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Evidence-based Mental Health Aug 2019In most, if not all, healthcare conditions, there is a plethora of competing interventions with few head-to-head comparisons and classical meta-analysis fails to handle...
In most, if not all, healthcare conditions, there is a plethora of competing interventions with few head-to-head comparisons and classical meta-analysis fails to handle simultaneously the multiple comparisons among interventions. Network meta-analysis is an extension of pairwise meta-analysis to accommodate multiple interventions and comparisons.
Topics: Humans; Meta-Analysis as Topic; Network Meta-Analysis; Statistics as Topic
PubMed: 31302611
DOI: 10.1136/ebmental-2019-300104 -
The Journal of International Medical... Jun 2023To undertake a network meta-analysis to compare the relative efficacy of a dual peroxisome proliferator-activated receptor (PPAR)α and PPARγ agonist, glucagon-like... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To undertake a network meta-analysis to compare the relative efficacy of a dual peroxisome proliferator-activated receptor (PPAR)α and PPARγ agonist, glucagon-like peptide-1 receptor agonists (GLP-1RAs) and metformin in patients with non-alcoholic fatty liver disease (NAFLD).
METHODS
Electronic databases, including Embase®, PubMed® and The Cochrane Library, were searched systematically for eligible studies from inception to 20 July 2022. Randomized controlled trials (RCTs) that investigated aspartate aminotransferase, alanine aminotransferase (ALT) and triglyceride levels were considered for inclusion. Data were extracted using a standardized data collection table. A network meta-analysis was performed. Relative risk and 95% confidence interval were calculated for continuous data and was used to assess the heterogeneity of studies.
RESULTS
A total of 22 RCTs involving 1698 patients were eligible for inclusion in the analysis. Both direct analysis and indirect analysis showed that saroglitazar was significantly superior to GLP-1RAs in improving ALT levels. Metformin improved ALT levels, but the effect was not as good as saroglitazar.
CONCLUSION
Saroglizatar was the most effective drug for improving NAFLD.INPLASY registration number: INPLASY202340066.
Topics: Humans; Metformin; Network Meta-Analysis; Glucagon-Like Peptide-1 Receptor; Non-alcoholic Fatty Liver Disease; Peroxisome Proliferator-Activated Receptors
PubMed: 37317834
DOI: 10.1177/03000605231177191 -
BMC Psychiatry Mar 2021Conditional power of network meta-analysis (NMA) can support the planning of randomized controlled trials (RCTs) assessing medical interventions. Conditional power is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Conditional power of network meta-analysis (NMA) can support the planning of randomized controlled trials (RCTs) assessing medical interventions. Conditional power is the probability that updating existing inconclusive evidence in NMA with additional trial(s) will result in conclusive evidence, given assumptions regarding trial design, anticipated effect sizes, or event probabilities.
METHODS
The present work aimed to estimate conditional power for potential future trials on antidepressant treatments. Existing evidence was based on a published network of 502 RCTs conducted between 1979-2018 assessing acute antidepressant treatment in major depressive disorder (MDD). Primary outcomes were efficacy in terms of the symptom change on the Hamilton Depression Scale (HAMD) and tolerability in terms of the dropout rate due to adverse events. The network compares 21 antidepressants consisting of 231 relative treatment comparisons, 164 (efficacy) and 127 (tolerability) of which are currently assumed to have inconclusive evidence.
RESULTS
Required sample sizes to achieve new conclusive evidence with at least 80% conditional power were estimated to range between N = 894 - 4190 (efficacy) and N = 521 - 1246 (tolerability). Otherwise, sample sizes ranging between N = 49 - 485 (efficacy) and N = 40 - 320 (tolerability) may require stopping for futility based on a boundary at 20% conditional power. Optimizing trial designs by considering multiple trials that contribute both direct and indirect evidence, anticipating alternative effect sizes or alternative event probabilities, may increase conditional power but required sample sizes remain high. Antidepressants having the greatest conditional power associated with smallest required sample sizes were identified as those on which current evidence is low, i.e., clomipramine, levomilnacipran, milnacipran, nefazodone, and vilazodone, with respect to both outcomes.
CONCLUSIONS
The present results suggest that conditional power to achieve new conclusive evidence in ongoing or future trials on antidepressant treatments is low. Limiting the use of the presented conditional power analysis are primarily due to the estimated large sample sizes which would be required in future trials as well as due to the well-known small effect sizes in antidepressant treatments. These findings may inform researchers and decision-makers regarding the clinical relevance and justification of research in ongoing or future antidepressant RCTs in MDD.
Topics: Antidepressive Agents; Depressive Disorder, Major; Humans; Network Meta-Analysis
PubMed: 33673822
DOI: 10.1186/s12888-021-03094-5 -
Eye (London, England) Apr 2022
Topics: Humans; Meta-Analysis as Topic
PubMed: 34987196
DOI: 10.1038/s41433-021-01867-6 -
Brazilian Oral Research 2023This meta-research aimed to provide an overview of the methodological quality and risk of bias of network meta-analyses (NMA) in dentistry. Searches for NMA of... (Meta-Analysis)
Meta-Analysis
This meta-research aimed to provide an overview of the methodological quality and risk of bias of network meta-analyses (NMA) in dentistry. Searches for NMA of randomized clinical trials with clinical outcomes in dentistry were performed in databases up to January 2022. Two reviewers independently screened titles/abstracts, selected full texts, and extracted the data. The adherence to PRISMA-NMA reporting guideline, the AMSTAR-2 methodological quality tool, and the ROBIS risk of bias tool were assessed in the studies. Correlation between the PRISMA-NMA adherence and the AMSTAR-2 and ROBIS results was also investigated. Sixty-two NMA studies were included and presented varied methodological quality. According to AMSTAR-2, half of the NMA presented moderate quality (n = 32; 51.6%). The adherence to PRISMA-NMA also varied. Only 36 studies (58.1%) prospectively registered the protocol. Other issues lacking of reporting were data related were data related to the NMA geometry and the assessment of results consistency, and the evaluation of risk of bias across the studies. ROBIS assessment showed a high risk of bias mainly for domains 1 (study eligibility criteria) and 2 (identification and selection of studies). Correlation coefficients between the PRISMA-NMA adherence and the AMSTAR-2 and ROBIS results showed moderate correlation (rho < 0.6). Overall, NMA studies in dentistry were of moderate quality and at high risk of bias in several domains, especially study selection. Future reviews should be better planned and conducted and have higher compliance with reporting and quality assessment tools.
Topics: Network Meta-Analysis; Bias; Dentistry
PubMed: 37436290
DOI: 10.1590/1807-3107bor-2023.vol37.0062 -
Frontiers in Immunology 2023This systematic review and meta-analysis aimed to investigate the role of neoadjuvant immunochemotherapy with or without radiotherapy [NIC(R)T] compared to traditional... (Meta-Analysis)
Meta-Analysis
Evaluation of neoadjuvant immunotherapy and traditional neoadjuvant therapy for resectable esophageal cancer: a systematic review and single-arm and network meta-analysis.
OBJECTIVE
This systematic review and meta-analysis aimed to investigate the role of neoadjuvant immunochemotherapy with or without radiotherapy [NIC(R)T] compared to traditional neoadjuvant therapies, without immunotherapy [NC(R)T].
SUMMARY BACKGROUND DATA
NCRT followed by surgical resection is recommended for patients with early-stage esophageal cancer. However, it is uncertain whether adding immunotherapy to preoperative neoadjuvant therapy would improve patient outcomes when radical surgery is performed following neoadjuvant therapy.
METHODS
We searched PubMed, Web of Science, Embase, and Cochrane Central databases, as well as international conference abstracts. Outcomes included R0, pathological complete response (pCR), major pathological response (mPR), overall survival (OS) and disease-free survival (DFS) rates.
RESULTS
We included data from 5,034 patients from 86 studies published between 2019 and 2022. We found no significant differences between NICRT and NCRT in pCR or mPR rates. Both were better than NICT, with NCT showing the lowest response rate. Neoadjuvant immunotherapy has a significant advantage over traditional neoadjuvant therapy in terms of 1-year OS and DFS, with NICT having better outcomes than any of the other three treatments. There were no significant differences among the four neoadjuvant treatments in terms of R0 rates.
CONCLUSIONS
Among the four neoadjuvant treatment modalities, NICRT and NCRT had the highest pCR and mPR rates. There were no significant differences in the R0 rates among the four treatments. Adding immunotherapy to neoadjuvant therapy improved 1-year OS and DFS, with NICT having the highest rates compared to the other three modalities.
SYSTEMATIC REVIEW REGISTRATION
https://inplasy.com/inplasy-2022-12-0060/, identifier INPLASY2022120060.
Topics: Humans; Neoadjuvant Therapy; Network Meta-Analysis; Esophageal Neoplasms; Immunotherapy
PubMed: 37251393
DOI: 10.3389/fimmu.2023.1170569 -
American Journal of Nephrology 2023Clinical guidelines recommend exercise training for patients undergoing maintenance hemodialysis (MHD). However, the effectiveness of different types of exercise remains... (Meta-Analysis)
Meta-Analysis
Effects of Different Exercises on Physical Function, Dialysis Adequacy, and Health-Related Quality of Life in Maintenance Hemodialysis Patients: A Systematic Review and Network Meta-Analysis.
BACKGROUND
Clinical guidelines recommend exercise training for patients undergoing maintenance hemodialysis (MHD). However, the effectiveness of different types of exercise remains uncertain.
OBJECTIVES
The aims of the study were to compare and rank the effect of different types of exercise on walking capacity, cardiorespiratory fitness, dialysis adequacy, and health-related quality of life (HRQOL) in patients undergoing MHD.
METHODS
Eight databases (four English and four Chinese) were searched from inception to January 1, 2022. Randomized controlled trials evaluating the efficacy of different exercises for patients undergoing MHD were included. Two independent reviewers screened the literature, extracted data, assessed the risk of bias, and evaluated the certainty of evidence. A frequentist random-effect network meta-analysis was conducted.
RESULTS
Ninety trials with 4,084 participants comparing 15 types of exercise were included, reporting on the six-minute walking test (45 trials), peak oxygen uptake (22 trials), dialysis adequacy (30 trials), and HRQOL (23 trials). Network meta-analysis showed that the most effective intervention for walking capacity was intradialytic aerobic exercise combined with blood flow restriction with a mean difference and 95% confidence interval of 97.35 (11.89-182.81), for peak oxygen uptake it was non-intradialytic combined aerobic and resistance exercise with a value of 4.35 (2.25-6.44), for dialysis adequacy it was intradialytic combined aerobic and resistance exercise with a value of 0.17 (0.06-0.28), for the physical component summary of HRQOL it was intradialytic aerobic exercise with a value of 4.93 (2.31-7.54), and for the mental component summary of HRQOL it was non-intradialytic combined aerobic and resistance exercise with a value of 6.36 (0.45-12.27). Ultimately, intradialytic combined aerobic and resistance exercise could improve all the above outcomes compared to usual care.
CONCLUSIONS
This study concluded that intradialytic combined aerobic and resistance exercise is optimal for MHD patients due to its significant positive effects on multiple outcomes. Walking capacity can be further enhanced by combining blood flow restriction with exercise. For improving dialysis adequacy, intradialytic exercise proves to be more effective than non-intradialytic exercise. Further well-designed clinical trials are needed to investigate the effects of exercise with varying durations, intensities, and frequencies.
Topics: Humans; Quality of Life; Renal Dialysis; Network Meta-Analysis; Exercise Therapy; Exercise; Oxygen
PubMed: 37536298
DOI: 10.1159/000532109 -
Diabetologia Apr 2023An overwhelming number of meta-analyses and reviews are published by scientific journals. In part this may reflect some preference of editors and publishers for these...
An overwhelming number of meta-analyses and reviews are published by scientific journals. In part this may reflect some preference of editors and publishers for these types of papers, which are more frequently cited and can increase the impact factor of their journals. Meta-analyses and reviews are also attractive for investigators looking for a greater chance of having successful publications with several citations, and therefore an improved personal h-index. This greater 'promise of success' might have a deleterious effect on the intellectual maturation of investigators, particularly early career investigators, who might neglect original research and concentrate their efforts on meta-analyses and reviews. However, while meta-analyses and reviews are useful for emphasising data and disseminating concepts, progress in science requires original ideas, original experiments and original papers. 'Analysts' and 'novelists' are welcome, but 'scientists' are indispensable.
Topics: Benchmarking; Cognition; Review Literature as Topic; Meta-Analysis as Topic
PubMed: 36547691
DOI: 10.1007/s00125-022-05808-0 -
BMJ Open Mar 2022It is unclear how pharmacological and non-pharmacological interventions compare with each other in terms of efficacy and tolerability for core symptoms and additional...
INTRODUCTION
It is unclear how pharmacological and non-pharmacological interventions compare with each other in terms of efficacy and tolerability for core symptoms and additional problems in adults with attention-deficit/hyperactivity disorder (ADHD). We aim to conduct the first network meta-analysis (NMA) comparing pharmacological and non-pharmacological interventions (or their combinations) in adults with ADHD.
METHODS AND ANALYSIS
We will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for NMAs. We will search a broad set of electronic databases/registries and contact drug companies and experts in the field to retrieve published and unpublished randomised controlled trials (RCTs) (parallel or cross-over) of medications (either licensed or unlicensed) and any non-pharmacological intervention in adults (≥18 years) with ADHD. Primary outcomes will be: (1) change in severity of ADHD core symptoms, and (2) acceptability (all-cause discontinuation). Secondary outcomes will include tolerability (drop-out due to side effects) and change in the severity of emotional dysregulation, executive dysfunctions and quality of life. The risk of bias in each individual RCT included in the NMA will be assessed using the Cochrane Risk of Bias tool-version 2. We will evaluate the transitivity assumption comparing the distribution of possible effect modifiers across treatment comparisons. We will perform Bayesian NMA for each outcome with random-effects model in OpenBUGS. Pooled estimates of NMA will be obtained using the Markov Chains Monte Carlo method. We will judge the credibility in the evidence derived from the NMA using the CINeMA tool (which includes assessment of publication bias). We will conduct a series of sensitivity analyses to assess the robustness of the findings.
ETHICS AND DISSEMINATION
As this is the protocol for an aggregate-data level NMA, ethical approval will not be required. Results will be disseminated at national/international conferences and in peer-reviewed journals.
PROSPERO REGISTRATION NUMBER
CRD42021265576.
Topics: Adult; Attention Deficit Disorder with Hyperactivity; Humans; Meta-Analysis as Topic; Network Meta-Analysis; Quality of Life; Systematic Reviews as Topic
PubMed: 35277411
DOI: 10.1136/bmjopen-2021-058102 -
BMC Medical Genomics Jul 2019In genome-wide association studies (GWASs), meta-analysis has been widely used to improve statistical power by combining the results of different studies. Meta-analysis...
BACKGROUND
In genome-wide association studies (GWASs), meta-analysis has been widely used to improve statistical power by combining the results of different studies. Meta-analysis can detect phenotype associated variants that are failed to be detected in single studies. Especially, in biomedical sciences, meta-analysis is often necessary not only for improving statistical power, but also for reducing unavoidable limitation in data collection. As next-generation sequencing (NGS) technology has been developed, meta-analysis of rare variants is proceeding briskly along with meta-analysis of common variants in GWASs. However, meta-analysis on a single variant that is commonly used in common variant association test is improper for rare variants. A sparse signal of rare variant undermines the association signal and its large number causes multiple testing problem. To over-come these problems, we propose a meta-analysis method at the gene-level rather than variant level.
RESULTS
Among many methods that have been developed, we used the unified quadratic tests (Q-tests); Q-test is more powerful than or as powerful as other tests such as Sequence Kernel Association Tests (SKAT). Since there are three different versions of Q-test (QTest1, QTest2, QTest3), each assumes different relationships among multiple rare variants, we extended them into meta-study accordingly. For meta-analysis, we consider two types of approaches, the one is to combine regression coefficients and the other is to combine test statistics from each single study. We extend the Q-test for meta-analysis, proposing Meta Quadratic Test (Meta-Qtest). Meta Q-test avoids the limitations of MetaSKAT. It does not only consider genetic heterogeneity among studies as MetaSKAT but also reflects diverse real situations; since we extend three different Q-tests into meta-analysis respectively, flexible Meta Q-test suggests way to deal with gene-level rare variant meta-analysis efficiently From the results of real data analysis of blood pressure trait, our meta-analysis could successfully discovered genes, KCNA5 and CABIN1 that are already well known for relevance with hypertension disease and they are not detected in MetaSKAT.
CONCLUSION
As exemplified by an application to T2D Genes projects data set, Meta-Qtest more effectively identified genes associated with hypertension disease than MetaSKAT did.
Topics: Genetic Variation; Meta-Analysis as Topic
PubMed: 31296221
DOI: 10.1186/s12920-019-0516-5