A scoping review of network meta-analyses assessing the efficacy and safety of complementary and alternative medicine interventions

Abstract

Background Network meta-analysis (NMA) has rapidly grown in use during the past decade for the comparison of healthcare interventions. While its general use in the comparison of conventional medicines has been studied previously, to our awareness, its use to assess complementary and alternative medicines (CAM) has not been studied. A scoping review of the literature was performed to identify systematic reviews incorporating NMAs involving one or more CAM interventions. Methods An information specialist executed a multi-database search (e.g., MEDLINE, Embase, Cochrane), and two reviewers performed study selection and data collection. Information on publication characteristics, diseases studied, interventions compared, reporting transparency, outcomes assessed, and other parameters were extracted from each review. Results A total of 89 SR/NMAs were included. The largest number of NMAs was conducted in China (39.3%), followed by the United Kingdom (12.4%) and the United States (9.0%). Reviews were published between 2010 and 2018, with the majority published between 2015 and 2018. More than 90 different CAM therapies appeared at least once, and the median number per NMA was 2 (IQR 1–4); 20.2% of reviews consisted of only CAM therapies. Dietary supplements (51.1%) and vitamins and minerals (42.2%) were the most commonly studied therapies, followed by electrical stimulation (31.1%), herbal medicines (24.4%), and acupuncture and related treatments (22.2%). A diverse set of conditions was identified, the most common being various forms of cancer (11.1%), osteoarthritis of the hip/knee (7.8%), and depression (5.9%). Most reviews adequately addressed a majority of the PRISMA NMA extension items; however, there were limitations in indication of an existing review protocol, exploration of network geometry, and exploration of risk of bias across studies, such as publication bias. Conclusion The use of NMA to assess the effectiveness of CAM interventions is growing rapidly. Efforts to identify priority topics for future CAM-related NMAs and to enhance methods for CAM comparisons with conventional medicine are needed. Systematic review registration https://ruor.uottawa.ca/handle/10393/35658

Do Reporting Guidelines Have an Impact? Empirical Assessment of Changes in Reporting Before and After the PRISMA Extension Statement for Network Meta-analysis

“…To the best of our knowledge, this is the largest review assessing the PRISMA extension guideline for NMA in more than 1,000 systematic reviews and NMAs. Our ndings are aligned with previous ndings by Hutton et al, (11) who evaluated 89 NMAs of non-pharmacological therapies, Tonin et al (10) who assessed 477 NMAs of pharmacological treatments, and Lee and Shin ( 9) who assessed 21 NMAs in dental care. In agreement with assessments in systematic reviews and meta-analyses, reporting in the 27 core PRISMA items was suboptimal.…”

“…A scoping review of 89 NMAs with complementary and alternative medicines published up until 2018 showed that the PRISMA-NMA guideline was overall adequately adopted through key reporting items such as the existence of a protocol, exploring network geometry, and risk of bias assessment were often missing (up to 65%). (11) As previous empirical research has suggested that reporting of NMAs is improving over time, it is unclear whether the PRISMA-NMA statement has accelerated this improvement. Our objective was to empirically assess whether the PRISMA-NMA statement had an important impact on the completeness of reporting by comparing NMA articles of randomized controlled trials (RCTs) between two time periods (2013-2015 and 2016-2018).…”

Do reporting guidelines have an impact? Empirical assessment of changes in reporting before and after the PRISMA extension statement for network meta-analysis

“…Our findings are aligned with previous findings by Hutton et al . [ 11 ], who evaluated 89 NMAs of non-pharmacological therapies; Tonin et al [ 10 ] who assessed 477 NMAs of pharmacological treatments; and Lee and Shin [ 9 ] who assessed 21 NMAs in dental care. In agreement with assessments in systematic reviews and meta-analyses, reporting in the 27 core PRISMA items was suboptimal [ 2 ].…”

“…Tonin et al [ 10 ] assessed the extend of compliance with PRISMA (for NMAs published before 2015) and PRISMA-NMA (for NMAs published between 2015 and end of 2016) in 477 NMAs of pharmacological treatments and showed minor improvement in reporting according to the PRISMA score. A scoping review of 89 NMAs with complementary and alternative medicines published up until 2018 showed that the PRISMA-NMA guideline was overall adequately adopted through key reporting items such as the existence of a protocol, exploring network geometry, and risk of bias assessment were often missing (up to 65%) [ 11 ].…”

Prevalence of complementary and alternative medicine despite limited perceived efficacy in patients with rheumatic diseases in Mexico: Cross-sectional study

“…Similarly, in other fields of non-pharmacological treatment of RD, such as physiotherapy, psychotherapy, balneology, and rehabilitation, limited access to research funding for the effectiveness of CAM has led to a slow increase in scientific evidence. However, recent publications have confirmed the interest in CAM as a research field, particularly in China, with most research dealing with herbal or dietary supplements [ 46 , 47 ].…”