Evidence Synthesis for Decision Making 4

Dias, Sofia; Welton, Nicky J; Sutton, Alex J.; Caldwell, Deborah M; Lu, Guobing; Ades, A E

doi:10.1177/0272989x12455847

Cited by 576 publications

(342 citation statements)

References 31 publications

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“…A network meta-analysis also required that studies were sufficiently similar to pool their results (Dias et al, 2013;Jansen and Naci, 2013). We assessed available study and patient characteristics to ensure similarity and to investigate the potential effect of heterogeneity on effect estimates.…”

Section: Resultsmentioning

confidence: 99%

Risk analysis of new oral anticoagulants for gastrointestinal bleeding and intracranial hemorrhage in atrial fibrillation patients: a systematic review and network meta-analysis

2017

J. Zhejiang Univ. Sci. B

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Background: Antithrombotic therapy using new oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) has been generally shown to have a favorable risk-benefit profile. Since there has been dispute about the risks of gastrointestinal bleeding (GIB) and intracranial hemorrhage (ICH), we sought to conduct a systematic review and network meta-analysis using Bayesian inference to analyze the risks of GIB and ICH in AF patients taking NOACs. Methods: We analyzed data from 20 randomized controlled trials of 91 671 AF patients receiving anticoagulants, antiplatelet drugs, or placebo. Bayesian network meta-analysis of two different evidence networks was performed using a binomial likelihood model, based on a network in which different agents (and doses) were treated as separate nodes. Odds ratios (ORs) and 95% confidence intervals (CIs) were modeled using Markov chain Monte Carlo methods. Results: Indirect comparisons with the Bayesian model confirmed that aspirin+clopidogrel significantly increased the risk of GIB in AF patients compared to the placebo (OR 0.33, 95% CI 0.01-0.92). Warfarin was identified as greatly increasing the risk of ICH compared to edoxaban 30 mg (OR 3.42,) and dabigatran 110 mg (OR 3.56,). We further ranked the NOACs for the lowest risk of GIB (apixaban 5 mg) and ICH (apixaban 5 mg, dabigatran 110 mg, and edoxaban 30 mg). Conclusions: Bayesian network meta-analysis of treatment of nonvalvular AF patients with anticoagulants suggested that NOACs do not increase risks of GIB and/or ICH, compared to each other.

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Section: Resultsmentioning

confidence: 99%

Risk analysis of new oral anticoagulants for gastrointestinal bleeding and intracranial hemorrhage in atrial fibrillation patients: a systematic review and network meta-analysis

2017

J. Zhejiang Univ. Sci. B

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“…The PRISMA statement was published only recently and we do not expect it to have had any major impact on the improvements in reporting observed in our study. The educational papers published several years ago [12,27,28,56,57] might, however, have had some impact. Alternatively, improvements in NMA methods might be due to statisticians and clinicians becoming more experienced with NMA techniques.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

Bibliographic study showed improving statistical methodology of network meta-analyses published between 1999 and 2015

Πετροπούλου

Nikolakopoulou

Veroniki

et al. 2017

Journal of Clinical Epidemiology

113

147

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Objective: To assess the characteristics and core statistical methodology specific to network meta-analyses (NMAs) in clinical research articles. Study Design and What is new?Key findings Although the amount of evidence (the number of treatments and studies) included in published NMAs remains stable, the undertaking and reporting of statistical methods have significantly improved over the years. The assumptions underlying NMA are increasingly discussed and evaluated using appropriate methods. Less than 10% of NMAs published in 2014 and 2015 failed to evaluate the assumptions of the joint synthesis. What this adds to what is knownThis meta-epidemiological study presents the largest collection of published NMAs over the past 16 years. It provides an overview of the structural characteristics and statistical methodology of 456 published networks of interventions. It shows that the statistical methods in NMA have considerably improved in all aspects and some, such as the use of appropriate methods to evaluate the plausibility of the assumptions, are now routinely performed. We conclude that the increasingly populous community of NMA methodologists is quickly advancing through the learning curve of statistical methods employed in NMA. What is the implication, what should change nowThe updated description of the structural characteristics of the published NMAs can be used to inform pragmatic simulations studies and the development of methods that are relevant to the type of networks typically found in the medical literature. Future tutorials and training should be focused on improving the methodology and reporting on items that, although they have improved, their prevalence remains low, such as the formal exploration of heterogeneity and inconsistency and the presentation of all pairwise treatment effects.

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“…Within a three-arm trial no inconsistency exists, and no inconsistency is brought to the evidence network from these multiarm trials, potentially only between-trial heterogeneity. 240 These three evidence loops of interest include a mixture of two-and three-arm trial evidence. In these circumstances defining and assessing inconsistency creates inherent technical difficulties.…”

Section: Doi: 103310/hta21640mentioning

confidence: 99%

Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people: systematic review and economic evaluation

Duarte

Mebrahtu

Gonçalves

et al. 2017

Health Technol Assess

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Background Psoriasis is a chronic inflammatory disease that predominantly affects the skin. Adalimumab (HUMIRA®, AbbVie, Maidenhead, UK), etanercept (Enbrel®, Pfizer, New York, NY, USA) and ustekinumab (STELARA®, Janssen Biotech, Inc., Titusville, NJ, USA) are the three biological treatments currently licensed for psoriasis in children. Objective To determine the clinical effectiveness and cost-effectiveness of adalimumab, etanercept and ustekinumab within their respective licensed indications for the treatment of plaque psoriasis in children and young people. Data sources Searches of the literature and regulatory sources, contact with European psoriasis registries, company submissions and clinical study reports from manufacturers, and previous National Institute for Health and Care Excellence (NICE) technology appraisal documentation. Review methods Included studies were summarised and subjected to detailed critical appraisal. A network meta-analysis incorporating adult data was developed to connect the effectiveness data in children and young people and populate a de novo decision-analytic model. The model estimated the cost-effectiveness of adalimumab, etanercept and ustekinumab compared with each other and with either methotrexate or best supportive care (BSC), depending on the position of the intervention in the management pathway. Results Of the 2386 non-duplicate records identified, nine studies (one randomised controlled trial for each drug plus six observational studies) were included in the review of clinical effectiveness and safety. Etanercept and ustekinumab resulted in significantly greater improvements in psoriasis symptoms than placebo at 12 weeks’ follow-up. The magnitude and persistence of the effects beyond 12 weeks is less certain. Adalimumab resulted in significantly greater improvements in psoriasis symptoms than methotrexate for some but not all measures at 16 weeks. Quality-of-life benefits were inconsistent across different measures. There was limited evidence of excess short-term adverse events; however, the possibility of rare events cannot be excluded. The majority of the incremental cost-effectiveness ratios for the use of biologics in children and young people exceeded NICE’s usual threshold for cost-effectiveness and were reduced significantly only when combined assumptions that align with those made in the management of psoriasis in adults were adopted. Limitations The clinical evidence base for short- and long-term outcomes was limited in terms of total participant numbers, length of follow-up and the absence of young children. Conclusions The paucity of clinical and economic evidence to inform the cost-effectiveness of biological treatments in children and young people imposed a number of strong assumptions and uncertainties. Health-related quality-of-life (HRQoL) gains associated with treatment and the number of hospitalisations in children and young people are areas of considerable uncertainty. The findings suggest that biological treatments may not be cost-effective for the management of psoriasis in children and young people at a willingness-to-pay threshold of £30,000 per quality-adjusted life-year, unless a number of strong assumptions about HRQoL and the costs of BSC are combined. Registry data on biological treatments would help determine safety, patterns of treatment switching, impact on comorbidities and long-term withdrawal rates. Further research is also needed into the resource use and costs associated with BSC. Adequately powered randomised controlled trials (including comparisons against placebo) could substantially reduce the uncertainty surrounding the effectiveness of biological treatments in biologic-experienced populations of children and young people, particularly in younger children. Such trials should establish the impact of biological therapies on HRQoL in this population, ideally by collecting direct estimates of EuroQol-5 Dimensions for Youth (EQ-5D-Y) utilities. Study registration This study is registered as PROSPERO CRD42016039494. Funding The National Institute for Health Research Health Technology Assessment programme.

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Evidence Synthesis for Decision Making 4

Cited by 576 publications

References 31 publications

Risk analysis of new oral anticoagulants for gastrointestinal bleeding and intracranial hemorrhage in atrial fibrillation patients: a systematic review and network meta-analysis

Risk analysis of new oral anticoagulants for gastrointestinal bleeding and intracranial hemorrhage in atrial fibrillation patients: a systematic review and network meta-analysis

Bibliographic study showed improving statistical methodology of network meta-analyses published between 1999 and 2015

Adalimumab, etanercept and ustekinumab for treating plaque psoriasis in children and young people: systematic review and economic evaluation

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