Do Author Conflicts of Interest and Industry Sponsorship Influence Outcomes of Systematic Reviews and Meta-Analyses Regarding Glaucoma Interventions? A Cross-sectional Analysis

Abstract

Précis: In our sample of systematic reviews focusing on treatments for glaucoma, reviews conducted by authors with a conflict of interest were more likely to reach favorable conclusions compared with reviews without conflicted authors. Purpose: Previous studies have demonstrated that authors’ conflict of interest can influence outcomes of systematic reviews. Therefore, we aimed to determine whether the presence of 1 of more conflicts was associated with more favorable results and conclusions in systematic reviews of glaucoma interventions. Materials and Methods: MEDLINE and Embase were searched for systematic reviews of glaucoma treatments published between September 1, 2016 and June 2, 2020. Author conflicts of interest were located using multiple databases (eg, CMS Open Payments Database, Dollars for Profs, Google Patents, the United States Patent and Trademark Office USPTO) and previously published disclosure statements. Study sponsorship was determined using each review’s funding disclosure statement. Results: Our study included 26 systematic reviews conducted by 108 authors. Of these reviews, 9 (35%) were conducted by at least 1 author with an undisclosed conflict of interest. Of those 9, 3 (33%) reported results favoring the treatment group, and 5 (56%) reported conclusions favoring the treatment group. Of the 17 systematic reviews with no conflicted authors, 1 (6%) reported results favoring the treatment group, and 2 (12%) reported conclusions favoring the treatment group. The Fisher exact tests demonstrated that these differences held a statistically significant association between author conflicts and the favorability of the reviews’ conclusions toward the treatment group (P=0.04). Conclusions: We found that systematic reviews conducted by 1 or more authors with conflicts of interest were more likely than those with no conflicted authors to draw favorable conclusions about the investigated intervention.

Analysis of Systematic Reviews in Clinical Practice Guidelines for Head and Neck Cancer

“…62 To mitigate concerns that findings are influenced by hidden motives, it should be the responsibility of authors to fully report on relationships that may cause concern for secondary gain. 63 Investigating publication bias was another area that contributed to the poor quality of SRs. Although PRISMA requires an assessment of publication bias, only 60% of all articles adhered to this item.…”

“…For example, Riaz et al discovered that half of the studies funded by industry declared positive outcomes in cardiovascular trials compared to one‐fifth of the studies financed by a non‐industry source 62 . To mitigate concerns that findings are influenced by hidden motives, it should be the responsibility of authors to fully report on relationships that may cause concern for secondary gain 63 …”

Trends in Industry Payments to Physicians in the First 6 Years After Graduate Medical Training

“…[1][2][3] Although physicians and researchers collaborate with the pharmaceutical and medical device industry to develop products to benefit patients, increasing concerns have been raised that these relationships may affect the cost of drugs and medical devices, the quality of patient care, the integrity of scientific investigations, medical education, and clinical practice recommendations. [4][5][6][7][8][9][10][11] Substantial efforts have been made to identify, limit, and manage potential conflicts of interest in financial relationships between physicians and industry to protect the integrity of professional judgment and to preserve public trust. 4 Originally implemented under section 6002 of the Patient Protection and Affordable Care Act in 2013, the Open Payments program (OPP), also known as the Physician Payments Sunshine Act, is a federally mandated national disclosure program that promotes a more transparent and accountable health care system.…”

“…Financial incentives and conflicts of interest have been considered important elements that may influence physician decision-making and may contribute to an increase in health care costs . Although physicians and researchers collaborate with the pharmaceutical and medical device industry to develop products to benefit patients, increasing concerns have been raised that these relationships may affect the cost of drugs and medical devices, the quality of patient care, the integrity of scientific investigations, medical education, and clinical practice recommendations . Substantial efforts have been made to identify, limit, and manage potential conflicts of interest in financial relationships between physicians and industry to protect the integrity of professional judgment and to preserve public trust…”

Cost-analysis of Surgical Intraocular Pressure Management in Glaucoma

“…27 It should be noted that both iStent cost benefit studies were sponsored by the same commercial corporation, 27,46 which raises possible biases. 51,52 Several limitations for the current study and some are admittedly quite severe, but most of these are inherent in the complexities of glaucoma treatment responses. First, our assumptions were based on > 25 studies reviewed which have been conducted on different ethnic groups, different group of patients, different study designs and different reported data.…”