Automated generation of node‐splitting models for assessment of inconsistency in network meta‐analysis

Valkenhoef, Gert van; Dias, Sofia; Ades, A E; Welton, Nicky J

doi:10.1002/jrsm.1167

Cited by 440 publications

(320 citation statements)

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“…Incoherence between the direct and indirect effect estimates was assessed using the node-splitting method. 21 When the assumptions are challenged, the results of the network meta-analysis might be limited. These limitations were operationalised using the GRADE approach for network meta-analysis, which, among other aspects such as risk of bias of the studies, takes into consideration these assumptions to rate the quality of the evidence, downgrading its rating if there is heterogeneity, intransitivity or incoherence.…”

Section: Data Synthesis and Statistical Analysesmentioning

confidence: 99%

Effectiveness of progesterone, cerclage and pessary for preventing preterm birth in singleton pregnancies: a systematic review and network meta‐analysis

Jarde

Lutsiv

Park

et al. 2017

BJOG

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Background Preterm birth (PTB) is the leading cause of infant death, but it is unclear which intervention is best to prevent it.Objectives To compare progesterone, cerclage and pessary, determine their relative effects and rank them.Search strategy We searched Medline, EMBASE, CINAHL, Cochrane CENTRAL and Web of Science (to April 2016), without restrictions, and screened references of previous reviews.Selection criteria We included randomised trials of progesterone, cerclage or pessary for preventing PTB in women with singleton pregnancies at risk as defined by each study.Data collection and analysis We extracted data by duplicate using a piloted form and performed Bayesian random-effects network meta-analyses and pairwise meta-analyses. We rated evidence quality using GRADE, ranked interventions using SUCRA and calculated numbers needed to treat (NNT).Main results We included 36 trials (9425 women; 25 low risk of bias trials). Progesterone ranked first or second for most outcomes, reducing PTB < 34 weeks [odds ratio (OR) 0.44; 95% credible interval (CrI) 0.22-0.79; NNT 9; low quality], <37 weeks (OR 0.58; 95% CrI 0.41-0.79; NNT 9; moderate quality), and neonatal death (OR 0.50; 95% CrI 0.28-0.85; NNT 35; high quality), compared with control, in women overall at risk. We found similar results in the subgroup with previous PTB, but only a reduction of PTB < 34 weeks in women with a short cervix. Pessary showed inconsistent benefit and cerclage did not reduce PTB < 37 or <34 weeks.Conclusions Progesterone was the best intervention for preventing PTB in singleton pregnancies at risk, reducing PTB < 34 weeks, <37 weeks, neonatal demise and other sequelae.Keywords Cervical cerclage, cervical pessary, network metaanalysis, preterm birth, progesterone, systematic review.Tweetable abstract Progesterone was better than cerclage and pessary to prevent preterm birth, neonatal death and more in network meta-analysis.Please cite this paper as: Jarde A, Lutsiv O, Park CK, Beyene J, Dodd JM, Barrett J, Shah PS, Cook JL, Saito S, Biringer AB, Sabatino L, Giglia L, Han Z, Staub K, Mundle W, Chamberlain J, McDonald SD. Effectiveness of progesterone, cerclage and pessary for preventing preterm birth in singleton pregnancies: a systematic review and network meta-analysis.

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Section: Data Synthesis and Statistical Analysesmentioning

confidence: 99%

Effectiveness of progesterone, cerclage and pessary for preventing preterm birth in singleton pregnancies: a systematic review and network meta‐analysis

Jarde

Lutsiv

Park

et al. 2017

BJOG

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“…Summary OR and its 95% credible interval (95% CrI) for the event of tumor recurrence or progression were produced for comparison. Evidence inconsistency for each pair of comparison was assessed by the node-splitting method [7]. Evidence was significantly inconsistent if the P-value of the node-splitting method < 0.05.…”

Section: Methodsmentioning

confidence: 99%

Assessing the Feasibility of Replacing Standard-Dose Bacillus Calmette–Guérin Immunotherapy with Other Intravesical Instillation Therapies in Bladder Cancer Patients: A Network Meta-Analysis

Wu¹,

Xingqin²,

Miao³

et al. 2017

Cell Physiol Biochem

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Background: Bacillus Calmette–Guérin (BCG) immunotherapy plays a key role in patients with bladder cancer. The shortage of intravesical BCG has motivated researchers to seek alternatives with equivalent efficacy If other alternative intravesical agents have equivalent efficacy compared to BCG, then it may be feasible to replace standard BCG with alternative options. Methods: We searched all relevant evidence in multiple sources and key data was extracted from included studies. Conventional and network meta-analysis were conducted so that pooled odds ratios (ORs) for the event of tumor recurrence and progression can be computed. The relative efficacy of different intravesical instillation procedures was computed by pooled odds ratios and their 95% confidence or creditable intervals. Besides, several key model assumptions were evaluated in our analysis. Results: Three intravesical instillation procedures have the potential for preventing tumor recurrence: standard-dose BCG (BCG_SD), Epirubicin (EPI) and Mitomycin C (MMC) (ORs < 1). Patients with BCG SD also exhibited a decreased risk of tumor recurrence and progression compared to those with EPI. No significant difference in the risk of tumor recurrence or progression was detected between patients treated with BCG_ SD and those with low-dose BCG (BCG_LD). Results of SUCRA indicated that BCG_EPI, BCG_ MMC and BCG SD had higher rankings with respect to tumor recurrence and progression. Conclusions: BCG SD, EPI and MMC exhibited established efficacy for preventing tumor recurrence in postoperative BC patients. The efficacy of BCG may not be significantly reduced if standard dose was reduced to a lower level. However, there is no consensus suggesting that intravesical BCG with standard dose can be replaced by alternating or sequentially combined intravesical instillation therapies.

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“…The R package netmeta (Rücker et al 2015) provides models in a frequentist framework described in Rücker (2012). The R package gemtc (van Valkenhoef and Kuiper 2015) and the Stata (StataCorp 2015) command network perform contrast-based analyses. Neither package provides estimates for population-averaged treatment-specific parameters.…”

Section: Introductionmentioning

confidence: 99%

Performing Arm-Based Network Meta-Analysis in R with the pcnetmeta Package

et al. 2017

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Network meta-analysis is a powerful approach for synthesizing direct and indirect evidence about multiple treatment comparisons from a collection of independent studies. At present, the most widely used method in network meta-analysis is contrast-based, in which a baseline treatment needs to be specified in each study, and the analysis focuses on modeling relative treatment effects (typically log odds ratios). However, population-averaged treatment-specific parameters, such as absolute risks, cannot be estimated by this method without an external data source or a separate model for a reference treatment. Recently, an arm-based network meta-analysis method has been proposed, and the R package pcnetmeta provides user-friendly functions for its implementation. This package estimates both absolute and relative effects, and can handle binary, continuous, and count outcomes.

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Automated generation of node‐splitting models for assessment of inconsistency in network meta‐analysis

Cited by 440 publications

References 28 publications

Effectiveness of progesterone, cerclage and pessary for preventing preterm birth in singleton pregnancies: a systematic review and network meta‐analysis

Effectiveness of progesterone, cerclage and pessary for preventing preterm birth in singleton pregnancies: a systematic review and network meta‐analysis

Assessing the Feasibility of Replacing Standard-Dose Bacillus Calmette–Guérin Immunotherapy with Other Intravesical Instillation Therapies in Bladder Cancer Patients: A Network Meta-Analysis

Performing Arm-Based Network Meta-Analysis in R with the pcnetmeta Package

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