for a systematic review and network meta-analysis. Medicine (Baltimore) 2022; 101:e31517. [PMID: 36316916 PMCID: PMC9622718 DOI: 10.1097/md.0000000000031517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND As the most common long-term complication of herpes zoster (HZ), postherpetic neuralgia (PHN) is characterized by chronic, persistent, and debilitating neuropathic pain. PHN seriously harms human health and currently becomes a topic of clinical importance. To date, the common methods of pain management in PHN include external therapies of traditional Chinese medicine and surgical treatments. However, there is no high-quality or direct evidence of their comparative effectiveness. This review aims to provide a network meta-analysis to compare the efficacy of external therapies of traditional Chinese medicine and surgical treatments in the pain management of PHN. METHODS Databases such as PubMed, Cochrane Central Register of Controlled Trials, EMBASE, China National Knowledge Infrastructure, China Biology Medicine Disc will be searched for relevant randomized controlled trials to obtain literatures on the treatment of PHN with external therapies of traditional Chinese medicine and surgical treatments, and clinical randomized controlled trials will be screened out from their inception to August 5, 2022. The participant intervention comparator outcomes of this study are as flowing: P, patients with PHN; I, external therapies of traditional Chinese medicine and surgical treatments; C, no treatment, pharmacological placebo, treatment as usual or sham acupuncture groups; O, primary outcome is pain intensity, and secondary outcomes are onset of pain relief time, quality of life, therapeutic effective rate and reverse effects. Cochrane Risk of Bias Tool will be used in assessing literature's quality. Network meta-analyses will be conducted to generate estimates of comparative effectiveness of each intervention class and rankings of their effectiveness, in terms of pain management. RESULT This systematic review and network meta-analysis will provide evidence of the efficacy of different therapeutic methods for pain management in PHN, to show which forms of therapy are more commonly used with higher effectiveness. DISCUSSION The results will systematically provide suggestions for medical practitioners to choose effective, time-saving and economical pain management method for PHN.
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Affiliation(s)
- Zhengqi Pan
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Shijie Huang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Tingting Ma
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Rongli Yuan
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Mengjing Wang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Rui Luo
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Maogui Yu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Wuyu Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
| | - Ao Zhang
- School of Chinese Medicine, School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Jie Wu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, China
- * Correspondence: Jie Wu, Hospital of Chengdu University of Traditional Chinese Medicine, No. 39 Shi-er-qiao Road, 610072 Chengdu, Sichuan Province, China (e-mail: )
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Impact of Regulatory Approval Status on CADTH Reimbursement of Oncology Drugs and Role of Real-World Evidence on Conditional Approvals from 2019 to 2021. Curr Oncol 2022; 29:8031-8042. [PMID: 36354695 PMCID: PMC9689244 DOI: 10.3390/curroncol29110635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/23/2022] [Accepted: 10/23/2022] [Indexed: 01/09/2023] Open
Abstract
Real-world evidence (RWE) is health and outcomes data generated from a patient's journey through the health care system or disease process (i.e., real-world data). RWE is now having an increasingly important role in regulatory/reimbursement decisions. This article examines reimbursement recommendations by the Canadian Agency for Drugs and Technology in Health (CADTH) on oncology drugs approved between 2019 and 2021. Oncology drugs with a Summary Basis of Decision (SBD) for original marketing approvals were used to generate a corresponding list of CADTH final clinical recommendations for review. Of the 45 oncology drugs approved by Health Canada, CADTH granted positive funding recommendations to all 11 drugs that had priority review approvals. Two of the 17 drugs with standard reviews did not file to CADTH and 3 received a negative recommendation. Of the 17 drugs with Notice of Compliance with Conditions (NOCc) status, three were not filed to CADTH and four were under active reviews. Of the ten completed NOCc reviews, all contained RWE from sponsors and six received a negative decision on their first review. No significant differences in review times were found between the three approval statuses. Regulatory approval status appeared to influence reimbursement outcomes in Canada and evaluation of 10 NOCc approvals provided little insight regarding robustness of RWE required for more favorable considerations.
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Shah S, Dibben G, Ketkar A, Hare DL, Myers J, Franklin B, Babu AS, Taylor RS. Identifying the Optimal Exercise Prescription for Patients with Coronary Artery Disease Undergoing Cardiac Rehabilitation: Protocol for a Systematic Review and Network Meta-Analysis of Randomized Control Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12317. [PMID: 36231615 PMCID: PMC9566022 DOI: 10.3390/ijerph191912317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/16/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
Coronary artery disease (CAD) is one of the leading causes of mortality and morbidity. Exercise-based cardiac rehabilitation (EBCR) has been shown to improve clinical outcomes in these patients, and yet clinicians are often challenged to prescribe the most effective type of exercise training. Therefore, this systematic review and network meta-analysis (NMA) aims to formally quantify the optimal dose of exercise training interventions to improve exercise capacity and quality of life by undertaking direct and indirect pooled comparisons of randomized controlled trials. A detailed search will be conducted on PubMed/MEDLINE, Cumulative Index to Nursing and Allied Health (CINAHL), EMBASE and Web of Science. Two reviewers will screen the existing literature and assess the quality of the studies. Disagreements will be resolved through consensus. We anticipate that the analysis will include pairwise and Bayesian network meta-analyses. Most of the trials have studied the impact of exercise training comparing one or two modalities. As a result, little evidence exists to support which interventions will be most effective. The current NMA will address this gap in the literature and assist clinicians and cardiac rehabilitation specialists in making an informed decision. Results will be disseminated through peer-reviewed journals. Ethical approval is not applicable, as no research participants will be involved. PROSPERO Registration number: CRD42022262644.
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Affiliation(s)
- Shraddha Shah
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal 576104, India
| | - Grace Dibben
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow G12 8QQ, UK
| | - Aditi Ketkar
- DES Institutes, Brijlal Jindal College of Physiotherapy, Pune 411004, India
| | - David L. Hare
- Department of Cardiology, Austin Health, University of Melbourne, Melbourne, VIC 3084, Australia
| | - Jonathan Myers
- Department of Cardiology, Veterans Affairs Palo Alto Health Care System/Stanford University, Palo Alto, CA 94304, USA
| | - Barry Franklin
- Department of Preventive Cardiology and Cardiac Rehabilitation, William Beaumont Hospital, Royal Oak, MI 48073, USA
| | - Abraham Samuel Babu
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal 576104, India
- Department of Cardiology, Austin Health, University of Melbourne, Melbourne, VIC 3084, Australia
| | - Rod S. Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow G12 8QQ, UK
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Śladowska K, Kawalec P, Holko P, Osiecka O. Comparative safety of high-efficacy disease-modifying therapies in relapsing–remitting multiple sclerosis: a systematic review and network meta-analysis. Neurol Sci 2022; 43:5479-5500. [DOI: 10.1007/s10072-022-06197-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/04/2022] [Indexed: 10/18/2022]
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Riley RD, Dias S, Donegan S, Tierney JF, Stewart LA, Efthimiou O, Phillippo DM. Using individual participant data to improve network meta-analysis projects. BMJ Evid Based Med 2022; 28:197-203. [PMID: 35948411 DOI: 10.1136/bmjebm-2022-111931] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/04/2022]
Abstract
A network meta-analysis combines the evidence from existing randomised trials about the comparative efficacy of multiple treatments. It allows direct and indirect evidence about each comparison to be included in the same analysis, and provides a coherent framework to compare and rank treatments. A traditional network meta-analysis uses aggregate data (eg, treatment effect estimates and standard errors) obtained from publications or trial investigators. An alternative approach is to obtain, check, harmonise and meta-analyse the individual participant data (IPD) from each trial. In this article, we describe potential advantages of IPD for network meta-analysis projects, emphasising five key benefits: (1) improving the quality and scope of information available for inclusion in the meta-analysis, (2) examining and plotting distributions of covariates across trials (eg, for potential effect modifiers), (3) standardising and improving the analysis of each trial, (4) adjusting for prognostic factors to allow a network meta-analysis of conditional treatment effects and (5) including treatment-covariate interactions (effect modifiers) to allow relative treatment effects to vary by participant-level covariate values (eg, age, baseline depression score). A running theme of all these benefits is that they help examine and reduce heterogeneity (differences in the true treatment effect between trials) and inconsistency (differences in the true treatment effect between direct and indirect evidence) in the network. As a consequence, an IPD network meta-analysis has the potential for more precise, reliable and informative results for clinical practice and even allows treatment comparisons to be made for individual patients and targeted populations conditional on their particular characteristics.
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Affiliation(s)
| | - Sofia Dias
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Sarah Donegan
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | | | - Lesley A Stewart
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine (ISPMU), University of Bern, Bern, Switzerland
| | - David M Phillippo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Wingerchuk DM, Zhang I, Kielhorn A, Royston M, Levy M, Fujihara K, Nakashima I, Tanvir I, Paul F, Pittock SJ. A Response to: Letter to the Editor Regarding "Network Meta-analysis of Food and Drug Administration-approved Treatment Options for Adults with Aquaporin-4 Immunoglobulin G-positive Neuromyelitis Optica Spectrum Disorder". Neurol Ther 2022; 11:1445-1449. [PMID: 35780260 PMCID: PMC9338177 DOI: 10.1007/s40120-022-00378-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/07/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Friedemann Paul
- Charité-Universitätsmedizin Berlin and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
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Su WM, Gu XJ, Duan QQ, Jiang Z, Gao X, Shang HF, Chen YP. Genetic factors for survival in amyotrophic lateral sclerosis: an integrated approach combining a systematic review, pairwise and network meta-analysis. BMC Med 2022; 20:209. [PMID: 35754054 PMCID: PMC9235235 DOI: 10.1186/s12916-022-02411-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/18/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The time of survival in patients with amyotrophic lateral sclerosis (ALS) varies greatly, and the genetic factors that contribute to the survival of ALS are not well studied. There is a lack of a comprehensive study to elucidate the role of genetic factors in the survival of ALS. METHODS The published studies were systematically searched and obtained from PubMed, EMBASE, and the Cochrane Library without any language restrictions from inception to Oct 27, 2021. A network meta-analysis for ALS causative/risk genes and a systematic review and pairwise meta-analysis for other genetic modifiers were conducted. The PROSPERO registration number: CRD42022311646. RESULTS A total of 29,764 potentially relevant references were identified, and 71 papers were eligible for analysis based on pre-decided criteria, including 35 articles in network meta-analysis for 9 ALS causative/risk genes, 17 articles in pairwise meta-analysis for four genetic modifiers, and 19 articles described in the systematic review. Variants in three genes, including ATXN2 (HR: 3.6), C9orf72 (HR: 1.6), and FUS (HR:1.8), were associated with short survival of ALS, but such association was not identified in SOD1, TARDBP, TBK1, NEK1, UBQLN2, and CCNF. In addition, UNC13A rs12608932 CC genotype and ZNF521B rs2275294 C allele also caused a shorter survival of ALS; however, APOE ε4 allele and KIFAP3 rs1541160 did not be found to have any effect on the survival of ALS. CONCLUSIONS Our study summarized and contrasted evidence for prognostic genetic factors in ALS and would help to understand ALS pathogenesis and guide clinical trials and drug development.
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Affiliation(s)
- Wei-Ming Su
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Lab of Neurodegenerative Disorders, Institute of Inflammation and Immunology (III), Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Centre for Rare Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xiao-Jing Gu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Lab of Neurodegenerative Disorders, Institute of Inflammation and Immunology (III), Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Centre for Rare Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Qing-Qing Duan
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Lab of Neurodegenerative Disorders, Institute of Inflammation and Immunology (III), Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Centre for Rare Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Zheng Jiang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Lab of Neurodegenerative Disorders, Institute of Inflammation and Immunology (III), Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Centre for Rare Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Xia Gao
- Department of Geriatrics, Dazhou Central Hospital, Dazhou, Sichuan, China
| | - Hui-Fang Shang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Lab of Neurodegenerative Disorders, Institute of Inflammation and Immunology (III), Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.,Centre for Rare Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Yong-Ping Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China. .,Lab of Neurodegenerative Disorders, Institute of Inflammation and Immunology (III), Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China. .,Centre for Rare Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Efficacy and safety of first-line checkpoint inhibitors-based treatments for non-oncogene-addicted non-small-cell lung cancer: a systematic review and meta-analysis. ESMO Open 2022; 7:100465. [PMID: 35427835 PMCID: PMC9271478 DOI: 10.1016/j.esmoop.2022.100465] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/16/2022] [Accepted: 03/09/2022] [Indexed: 12/12/2022] Open
Abstract
Background Frontline immune checkpoint inhibitors (ICI)-based regimens in non-oncogene-addicted non-small-cell lung cancer (NSCLC) have been deeply investigated. To rank the available therapeutic options, we carried out a systematic review and Bayesian meta-analysis. Methods A comprehensive search for randomized controlled trials (RCTs) of ICI regimens, and a pairwise and a network meta-analysis (NMA) with an all-comers and a stratified strategy were conducted. Endpoints were overall survival (OS), progression-free survival (PFS), objective response rate (ORR) and treatment-related adverse events (TRAEs). Results Nineteen RCTs involving 17 treatment regimens were included. For the all-comers population, pembrolizumab/chemotherapy (CT) and cemiplimab were most likely the best treatments. For programmed death-ligand 1 (PD-L1) <1% nivolumab/ipilimumab with/without CT, for PD-L1 >1% and 1%-49% pembrolizumab/CT and for PD-L1 >50% cemiplimab ranked first for OS. In non-squamous (NSQ), pembrolizumab with/without CT ranked first for OS; cemiplimab ranked worse than the unselected population. In squamous (SQ), pooled hazard ratio (HR) showed a better chance in improving efficacy for combination strategy, while monotherapy did not, except for cemiplimab that ranked second. Atezolizumab/CT/bevacizumab ranked first in most subgroups for PFS. Direct comparison showed a non-statistically significant benefit of ICI regimens for the liver metastases cohort in OS, with a good ranking for pembrolizumab/CT and atezolizumab/bevacizumab/CT. Regarding brain metastases, all ICI regimens demonstrated an improvement in OS and PFS compared to CT. Nivolumab/ipilimumab/CT ranked better in this subset. Conclusions Our meta-analysis updated on the most recent findings demonstrates that different ICI treatments rank differently in specific NSCLC settings (histology, biomarker and clinical presentation) offering a novel challenging scenario for clinical decision making and research planning. Several frontline checkpoint inhibitors regimens for wild-type NSCLC are available. Efficacy and safety of these regimens were compared and ranked using a meta-analysis. Different ICI treatments rank differently in specific NSCLC cohorts of interest. Head-to-head RCTs are awaited to confirm this comprehensive and updated analysis.
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Greco A, Laudani C, Occhipinti G, Angiolillo DJ, Capodanno D. Reply: Short Duration of DAPT vs De-Escalation After Percutaneous Coronary Intervention for Acute Coronary Syndromes. JACC Cardiovasc Interv 2022; 15:999-1000. [PMID: 35512924 DOI: 10.1016/j.jcin.2022.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
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Lim RK, Trikalinos TA, Weinstock MA. Efficacy of Therapies for Actinic Keratosis. JAMA Dermatol 2022; 158:702-703. [PMID: 35475913 DOI: 10.1001/jamadermatol.2022.0889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rachel K Lim
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Thomas A Trikalinos
- Departments of Health Services, Policy & Practice and Biostatistics, Brown University, Providence, Rhode Island
| | - Martin A Weinstock
- Brown University, Veterans Affairs Medical Center, Providence, Rhode Island
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Lim J, Farhat I, Douros A, Panagiotoglou D. Relative effectiveness of medications for opioid-related disorders: A systematic review and network meta-analysis of randomized controlled trials. PLoS One 2022; 17:e0266142. [PMID: 35358261 PMCID: PMC8970369 DOI: 10.1371/journal.pone.0266142] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/15/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Several pharmacotherapeutic interventions are available for maintenance treatment for opioid-related disorders. However, previous meta-analyses have been limited to pairwise comparisons of these interventions, and their efficacy relative to all others remains unclear. Our objective was to unify findings from different healthcare practices and generate evidence to strengthen clinical treatment protocols for the most widely prescribed medications for opioid-use disorders. METHODS We searched Medline, EMBASE, PsycINFO, CENTRAL, and ClinicalTrials.gov for all relevant randomized controlled trials (RCT) from database inception to February 12, 2022. Primary outcome was treatment retention, and secondary outcome was opioid use measured by urinalysis. We calculated risk ratios (RR) and 95% credible interval (CrI) using Bayesian network meta-analysis (NMA) for available evidence. We assessed the credibility of the NMA using the Confidence in Network Meta-Analysis tool. RESULTS Seventy-nine RCTs met the inclusion criteria. Due to heterogeneity in measuring opioid use and reporting format between studies, we conducted NMA only for treatment retention. Methadone was the highest ranked intervention (Surface Under the Cumulative Ranking [SUCRA] = 0.901) in the network with control being the lowest (SUCRA = 0.000). Methadone was superior to buprenorphine for treatment retention (RR = 1.22; 95% CrI = 1.06-1.40) and buprenorphine superior to naltrexone (RR = 1.39; 95% CrI = 1.10-1.80). However, due to a limited number of high-quality trials, confidence in the network estimates of other treatment pairs involving naltrexone and slow-release oral morphine (SROM) remains low. CONCLUSION All treatments had higher retention than the non-pharmacotherapeutic control group. However, additional high-quality RCTs are needed to estimate more accurately the extent of efficacy of naltrexone and SROM relative to other medications. For pharmacotherapies with established efficacy profiles, assessment of their long-term comparative effectiveness may be warranted. TRIAL REGISTRATION This systematic review has been registered with PROSPERO (https://www.crd.york.ac.uk/prospero) (identifier CRD42021256212).
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Affiliation(s)
- Jihoon Lim
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Imen Farhat
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
| | - Antonios Douros
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada
- Institute of Clinical Pharmacology and Toxicology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Dimitra Panagiotoglou
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada
- * E-mail:
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Chang PC, Chen KH, Jhou HJ, Lee CH, Chou SH, Chen PH, Chang TW. Promising Effects of Digital Chest Tube Drainage System for Pulmonary Resection: A Systematic Review and Network Meta-Analysis. J Pers Med 2022; 12:jpm12040512. [PMID: 35455628 PMCID: PMC9029690 DOI: 10.3390/jpm12040512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: The chest tube drainage system (CTDS) of choice for the pleural cavity after pulmonary resection remains controversial. This systematic review and network meta-analysis (NMA) aimed to assess the length of hospital stay, chest tube placement duration, and prolonged air leak among different types of CTDS. Methods: This systemic review and NMA included 21 randomized controlled trials (3399 patients) in PubMed and Embase until 1 June 2021. We performed a frequentist random effect in our NMA, and a P-score was adopted to determine the best treatment. We assessed the clinical efficacy of different CTDSs (digital/suction/non-suction) using the length of hospital stay, chest tube placement duration, and presence of prolonged air leak. Results: Based on the NMA, digital CTDS was the most beneficial intervention for the length of hospital stay, being 1.4 days less than that of suction CTDS (mean difference (MD): −1.40; 95% confidence interval (CI): −2.20 to −0.60). Digital CTDS also had significantly reduced chest tube placement duration, being 0.68 days less than that of suction CTDSs (MD: −0.68; 95% CI: −1.32 to −0.04). Neither digital nor non-suction CTDS significantly reduced the risk of prolonged air leak. Conclusions: Digital CTDS is associated with better outcomes than suction and non-suction CTDS for patients undergoing pulmonary resections, specifically 0.68 days shorter chest tube duration and 1.4 days shorter hospital stay than suction CTDS.
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Affiliation(s)
- Po-Chih Chang
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan; (P.-C.C.); (S.-H.C.)
- Weight Management Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan
- Ph.D. Program in Biomedical Engineering, College of Medicine, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan
- Department of Sports Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan
| | - Kai-Hua Chen
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan;
| | - Hong-Jie Jhou
- Department of Neurology, Changhua Christian Hospital, Changhua 50006, Taiwan;
| | - Cho-Hao Lee
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei City 11490, Taiwan;
| | - Shah-Hwa Chou
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan; (P.-C.C.); (S.-H.C.)
- Department of Surgery, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan
| | - Po-Huang Chen
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City 11490, Taiwan
- Correspondence: (P.-H.C.); (T.-W.C.); Tel.: +886-7-3121101 (ext. 6206)
| | - Ting-Wei Chang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan;
- Correspondence: (P.-H.C.); (T.-W.C.); Tel.: +886-7-3121101 (ext. 6206)
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Veroniki AA, Tsokani S, Rücker G, Mavridis D, Takwoingi Y. Challenges in Comparative Meta-Analysis of the Accuracy of Multiple Diagnostic Tests. Methods Mol Biol 2022; 2345:299-316. [PMID: 34550598 DOI: 10.1007/978-1-0716-1566-9_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The rapid increase in diagnostic and screening techniques has urged the need to choose among multiple diagnostic tests. For the majority of diseases, there is more than a single test available, and studies usually compare a subset of these tests. In such cases, a separate meta-analysis of each test cannot provide a reliable answer on the relative accuracy of the multiple available tests. Extensions of standard (hierarchical) meta-analysis to network meta-analysis (NMA) models for the comparison of at least three diagnostic tests have been the subject of methodological research in recent years. NMA can be used to jointly analyze the totality of evidence in order to provide estimates of relative accuracy (sensitivity and specificity ), to compare tests that have not been compared head-to-head, and to obtain a ranking of all competing tests in order to further facilitate the decision-making process.In this chapter, we illustrate current methodology for meta-analysis of multiple test comparisons, introduce NMA methods of diagnostic tests as an extension to the standard meta-analysis of diagnostic test accuracy (DTA) studies, and present existing approaches to rank tests according to their accuracy, specificity , and sensitivity . We also describe the basic concepts, underlying assumptions, and challenges in NMA of multiple diagnostic tests.
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Affiliation(s)
- Areti Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
- Department of Surgery and Cancer, Faculty of Medicine, Institute of Reproductive and Developmental Biology, Imperial College, London, UK.
| | - Sofia Tsokani
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
| | - Gerta Rücker
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Dimitris Mavridis
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
- Paris Descartes University, Sorbonne Paris Cité, Faculté de Médecine, Paris, France
| | - Yemisi Takwoingi
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
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Abstract
There are often multiple potential interventions to treat a disease; therefore, we need a method for simultaneously comparing and ranking all of these available interventions. In contrast to pairwise meta-analysis, which allows for the comparison of one intervention to another based on head-to-head data from randomized trials, network meta-analysis (NMA) facilitates simultaneous comparison of the efficacy or safety of multiple interventions that may not have been directly compared in a randomized trial. NMAs help researchers study important and previously unanswerable questions, which have contributed to a rapid rise in the number of NMA publications in the biomedical literature. However, the conduct and interpretation of NMAs are more complex than pairwise meta-analyses: there are additional NMA model assumptions (i.e., network connectivity, homogeneity, transitivity, and consistency) and outputs (e.g., network plots and surface under the cumulative ranking curves [SUCRAs]). In this chapter, we will: (1) explore similarities and differences between pairwise and network meta-analysis; (2) explain the differences between direct, indirect, and mixed treatment comparisons; (3) describe how treatment effects are derived from NMA models; (4) discuss key criteria predicating completion of NMA; (5) interpret NMA outputs; (6) discuss areas of ongoing methodological research in NMA; (7) outline an approach to conducting a systematic review and NMA; (8) describe common problems that researchers encounter when conducting NMAs and potential solutions; and (9) outline an approach to critically appraising a systematic review and NMA.
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Affiliation(s)
- Jennifer Watt
- St. Michael's Hospital-Unity Health Toronto, Toronto, ON, Canada.
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
- Li Ka Shing Knowledge Institute, Toronto, ON, Canada.
| | - Cinzia Del Giovane
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Population Health Laboratory (#PopHealthLab), University of Fribourg, Fribourg, Switzerland
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Jung HN, Cho YK, Min SH, Kim HS, Kim YJ, Park JY, Lee WJ, Jung CH. Free Versus Fixed-Ratio Combination of Basal Insulin and GLP-1 Receptor Agonists in Type 2 Diabetes Uncontrolled With GLP-1 Receptor Agonists: A Systematic Review and Indirect Treatment Comparison. Front Endocrinol (Lausanne) 2022; 13:870722. [PMID: 35669682 PMCID: PMC9165059 DOI: 10.3389/fendo.2022.870722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/13/2022] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION This study evaluates the efficacy and safety of the free up-titration of basal insulin and fixed-ratio combination (FRC) of basal insulin and glucagon-like peptide-1 receptor agonists (GLP-1RAs) in type 2 diabetes mellitus (T2DM) patients inadequately controlled with GLP-1RA. METHODS With the use of a systematic literature review of PubMed, Embase, Web of Science, and the Cochrane Library databases through July 2021, randomized controlled trials that compared the free up-titration or FRC with remaining on GLP-1RA in T2DM patients uncontrolled with GLP-1RA were included. A comparison of adding basal insulin to maintaining GLP-1RA and an indirect comparison between the two strategies were conducted on the change in HbA1c, fasting plasma glucose (FPG), target achievement [HbA1c < 7.0%], and the risk of confirmed hypoglycemia. The Cochrane Collaboration's tool was used to assess the risk of bias. RESULTS Two free up-titration and two FRC trials involving 1,612 participants, all lasting 26 weeks, were included. Both approaches significantly lowered HbA1c levels (weighted mean difference [WMD] -0.75%, 95% CI -0.97 to -0.53) but increased hypoglycemic risk [risk ratio (RR) 7.59, 95% CI 3.35-17.17] compared to the unchanged GLP-1RA. No significant differences were discovered between the two methods regarding the decrease in HbA1c (WMD 0.08%, 95% CI -1.07% to 1.23%), FPG (WMD -2.29 mg/dl, 95% CI -45.07 to 40.49 mg/dl), target achievement (RR 1.03, 95% CI 0.50-2.14), and hypoglycemic risk (RR 0.32, 95% CI 0.03-3.59). CONCLUSION In patients who failed to reach target HbA1c levels despite the GLP-1RA treatment, both strategies of adding basal insulin, free up-titration and FRC, are comparable options are comparable options.
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Affiliation(s)
- Han Na Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, South Korea
| | - Yun Kyung Cho
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, South Korea
| | - Se Hee Min
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, South Korea
| | - Hwi Seung Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, South Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Joong-Yeol Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, South Korea
| | - Woo Je Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, South Korea
| | - Chang Hee Jung
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- Asan Diabetes Center, Asan Medical Center, Seoul, South Korea
- *Correspondence: Chang Hee Jung, ;
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Ronnebaum S, Bron M, Patel D, Menno D, Bujanover S, Kratochvil D, Lucas E, Stepnowsky C. Indirect treatment comparison of solriamfetol, modafinil, and armodafinil for excessive daytime sleepiness in obstructive sleep apnea. J Clin Sleep Med 2021; 17:2543-2555. [PMID: 34402784 DOI: 10.5664/jcsm.9610] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Excessive daytime sleepiness associated with obstructive sleep apnea affects 9%-22% of continuous positive airway pressure-treated patients. An indirect treatment comparison meta-analysis was performed to compare efficacy and safety of medications (solriamfetol, modafinil, and armodafinil) approved to treat excessive daytime sleepiness associated with obstructive sleep apnea. METHODS Efficacy and safety measures assessed in this indirect treatment comparison included Epworth Sleepiness Scale (ESS), 20-minute Maintenance of Wakefulness Test (MWT20), Clinical Global Impression of Change (CGI-C), Functional Outcomes of Sleep Questionnaire (FOSQ), and incidence of treatment-emergent adverse events (any, serious, or leading to discontinuation). RESULTS A systematic literature review identified 6 parallel-arm, placebo-controlled randomized controlled trials that randomized 1,714 total participants to placebo, solriamfetol, modafinil, or armodafinil. In this indirect treatment comparison, all comparators were associated with greater improvements than placebo on the ESS, MWT20, and CGI-C after 4, 8, and 12 weeks of treatment. Relative to comparators and placebo at 12 weeks, solriamfetol at 150 mg or 300 mg had the highest probabilities of improvement in the ESS, MWT20, and CGI-C. Modafinil (200 or 400 mg) and solriamfetol (150 or 300 mg) were associated with greater improvement on the FOSQ than placebo at 12 weeks. Less than 2% of patients using placebo or comparators experienced serious or discontinuation-related treatment-emergent adverse events. CONCLUSIONS The results of this indirect treatment comparison show 12 weeks of treatment with solriamfetol, modafinil, and armodafinil resulted in varying levels of improvement on the ESS, MWT20, and CGI-C and similar safety risks in participants with excessive daytime sleepiness associated with obstructive sleep apnea. CITATION Ronnebaum S, Bron M, Patel D, et al. Indirect treatment comparison of solriamfetol, modafinil, and armodafinil for excessive daytime sleepiness in obstructive sleep apnea. J Clin Sleep Med. 2021;17(12):2543-2555.
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Network Meta-analysis of Food and Drug Administration-approved Treatment Options for Adults with Aquaporin-4 Immunoglobulin G-positive Neuromyelitis Optica Spectrum Disorder. Neurol Ther 2021; 11:123-135. [PMID: 34773597 PMCID: PMC8857350 DOI: 10.1007/s40120-021-00295-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/18/2021] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease defined by attacks on the central nervous system that cause irreversible damage. Recent approval of NMOSD therapies warrants investigations of comparative efficacy to inform treatment decisions. METHODS A network meta-analysis (NMA) of all U.S. Food and Drug Administration-approved therapies (eculizumab, inebilizumab, and satralizumab) for adults with aquaporin-4 immunoglobulin G-positive (AQP4+) NMOSD was conducted via a systematic literature review (SLR) using data from randomized controlled trials (RCTs). Database searches of MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were executed for the SLR. A fixed-effects proportional hazards Bayesian NMA was used to estimate relative treatment effects based on data extracted from RCTs identified during the SLR (search end date: 11 September 2020). Four unique RCTs (N-MOmentum, PREVENT, SAkuraSky, and SAkuraStar) were identified, and data from 29 publications were extracted for analysis. Network scenarios describing the most comparable patient population groups (such as by treatment settings) were evaluated in our analyses. Relative treatment effects were evaluated based on time-to-first relapse and were expressed as hazard ratios (HRs) with 95% credible intervals (CrIs). RESULTS In patients treated with a monoclonal antibody only, eculizumab was associated with a lower risk of relapse compared with satralizumab (HR 0.10, 95% CrI 0.01, 0.65) and inebilizumab (HR 0.11, 95% CrI 0.02, 0.68). In patients treated with monoclonal antibody with or without background immunosuppressive therapy (IST), patients treated with eculizumab ± IST were also less likely to relapse than patients treated with satralizumab ± IST (HR 0.24, 95% CrI 0.06, 0.98). CONCLUSION The NMA results suggest that complement component 5 (C5) inhibition prevents NMOSD relapses more effectively than broader mechanisms of action.
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Jhou HJ, Chen PH, Ou-Yang LJ, Lin C, Tang SE, Lee CH. Methods of Weaning From Mechanical Ventilation in Adult: A Network Meta-Analysis. Front Med (Lausanne) 2021; 8:752984. [PMID: 34671629 PMCID: PMC8521009 DOI: 10.3389/fmed.2021.752984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/13/2021] [Indexed: 12/16/2022] Open
Abstract
Background/Objective: The aim of study is to assess the efficacy of each ventilator weaning method for ventilated patients in intensive care units (ICUs). Methods: A systematic search was conducted using PubMed, Embase, and China National Knowledge Infrastructure to identify randomized control studies on ventilated patients regarding extubation associated outcomes (weaning success or failure, proportion requiring re-intubation, or mortality) from inception until April 01, 2020. Commonly used ventilation modes involved pressure support ventilation, synchronized intermittent mandatory ventilation, automatic tube compensation, continuous positive airway pressure, adaptive support ventilation, neurally adjusted ventilatory assist, proportional assisted ventilation, and SmartCare. Pooled estimates regarding extubation associated outcomes were calculated using network meta-analysis. Results: Thirty-nine randomized controlled trials including 5,953 patients met inclusion criteria. SmartCare and proportional assist ventilation were found to be effective methods in increasing weaning success (odds ratio, 2.72, 95% confidence interval (CI), 1.33–5.58, P-score: 0.84; odds ratio, 2.56, 95% CI, 1.60–4.11, P-score: 0.83; respectively). Besides, proportional assist ventilation had superior in reducing proportion requiring re-intubation rate (odds ratio, 0.48, 95% CI, 0.25–0.92, P-score: 0.89) and mortality (odds ratio, 0.48, 95% CI, 0.26–0.92, P-score: 0.91) than others. Conclusion: In general consideration, our study provided evidence that weaning with proportional assist ventilation has a high probability of being the most effective ventilation mode for patients with mechanical ventilation regarding a higher rate of weaning success, a lower proportion requiring reintubation, and a lower mortality rate than other ventilation modes.
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Affiliation(s)
- Hong-Jie Jhou
- Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Huang Chen
- Department of General Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Liang-Jun Ou-Yang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chin Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Department of Research and Development, National Defense Medical Center, Taipei, Taiwan
| | - Shih-En Tang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan.,National Defense Medical Center, Graduate Institute of Aerospace and Undersea Medicine, Taipei, Taiwan
| | - Cho-Hao Lee
- Division of Hematology and Oncology Medicine, Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
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A network meta-analysis of secondary attack rates of COVID-19 in different contact environments. Epidemiol Infect 2021; 149:e219. [PMID: 35686655 PMCID: PMC8523971 DOI: 10.1017/s0950268821002223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Abstract
As the corona virus disease 2019 (COVID-19) pandemic continues around the world, understanding the transmission characteristics of COVID-19 is vital for prevention and control. We conducted the first study aiming to estimate and compare the relative risk of secondary attack rates (SARs) of COVID-19 in different contact environments. Until 26 July 2021, epidemiological studies and cluster epidemic reports of COVID-19 were retrieved from SCI, Embase, PubMed, CNKI, Wanfang and CBM in English and Chinese, respectively. Relative risks (RRs) were estimated in pairwise comparisons of SARs between different contact environments using the frequentist NMA framework, and the ranking of risks in these environments was calculated using the surface under the cumulative ranking curve (SUCRA). Subgroup analysis was performed by regions. Thirty-two studies with 68 260 participants were identified. Compared with meal or gathering, transportation (RR 10.55, 95% confidence interval (CI) 1.43–77.85), medical care (RR 11.68, 95% CI 1.58–86.61) and work or study places (RR 10.15, 95% CI 1.40–73.38) had lower risk ratios for SARs. Overall, the SUCRA rankings from the highest to the lowest were household (95.3%), meal or gathering (81.4%), public places (58.9%), daily conversation (50.1%), transportation (30.8%), medical care (18.2%) and work or study places (15.3%). Household SARs were significantly higher than other environments in the subgroup of mainland China and sensitive analysis without small sample studies (<100). In light of the risks, stratified personal protection and public health measures need to be in place accordingly, so as close contacts categorising and management.
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Yanes-Lane M, Ortiz-Brizuela E, Campbell JR, Benedetti A, Churchyard G, Oxlade O, Menzies D. Tuberculosis preventive therapy for people living with HIV: A systematic review and network meta-analysis. PLoS Med 2021; 18:e1003738. [PMID: 34520459 PMCID: PMC8439495 DOI: 10.1371/journal.pmed.1003738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 07/18/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) preventive therapy (TPT) is an essential component of care for people living with HIV (PLHIV). We compared efficacy, safety, completion, and drug-resistant TB risk for currently recommended TPT regimens through a systematic review and network meta-analysis (NMA) of randomized trials. METHODS AND FINDINGS We searched MEDLINE, Embase, and the Cochrane Library from inception through June 9, 2020 for randomized controlled trials (RCTs) comparing 2 or more TPT regimens (or placebo/no treatment) in PLHIV. Two independent reviewers evaluated eligibility, extracted data, and assessed the risk of bias. We grouped TPT strategies as follows: placebo/no treatment, 6 to 12 months of isoniazid, 24 to 72 months of isoniazid, and rifamycin-containing regimens. A frequentist NMA (using graph theory) was carried out for the outcomes of development of TB disease, all-cause mortality, and grade 3 or worse hepatotoxicity. For other outcomes, graphical descriptions or traditional pairwise meta-analyses were carried out as appropriate. The potential role of confounding variables for TB disease and all-cause mortality was assessed through stratified analyses. A total of 6,466 unique studies were screened, and 157 full texts were assessed for eligibility. Of these, 20 studies (reporting 16 randomized trials) were included. The median sample size was 616 (interquartile range [IQR], 317 to 1,892). Eight were conducted in Africa, 3 in Europe, 3 in the Americas, and 2 included sites in multiple continents. According to the NMA, 6 to 12 months of isoniazid were no more efficacious in preventing microbiologically confirmed TB than rifamycin-containing regimens (incidence rate ratio [IRR] 1.0, 95% CI 0.8 to 1.4, p = 0.8); however, 6 to 12 months of isoniazid were associated with a higher incidence of all-cause mortality (IRR 1.6, 95% CI 1.2 to 2.0, p = 0.02) and a higher risk of grade 3 or higher hepatotoxicity (risk difference [RD] 8.9, 95% CI 2.8 to 14.9, p = 0.004). Finally, shorter regimens were associated with higher completion rates relative to longer regimens, and we did not find statistically significant differences in the risk of drug-resistant TB between regimens. Study limitations include potential confounding due to differences in posttreatment follow-up time and TB incidence in the study setting on the estimates of incidence of TB or all-cause mortality, as well as an underrepresentation of pregnant women and children. CONCLUSIONS Rifamycin-containing regimens appear safer and at least as effective as isoniazid regimens in preventing TB and death and should be considered part of routine care in PLHIV. Knowledge gaps remain as to which specific rifamycin-containing regimen provides the optimal balance of efficacy, completion, and safety.
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Affiliation(s)
- Mercedes Yanes-Lane
- Respiratory Epidemiology and Clinical Research Unit, McGill International TB Centre, McGill University, Montréal, Québec, Canada
| | - Edgar Ortiz-Brizuela
- Respiratory Epidemiology and Clinical Research Unit, McGill International TB Centre, McGill University, Montréal, Québec, Canada
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jonathon R. Campbell
- Respiratory Epidemiology and Clinical Research Unit, McGill International TB Centre, McGill University, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, McGill International TB Centre, McGill University, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Department of Medicine, McGill University, Montreal, Canada
| | - Gavin Churchyard
- The Aurum Institute, Parktown, South Africa
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Olivia Oxlade
- Respiratory Epidemiology and Clinical Research Unit, McGill International TB Centre, McGill University, Montréal, Québec, Canada
| | - Dick Menzies
- Respiratory Epidemiology and Clinical Research Unit, McGill International TB Centre, McGill University, Montréal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- * E-mail:
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Alsugair HA, Alshugair IF, Alharbi TJ, Bin Rsheed AM, Tourkmani AM, Al-Madani W. Weekly Semaglutide vs. Liraglutide Efficacy Profile: A Network Meta-Analysis. Healthcare (Basel) 2021; 9:healthcare9091125. [PMID: 34574899 PMCID: PMC8466858 DOI: 10.3390/healthcare9091125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/20/2021] [Accepted: 08/22/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Glucagon-like peptide 1 receptor agonist (GLP-1 RA) is a class of hypoglycemic medications. Semaglutide once-weekly (QW) and liraglutide once-daily (OD) significantly improved glycemic control compared to placebo. To date, no long-term phase III trials directly comparing semaglutide and liraglutide are available. This network meta-analysis (NMA) aims to compare the long-term efficacy of semaglutide and liraglutide. METHODS PubMed, Embase, and Cochrane Library were searched from inception until June 2019 to identify relevant articles. Nine long-term randomized controlled trials comparing once-weekly semaglutide or liraglutide with placebo or other active comparisons were identified. The outcomes of interest were changes in HbA1c and weight after 52 weeks. A Bayesian framework and NMA were used for data synthesis. This is a sub-study of the protocol registered in PROSPERO (number CRD42018091598). RESULTS The data showed significant superiority in HbA1c reduction of semaglutide 1 mg QW over liraglutide 1.2 and 1.8 mg with a treatment difference of 0.47% and 0.3%, respectively. Semaglutide 0.5 mg QW was found to be significantly superior to liraglutide 1.2 mg in HbA1c reduction with a treatment difference of 0.17%. Regarding weight reduction analysis, semaglutide 0.5 and 1 mg QW were significantly associated with a greater reduction than liraglutide 0.6 mg with a treatment difference of 2.42 and 3.06 kg, respectively. However, no significant reduction was found in comparison to liraglutide 1.2 and 1.8 mg. CONCLUSIONS Semaglutide improved the control of blood glucose and body weight. The capacity of long-term glycemic control and body weight control of semaglutide appears to be more effective than other GLP-1 RAs, including liraglutide. However, considering the number of included studies and potential limitations, more large-scale, head-to-head, well-designed randomized-controlled trials (RCTs) are needed to confirm these findings.
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Affiliation(s)
- Hassan A. Alsugair
- Family Medicine Department, Prince Sultan Military Medical City, Riyadh 12624, Saudi Arabia; (A.M.B.R.); (A.M.T.)
- Correspondence: or (H.A.A.); or (T.J.A.); Tel.: +966-114777714-40438 (T.J.A.)
| | - Ibrahim F. Alshugair
- Orthopedic Surgery Department, King Saud Medical City, Riyadh 12746, Saudi Arabia;
| | - Turki J. Alharbi
- Family Medicine Department, Prince Sultan Military Medical City, Riyadh 12624, Saudi Arabia; (A.M.B.R.); (A.M.T.)
- Correspondence: or (H.A.A.); or (T.J.A.); Tel.: +966-114777714-40438 (T.J.A.)
| | - Abdulaziz M. Bin Rsheed
- Family Medicine Department, Prince Sultan Military Medical City, Riyadh 12624, Saudi Arabia; (A.M.B.R.); (A.M.T.)
| | - Ayla M. Tourkmani
- Family Medicine Department, Prince Sultan Military Medical City, Riyadh 12624, Saudi Arabia; (A.M.B.R.); (A.M.T.)
| | - Wedad Al-Madani
- General Authority of Statistics, Riyadh 11481, Saudi Arabia;
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Huang R, Gan R, Zhang D, Xiao J. The comparative safety of human papillomavirus vaccines: A Bayesian network meta-analysis. J Med Virol 2021; 94:729-736. [PMID: 34453758 DOI: 10.1002/jmv.27304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS The safety of human papillomavirus (HPV) vaccines, one of the major challenges to public vaccination, has been controversial. This study assessed the adverse reactions of various HPV vaccines, including bivalent HPV (2vHPV), quadrivalent HPV (4vHPV), and 9-valent HPV (9vHPV) vaccines. METHODS PubMed, Embase, and Central databases were searched for randomized controlled trials (RCTs) on the comparative safety of HPV vaccines. A network meta-analysis was performed based on the Bayesian framework random-effects model. RESULTS This study included 23 RCTs. Analysis across these reports indicated that the 2vHPV vaccine was associated with significantly more systemic adverse events than the 4vHPV vaccine (risk ratio [RR]: 1.28, 95% credible interval [CrI]: 1.14-1.44), 9vHPV vaccine (RR: 1.25, 95% CrI: 1.06-1.49), and placebo (RR: 1.31, 95% CrI: 1.18-1.46). However, there were no statistically significant differences in serious adverse events between the vaccinated and placebo groups. For injection-site adverse events, there were substantial inconsistencies between the direct and indirect effects; therefore, the analysis results of the safety were presented only for systemic and serious adverse events. CONCLUSIONS The 2vHPV vaccine resulted in more systemic adverse events than other vaccines and placebo. No significant differences in serious adverse events were observed. Further studies are needed to obtain more information regarding the safety of HPV vaccines.
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Affiliation(s)
- Rongdong Huang
- Center for Vaccine Clinical Research, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Ruihuan Gan
- Department of Preventive Dentistry, Affiliated Stomatological Hospital, Fujian Medical University, Fuzhou, China
| | - Dongjuan Zhang
- Center for Vaccine Clinical Research, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
| | - Jianxiong Xiao
- Center for Vaccine Clinical Research, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, China
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Tricco AC, Ashoor HM, Antony J, Bouck Z, Rodrigues M, Pham B, Khan PA, Nincic V, Darvesh N, Yazdi F, Ghassemi M, Ivory JD, Veroniki AA, Yu CH, Moja L, Straus SE. Comparative Efficacy and Safety of Ultra-Long-Acting, Long-Acting, Intermediate-Acting, and Biosimilar Insulins for Type 1 Diabetes Mellitus: a Systematic Review and Network Meta-Analysis. J Gen Intern Med 2021; 36:2414-2426. [PMID: 33742305 PMCID: PMC8342652 DOI: 10.1007/s11606-021-06642-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Increasing availability of competing biosimilar alternatives makes it challenging to make treatment decisions. The purpose of this review is to evaluate the comparative efficacy and safety of ultra-long-/long-/intermediate-acting insulin products and biosimilar insulin compared to human/animal insulin in adults with type 1 diabetes mellitus (T1DM). METHODS MEDLINE, EMBASE, CENTRAL, and grey literature were searched from inception to March 27, 2019. Randomized controlled trials (RCTs), quasi-experimental studies, and cohort studies of adults with T1DM receiving ultra-long-/long-/intermediate-acting insulin, compared to each other, as well as biosimilar insulin compared to human/animal insulin were eligible for inclusion. Two reviewers independently screened studies, abstracted data, and appraised risk-of-bias. Pairwise meta-analyses and network meta-analyses (NMA) were conducted. Summary effect measures were mean differences (MD) and odds ratios (OR). RESULTS We included 65 unique studies examining 14,200 patients with T1DM. Both ultra-long-acting and long-acting insulin were superior to intermediate-acting insulin in reducing A1c, FPG, weight gain, and the incidence of major, serious, or nocturnal hypoglycemia. For fasting blood glucose, long-acting once a day (od) was superior to long-acting twice a day (bid) (MD - 0.44, 95% CI: - 0.81 to - 0.06) and ultra-long-acting od was superior to long-acting bid (MD - 0.73, 95% CI - 1.36 to - 0.11). For weight change, long-acting od was inferior to long-acting bid (MD 0.58, 95% CI: 0.05 to 1.10) and long-acting bid was superior to long-action biosimilar od (MD - 0.90, 95% CI: - 1.67 to - 0.12). CONCLUSIONS Our results can be used to tailor insulin treatment according to the desired results of patients and clinicians and inform strategies to establish a competitive clinical market, address systemic barriers, expand the pool of potential suppliers, and favor insulin price reduction. PROSPERO REGISTRATION CRD42017077051.
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Affiliation(s)
- Andrea C. Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
- Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Huda M. Ashoor
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
| | - Jesmin Antony
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
| | - Zachary Bouck
- Centre for Drug Policy and Evaluation, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Canada
| | - Myanca Rodrigues
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
| | - Ba’ Pham
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
| | - Paul A. Khan
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
| | - Vera Nincic
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
| | - Nazia Darvesh
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
| | - Fatemeh Yazdi
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario Canada
| | - Marco Ghassemi
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
| | - John D. Ivory
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
| | - Areti Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
- Department of Primary Education, School of Education, University of Ioannina, Ioannina, Greece
- Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, Imperial College, London, UK
| | - Catherine H. Yu
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
| | - Lorenzo Moja
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario Canada
- Department of Geriatric Medicine, University of Toronto, Toronto, Ontario Canada
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Wei L, Meng J, Qi J, Lu Y, Zhu X. Comparisons of intraocular lens power calculation methods for eyes with previous myopic laser refractive surgery: Bayesian network meta-analysis. J Cataract Refract Surg 2021; 47:1011-1018. [PMID: 34290197 DOI: 10.1097/j.jcrs.0000000000000562] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/14/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the accuracy of the methods for calculation of intraocular lens (IOL) power in eyes with previous myopic laser refractive surgery. SETTING EENT Hospital of Fudan University, Shanghai, China. DESIGN Network meta-analysis. METHODS A literature search of MEDLINE and Cochrane Library from January 2000 to July 2019 was conducted for studies that evaluated methods of calculating IOL power in eyes with previous myopic laser refractive surgery. Outcomes measurements were the percentages of prediction error within ±0.50 diopters (D) and ±1.00 D of the target refraction (% ±0.50 D and % ±1.00 D). Traditional and network meta-analysis were conducted. RESULTS Nineteen prospective or retrospective clinical studies, including 1217 eyes and 13 calculation methods, were identified. A traditional meta-analysis showed that compared with the widely used Haigis-L method, the Barrett True-K formula, optical coherence tomography (OCT), and Masket methods showed significantly higher % ±0.50 D, whereas no difference was found in the % ±1.00 D. A network meta-analysis revealed that compared with the Haigis-L method, the OCT, Barrett True-K formula, and optiwave refractive analysis (ORA) methods performed better on the % ±0.50 D, whereas the Barrett True-K formula and ORA methods performed better on the % ±1.00 D. Based on the performances of both outcomes, the Barrett True-K formula, OCT, and ORA methods showed highest probability to rank the top 3 among the 13 methods. CONCLUSIONS The Barrett True-K formula, OCT, and ORA methods seemed to offer greater accuracy than others in calculating the IOL power for postrefractive surgery eyes.
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Affiliation(s)
- Ling Wei
- From the Department of Ophthalmology and Eye Institute, Eye and ENT Hospital of Fudan University; NHC Key Laboratory of Myopia (Fudan University); Key Laboratory of Myopia, Chinese Academy of Medical Science; and Shanghai Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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Bae K, Shin IS. Critical evaluation of reporting quality of network meta-analyses assessing the effectiveness of acupuncture. Complement Ther Clin Pract 2021; 45:101459. [PMID: 34388562 DOI: 10.1016/j.ctcp.2021.101459] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/15/2021] [Accepted: 07/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND and purpose: Network meta-analyses (NMAs) comparing the effectiveness of multiple acupuncture have been published but the key concepts underlying NMAs have not been properly reported. This critical evaluation aims to assess the completeness of reporting for NMAs of acupuncture to enhance the validity of findings. MATERIALS AND METHODS Five databases were searched. The characteristics and reporting quality based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension Statement for reporting of NMA (PRISMA-NMA) were evaluated. NMAs were categorized into two groups according to the publication date, reporting guideline, and intervention. The group differences and correlation coefficients were calculated. RESULTS Forty-two NMAs of acupuncture were evaluated. The reporting quality for new items in the key concepts of NMAs was low (median 70.0 % (interquartile range 60.0-80.0)). While the issue of consistency was well reported, the assumption of transitivity and network geometry showed poor reporting. Seventeen studies that followed the PRISMA-NMA guideline showed a higher reporting rate for essential concepts of NMA. The recency of publication did not guarantee clear reporting. CONCLUSION The reporting quality of NMAs of acupuncture was low. The researchers should follow the guidelines on the reporting of NMAs.
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Affiliation(s)
- Kyeore Bae
- Center for Immunity and Pain, Kwanghye Hospital, Seoul, Republic of Korea.
| | - In-Soo Shin
- Department of Graduate School of Education, Dongguk University, Seoul, Republic of Korea.
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