5-azacitidine prolongs overall survival in patients with myelodysplastic syndrome - systematic review and meta-analysis (Reply to Kumar et al. and to Herbst et al.)

Abstract

method" and not Peto's method. Moreover, the very brief quality assessment appears to be based on the 4 th version of the Cochrane Handbook and not on version 5 which was implemented in 2008.6 Thus, for example, the new handbook requires a citation in order to justify the judgment of each quality item in a risk-of-bias assessment. Furthermore, the electronic search given in the paper of Gurion et al. was not carried out according to general recommendations. Among others, MeSH terms were not used and the EMBASE was not searched. We have not assessed whether a wider search would have increased the number of included studies.In summary, even a rough review of the presented metaanalysis and the included trials reveals many methodological shortcomings. A correction of the major errors in the meta-analysis of overall survival and its interpretation should change the conclusion of the meta-analysis into: "Currently it is unclear whether newer hypomethylating agents improve overall survival in MDS." We, therefore, strongly recommend that this meta-analysis should not be used as a basis for clinical decision making or guideline development.