Vitruvian plot: a visualisation tool for multiple outcomes in network meta-analysis

Abstract

ObjectiveA network meta-analysis (NMA) usually assesses multiple outcomes across several treatment comparisons. The Vitruvian plot aims to facilitate communication of multiple outcomes from NMAs to patients and clinicians.MethodsWe developed this tool following the recommendations on the communication of benefit–risk information from the available literature. We collected and implemented feedback from researchers, statisticians, methodologists, clinicians and people with lived experience of physical and mental health issues.ResultsWe present the Vitruvian plot, which graphically presents absolute estimates and relative performance of competing interventions against a common comparator for several outcomes of interest. We use two alternative colour schemes to highlight either the strength of statistical evidence or the confidence in the evidence. Confidence in the evidence is evaluated across six domains (within-study bias, reporting bias, indirectness, imprecision, heterogeneity and incoherence) using the Confidence in Network Meta-Analysis (CINeMA) system.ConclusionsThe Vitruvian plot allows reporting of multiple outcomes from NMAs, with colourings appropriate to inform credibility of the presented evidence.

Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis

“…As secondary outcomes, we analysed additional objective and subjective measures of efficacy (sleep onset latency, wake time after sleep onset, total sleep time, and number of awakenings, evaluated both by polysomnography and by sleep questionnaire or sleep diary), hangover (eg, sedation and reduced alertness during the day) or increased alertness, rebound or withdrawal phenomena, the total number of patients with one specific adverse event, and the total number of patients with serious adverse events as defined by the FDA (appendix pp [29][30]. We categorised common adverse events using Medical Dictionary for Regulatory Activities (MedDRA) and serious adverse events were defined as described by the FDA.…”

“…Vitruvian plots use radial bar visualisation tools that synthesise the results of multiple outcomes (appendix pp 173-195). 30…”

What I stand for asBMJ Mental Healtheditor

“…It is a fantastic opportunity to do things better and reach a wider audience of mental health clinicians and researchers. In the last year, EBMH published a variety of original articles, spanning from global health,1 self-harm2 and suicide3 to pharmacological interventions4 5 and psychological therapies,6 7 from childhood mental disorders8 to innovative methods in evidence synthesis 9 10. This is a great achievement for a journal, which started as an international digest commissioning commentaries about already published papers and which did not have an impact factor until 2020.…”

Comment on: ‘Vitruvian plot: a visualisation tool for multiple outcomes in network meta-analysis’

“…Ostinelli et al developed an interesting visualisation tool, the Vitruvian plot, to present multiple outcomes in network meta-analysis 1. We write to make some suggestions and potential improvements.…”