Compliance with QUOROM and quality of reporting of overlapping meta-analyses on the role of acetylcysteine in the prevention of contrast associated nephropathy: case study

Biondi‐Zoccai, Giuseppe; Lotrionte, Marzia; Abbate, Antonio; Testa, Luca; Remigi, Enrico; Burzotta, Francesco; Valgimigli, Marco; Romagnoli, Enrico; Crea, Filippo; Agostoni, Pierfrancesco

doi:10.1136/bmj.38693.516782.7c

Cited by 133 publications

(83 citation statements)

References 39 publications

(39 reference statements)

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“…Aunque las implicaciones de estos sesgos en la realización y publicación de revisiones sistemáticas en sí mismas no están claras, alguna investigación previa ha identificado que la publicación selectiva de resultados también puede producirse en el contexto de las revisiones sistemáticas 42 . posiblemente reduciendo el riesgo de un número excesivo de revisiones tratando el mismo tema 16,17 y proporcionando una mayor transparencia en las actualizaciones de las revisiones sistemáticas.…”

Section: Importancia De Los Sesgos Relacionados Con La Publicaciónunclassified

Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement

Moher

Liberati

Tetzlaff

et al. 2009

Journal of Clinical Epidemiology

30,249

28,671

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Section: Importancia De Los Sesgos Relacionados Con La Publicaciónunclassified

Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement

Moher

Liberati

Tetzlaff

et al. 2009

Journal of Clinical Epidemiology

30,249

28,671

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“…Moreover, a recent publication of multiple systematic reviews demonstrated the same observation as ours of a relation between sponsorship and study quality. 36 Cost-effectiveness studies that favoured widespread use of drug-eluting stents were more likely than those not favouring such use to be published early after the introduction of this technology (Table 1), when encouraging results are most essential to advance dissemination and adoption. Compared with the earlier studies, later studies by health technology assessment agencies were in general more extensive, were of higher quality, had no industry sponsorship and argued that widespread use of drug-eluting stents was economically unattractive and that a more focused approach concentrating on high-risk patients was indicated.…”

Section: Discussionmentioning

confidence: 99%

The cost-effectiveness of drug-eluting stents: a systematic review

Ligthart¹,

Vlemmix²,

Dendukuri³

et al. 2007

Canadian Medical Association Journal

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D rug-eluting stents became commercially available in 2002 in Europe and Canada and in 2003 in the United States 1 and are now widely used in the treatment of coronary artery disease. Restenosis of the target lesion has been the "Achilles heel" of percutaneous coronary interventions (PCIs), with 15%-40% of patients in randomized controlled trials (RCTs) who received bare-metal stents needing repeat revascularization within 6 months. 2 Numerous RCTs 3-6 and meta-analyses 7 have shown that the use of drug-eluting stents reduces this risk by an estimated 83%. Given their comparable short-term safety profiles, drugeluting stents have been seen as an attractive clinical alternative to bare-metal stents. However, no differences in deaths or myocardial infarctions have been seen between study groups receiving either type of stent. 7 Furthermore, the absolute reductions in the rate of repeat revascularization observed with drug-eluting stents may be overestimated, owing to protocoldriven angiographic follow-up in RCTs. 8,9 Nevertheless, the clinical benefits of fewer repeat revascularizations with drugeluting stents and improved quality of life, even if ephemeral, are enticing.Because drug-eluting stents are considerably more expensive than bare-metal stents, with an estimated world market of $6 billion annually, 10 cost-effectiveness analyses may help decision-makers assess the value of this additional investment. Although many cost-effectiveness studies have been carried out, they have arrived at different conclusions despite using a relatively constant measure of the efficacy of drugeluting stents. By systematically reviewing all published costeffectiveness analyses, we attempt to understand the determinants of the different conclusions. MethodsWe performed an extensive literature search for all Englishlanguage cost-effectiveness studies published between Jan. 1, 2000, and July 31, 2006, that assessed the impact of costs of drug-eluting stents compared with bare-metal stents on a health care system. We decided not to distinguish between the different models of drug-eluting stents because, although sirolimus-eluting stents appear to be more clinically effective than paclitaxel-eluting ones, 11 both are extensively used in clinical practice and because the prices of drug-eluting stents

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“…Few other studies, mainly anecdotic, have investigated sources of discordance among SRs: different interpretation of identical quantitative results [8]; different interpretation due to noncomparable analyses because of, mainly unmotivated, subgroup analyses; different selection of primary or secondary outcomes [6]; different inclusion criteria [6]; and different meta-analytical approaches [9,28]. Our systematic attempt to explore the theoretical model proposed by Jadad et al [5], although limited to the cardiologic field, confirms many of the sources of discordance hypothesized.…”

Section: Summary Of Findingsmentioning

confidence: 99%

“…There are some examples of discordant SRs that have generated controversy [6e8]. One emblematic case study explored the results of 10 multiple SRs focused on the role of acetylcysteine in the prevention of contrast-associated nephropathy [9]. Five reviews recommended routine use of acetylcysteine, whereas the others were more cautious and called for further trials.…”

Section: Introductionmentioning

confidence: 99%

Discordances originated by multiple meta-analyses on interventions for myocardial infarction: a systematic review

Lucenteforte

Moja

Pecoraro

et al. 2015

Journal of Clinical Epidemiology

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To clarify the impact of multiple (covering the same population,intervention, control, and outcomes) systematic reviews (SRs) on interventions for myocardial infarction (MI). STUDY DESIGN AND SETTING: Clinical Evidence (BMJ Group) sections and related search strategies regarding MI were used to identify multiple SRs published between 1997 and 2007. Multiple SRs were classified as discordant if they featured conflicting results or interpretation of them.RESULTS: Thirty-six SRs (23.5% of 153 on the treatment or prevention of MI) were classified as multiple and grouped in 16 clusters [ie, at least two SRs with the same PICO (population, condition/disease, intervention, control) and at least one common outcome] exploring angioplasty, angiotensin-converting enzyme inhibitors,anticoagulants, antiplatelets, beta-blockers, and stents. Complete agreement on statistically significant differences between interventions was found in 7 of 10 clusters with a shared composite outcome. Agreement was reduced when single outcomes were considered. Despite substantial variation and limited agreement in reporting of major outcomes, SRs agreed in their conclusions on the superiority of either the intervention or control in 14 of 16 clusters. Sources of minor discrepancies were found in terms of study and outcome selection, subgroup analyses, and interpretation of findings. CONCLUSION: Multiple SRs agreed in their qualitative conclusions but not on reporting and on analyses of hard outcomes. Discordance on significance of treatment effects was due to a combination of variation in design with inclusion of different studies and lack of precision for single hard outcomes compared with a composite outcome. Such inconsistencies among SRs could potentially slow the translation of SRs' results to clinical and public health decision making and suggest the need for a broader methodological and clinical agreement on their design

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Compliance with QUOROM and quality of reporting of overlapping meta-analyses on the role of acetylcysteine in the prevention of contrast associated nephropathy: case study

Abstract: Multiple systematic reviews on the same clinical topic varied in quality of reporting and recommendations. Longer manuscripts and previous not for profit funding were associated with higher quality.

Cited by 133 publications

References 39 publications

Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement

Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement

The cost-effectiveness of drug-eluting stents: a systematic review

Discordances originated by multiple meta-analyses on interventions for myocardial infarction: a systematic review

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