Network meta-analysis: the highest level of medical evidence?

Faltinsen, Erlend; Storebø, Ole Jakob; Jakobsen, Janus Christian; Boesen, Kim; Lange, Theis; Gluud, Christian

doi:10.1136/bmjebm-2017-110887

Cited by 78 publications

(46 citation statements)

References 36 publications

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“…NMA allows indirect comparison of interventions and facilitates assessment of benefits and harms for variable treatment options for a given clinical scenario. This methodology has recently been used by the World Health Organization to inform clinical guideline development, is considered to be a high level of evidence, and has specific advantages for VTE research in which multiple treatment options exist for a single pathology …”

Section: Discussionmentioning

confidence: 99%

Pharmacological thromboprophylaxis to prevent venous thromboembolism in patients with temporary lower limb immobilization after injury: systematic review and network meta‐analysis

Horner

Stevens

Pandor

et al. 2020

Journal of Thrombosis and Haemostasis

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Background: Thromboprophylaxis has the potential to reduce venous thromboembolism (VTE) following lower limb immobilization resulting from injury. Objectives:We aimed to estimate the effectiveness of thromboprophylaxis, compare different agents, and identify any factors associated with effectiveness. Methods:We undertook a systematic review and network meta-analysis (NMA) of randomized trials reporting VTE or bleeding outcomes that compared thromboprophylactic agents with each other or to no pharmacological prophylaxis, for this indication. An NMA was undertaken for each outcome or agent used, and a series of study-level network meta-regressions examined whether population characteristics, type of injury, treatment of injury, or duration of thromboprophylaxis were associated with treatment effect. Results: Data from 6857 participants across 13 randomized trials showed that, compared with no treatment, low molecular weight heparin (LMWH) reduced the risk of any VTE (odds ratio [OR]: 0.52; 95% credible interval [CrI]: 0.37-0.71), clinically detected deep vein thrombosis (DVT) (OR: 0.39; 95% CrI: 0.12-0.94) and pulmonary embolism (PE) (OR: 0.16; 95% CrI: 0.01-0.74), whereas fondaparinux reduced the risk of any VTE (OR: 0.13; 95% CrI: 0.05-0.30) and clinically detected DVT (OR: 0.10; 95% CrI: 0.01-0.86), with inconclusive results for PE (OR: 0.40; 95% CrI: 0.01-7.53).Conclusions: Thromboprophylaxis with either fondaparinux or LMWH appears to reduce the odds of both asymptomatic and clinically detected VTE in people with temporary lower limb immobilization following an injury. Treatment effects vary by outcome and are not always conclusive. We were unable to identify any treatment effect modifiers other than thromboprophylactic agent used.

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Section: Discussionmentioning

confidence: 99%

Pharmacological thromboprophylaxis to prevent venous thromboembolism in patients with temporary lower limb immobilization after injury: systematic review and network meta‐analysis

Horner

Stevens

Pandor

et al. 2020

Journal of Thrombosis and Haemostasis

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“…The network meta-analysis (NMA) has emerged as a suitable tool for comparing two interventions that have not been compared directly in a head-to-head clinical trial and also offers the chance to run a collective assessment of variable interventions in a single study 11 . Thus, on comparison of NMA to conventional metaanalysis, the former offers the following advantages: it produces an estimate of effect among all compared groups, enhances the precision of effect estimates, ranks different treatments, and improves generalizability [12][13][14] .…”

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confidence: 99%

Do osteoconductive bone substitutes result in similar bone regeneration for maxillary sinus augmentation when compared to osteogenic and osteoinductive bone grafts? A systematic review and frequentist network meta-analysis

Al‐Moraissi

Alkhutari

Abotaleb

et al. 2020

International Journal of Oral and Maxillofacial Surgery

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“…Related to network meta-analyses, multiple comparisons or multiplicity can raise the possibility of type I errors. 36 To mitigate concerns surrounding multiplicity, we established a single a priori primary outcome which remained constant throughout the course of this study. We did not find significant differences between study medications, which mitigates this issue.…”

Section: Discussionmentioning

confidence: 99%

Medications to reduce emergence coughing after general anaesthesia with tracheal intubation: a systematic review and network meta-analysis

Tung

Fergusson

et al. 2020

British Journal of Anaesthesia

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Background: Emergence coughing can harm the patient following completion of surgery, but it is unclear which medication is most effective at reducing this event. We conducted a systematic review and network meta-analysis of RCTs to determine the medications' relative efficacies on decreasing moderate to severe emergence coughing after general anaesthesia. Medications studied were lidocaine (i.v., intracuff, topical, or tracheal application), dexmedetomidine, remifentanil, and fentanyl. Methods: We searched eight different medical literature databases, conference abstracts, and article references. After screening, included citations were evaluated for bias and had their data extracted. Pooled odds ratios and 95% confidence intervals for each treatment comparison were calculated. A surface under the cumulative ranking curve analysis (SUCRA) determined the relative rank of each intervention to decrease moderate to severe emergence coughing. Subgroup analyses included severe coughing only, extubation times, type of maintenance anaesthetic, and dosages. Results: The network meta-analysis included 70 studies and 5286 patients. All study medications had favourable odds in reducing moderate and severe peri-extubation coughing compared with either no medication or placebo. No single medication was favoured over another. Dexmedetomidine had the highest SUCRA rank, followed in order by remifentanil, fentanyl, and lidocaine via intracuff, tracheal/topical, and i.v. routes. Remifentanil was ranked highest for decreasing severe coughing only. Intracuff lidocaine had higher odds of prolonging extubation times compared with placebo, dexmedetomidine, fentanyl, and remifentanil. Conclusion: All study medications were better than placebo or no medication in reducing moderate to severe emergence cough, with dexmedetomidine ranked the most effective. Systematic review registration: PROSPERO registration number: CRD42018102870. Editor's key pointsThe authors examined the literature to establish the effectiveness of various drugs in reducing coughing around the time of tracheal extubation.Dexmedetomidine, remifentanil, fentanyl, and lidocaine all reduced the incidence of moderate to severe emergence coughing. Dexmedetomidine appeared to be the most effective medication for decreasing the frequency of moderate to severe emergence cough.

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Network meta-analysis: the highest level of medical evidence?

Cited by 78 publications

References 36 publications

Pharmacological thromboprophylaxis to prevent venous thromboembolism in patients with temporary lower limb immobilization after injury: systematic review and network meta‐analysis

Pharmacological thromboprophylaxis to prevent venous thromboembolism in patients with temporary lower limb immobilization after injury: systematic review and network meta‐analysis

Do osteoconductive bone substitutes result in similar bone regeneration for maxillary sinus augmentation when compared to osteogenic and osteoinductive bone grafts? A systematic review and frequentist network meta-analysis

Medications to reduce emergence coughing after general anaesthesia with tracheal intubation: a systematic review and network meta-analysis

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