Is the Benefit of Granulocyte Monocyte Adsorptive Apheresis in Ulcerative Colitis Overstated?

Granulocyte-Monocyte Apheresis in Steroid-Dependent, Azathioprine-Intolerant/Resistant Moderate Ulcerative Colitis: A Prospective Multicenter Study

“…A subsequent meta-analysis [ 5 ], which considered six randomized trials evaluating GMA versus steroid (only one fully blinded), for a total of 549 patients, demonstrated a clinical benefit of GMA over traditional therapies and confirmed the low incidence of adverse events. However, these data had some criticisms and were not totally bias-free [ 6 ].…”

Systematic review: granulocyte/monocyte adsorptive apheresis for ulcerative colitis

“…They reported a statistically significant benefit of GMAA over control therapy, defined using either response to therapy or clinical remission, with a number needed to treat of five, and concluded that homogeneous evidence from seven RCTs uniformly indicated that GMAA was more successful than drug therapy in achieving response and remission. There are some limitations of this meta‐analysis that we have discussed elsewhere, 35 including pooling of data from RCTs regardless of the control intervention, and the inclusion of a pseudo‐randomized study in the analysis, 36 a type of study design that is liable to selection bias. In addition, the largest RCT that they identified showed no significant effect of GMAA on remission or response 26 .…”

How to Read a Systematic Review and Meta‐Analysis

“…Sometimes the risk of bias of the studies included is so high that performing a meta-analysis to obtain a summary effect size is of little value. At this point, the reader has to question the rationale for conducting one at all [21,22]. It is well worth remembering the proverb that it is not possible to make a silk purse out of a sow's ear, and similarly performing a meta-analysis for its own sake does not compensate for underlying poor methodology among all the included studies.…”