Conducting quantitative synthesis when comparing medical interventions: AHRQ and the Effective Health Care Program

Fu, Rongwei; Gartlehner, Gerald; Grant, Mark D; Shamliyan, Tatyana A.; Sedrakyan, Art; Wilt, Timothy J; Griffith, Lauren; Oremus, Mark; Raina, Parminder; Ismaila, Afisi S; Santaguida, Pasqualina; Lau, Joseph; Trikalinos, Thomas A

doi:10.1016/j.jclinepi.2010.08.010

Cited by 562 publications

(462 citation statements)

References 57 publications

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“…We used meta-analysis of RCTs for evaluating drug safety based on all available trials. 46 We analyzed sparse adverse effects data with various statistical methods 43,[47][48][49][50][51] for robustness by comparing statistical significance and magnitude of the harms. In cases of multi-arm trials, we created a single pair-wise comparison.…”

Section: Methodsmentioning

confidence: 99%

“…39,52 We tested consistency of the results by comparing the direction and strength of the association, 53 assessed heterogeneity in results with the chi-squared and I-squared tests, 54,55 and explored it with meta-regression and sensitivity analysis, reporting only the results from random effects models, 56 which incorporate inevitable differences between trials in patient populations, baseline rates of the outcomes, dosages of drugs, and other factors. 47 We examined whether the definition of migraine could contribute to differences in trial results. The FDA had approved four drugs for prevention of episodic migraine based on trials conducted prior to the recent implementation of the migraine definition proposed by the International Headache Society.…”

Section: Methodsmentioning

confidence: 99%

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Preventive Pharmacologic Treatments for Episodic Migraine in Adults

et al. 2013

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ELIGIBILITY CRITERIA: English-language randomized controlled trials (RCTs) of preventive drugs compared to placebo or active treatments examining rates of ≥50 % reduction in monthly migraine frequency or improvement in quality of life. STUDY APPRAISAL AND SYNTHESIS METHODS:We assessed risk of bias and strength of evidence and conducted random effects meta-analyses of absolute risk differences and Bayesian network meta-analysis. RESULTS: Of 5,244 retrieved references, 215 publications of RCTs provided mostly low-strength evidence because of the risk of bias and imprecision. RCTs examined 59 drugs from 14 drug classes. All approved drugs, including topiramate (9 RCTs), divalproex (3 RCTs), timolol (3 RCTs), and propranolol (4 RCTs); offlabel beta blockers metoprolol (4 RCTs), atenolol (1 RCT), nadolol (1 RCT), and acebutolol (1 RCT); angiotensin-converting enzyme inhibitors captopril (1 RCT) and lisinopril (1 RCT); and angiotensin II receptor blocker candesartan (1 RCT), outperformed placebo in reducing monthly migraine frequency by ≥50 % in 200-400 patients per 1,000 treated. Adverse effects leading to treatment discontinuation (68 RCTs) were greater with topiramate, off-label antiepileptics, and antidepressants than with placebo. Limited direct evidence as well as frequentist and exploratory network Bayesian meta-analysis showed no statistically significant differences in benefits between approved drugs. Off-label angiotensin-inhibiting drugs and beta-blockers were most effective and tolerable for episodic migraine prevention. LIMITATIONS:We did not quantify reporting bias or contact principal investigators regarding unpublished trials. CONCLUSIONS: Approved drugs prevented episodic migraine frequency by ≥50 % with no statistically significant difference between them. Exploratory network meta-analysis suggested that off-label angiotensin-inhibiting drugs and beta-blockers had favorable benefit-to-harm ratios. Evidence is lacking for longterm effects of drug treatments (i.e., trials of more than 3 months duration), especially for quality of life.KEY WORDS: migraine; evidence based medicine; adverse drug effects.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

et al. 2013

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“…We planned subgroup analyses, specifying a priori, to explore the following potential sources of heterogeneity: follow-up rates, treatment dose, and the level of human support given with the intervention. However, these analyses could not be done because subgroups did not meet the prespecified minimum of 4 trials per subgroup (31). When there were too few trials for quantitative synthesis, we analyzed the data qualitatively, focusing on identifying novel aspects of the e-intervention and patterns of efficacy.…”

Section: Data Synthesis and Analysismentioning

confidence: 99%

Electronic Interventions for Alcohol Misuse and Alcohol Use Disorders

et al. 2015

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“…The data were analysed using the meta-analysis described by Hedges et al (1999). The effect size of littermanipulation treatment for each individual observation was estimated by the natural log of the response ratio (RR): ln RR = ln X t /X c , where X c is the control mean, and X t is the treatment mean.…”

Section: Meta-analysismentioning

confidence: 99%

“…For each investigated parameter, a subgroup analysis was conducted to assess whether the magnitudes of effects differed across ecosystem types, soil depths or treatment duration. Although there is no accepted minimum number of studies that are required for a meta-analysis, we adopted the criteria for systematic review by Fu et al (2011) in which each subgroup should have a minimum of four studies. We therefore present results for separate ecosystems only where sufficient observations were available in more than one subgroup.…”

Section: Meta-analysismentioning

confidence: 99%

Variability of above-ground litter inputs alters soil physicochemical and biological processes: a meta-analysis of litterfall-manipulation experiments

2013

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Abstract. Global change has been shown to alter the amount of above-ground litter inputs to soil greatly, which could cause substantial cascading effects on below-ground biogeochemical cycling. Despite extensive study, there is uncertainty about how changes in above-ground litter inputs affect soil carbon and nutrient turnover and transformation. Here, we conducted a meta-analysis on 70 litter-manipulation experiments in order to assess how changes in above-ground litter inputs alter soil physicochemical properties, carbon dynamics and nutrient cycles. Our results demonstrated that litter removal decreased soil respiration by 34 %, microbial biomass carbon in the mineral soil by 39 % and total carbon in the mineral soil by 10 %, whereas litter addition increased them by 31, 26 and 10 %, respectively. This suggests that greater litter inputs increase the soil carbon sink despite higher rates of carbon release and transformation. Total nitrogen and extractable inorganic nitrogen in the mineral soil decreased by 17 and 30 %, respectively, under litter removal, but were not altered by litter addition. Overall, litter manipulation had a significant impact upon soil temperature and moisture, but not soil pH; litter inputs were more crucial in buffering soil temperature and moisture fluctuations in grassland than in forest. Compared to other ecosystems, tropical and subtropical forests were more sensitive to variation in litter inputs, as altered litter inputs affected the turnover and accumulation of soil carbon and nutrients more substantially over a shorter time period. Our study demonstrates that although the magnitude of responses differed greatly among ecosystems, the direction of the responses was very similar across different ecosystems. Interactions between plant productivity and below-ground biogeochemical cycling need to be taken into account to predict ecosystem responses to environmental change.

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Conducting quantitative synthesis when comparing medical interventions: AHRQ and the Effective Health Care Program

Cited by 562 publications

References 57 publications

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

Preventive Pharmacologic Treatments for Episodic Migraine in Adults

Electronic Interventions for Alcohol Misuse and Alcohol Use Disorders

Variability of above-ground litter inputs alters soil physicochemical and biological processes: a meta-analysis of litterfall-manipulation experiments

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