Uncertainty in Treatment Rankings: Reanalysis of Network Meta-analyses of Randomized Trials
Uncertainty in Treatment Rankings: Reanalysis of Network Meta-analyses of Randomized Trials
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DOI：
10.7326/m15-2521
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发表时间：
2016-05-17
影响因子：
39.2
通讯作者：
Ravaud, Philippe
中科院分区：
文献类型：
--
作者：
Trinquart, Ludovic;Attiche, Nassima;Ravaud, Philippe
背景：干预措施的排名是网络荟萃分析最吸引人的元素之一。然而，关于这些排名的可靠性的证据很少。目的：从经验上评估网络荟萃分析中干预排名的不确定性程度。数据来源：之前的两篇系统性综述，涉及检索科克伦图书馆、MEDLINE和Embase（截至2012年7月），检索至少包含3种干预的网络的文章。研究选择：58个网络荟萃分析，涉及1308个随机试验和404个干预措施，具有可用的汇总结果数据。对于每种干预措施，估计累积排序曲线下面积（SUCRA）及其95%可信区间（95%CrI）。通过使用SUCRA值，然后将干预在0%（最差）和100%（最佳）之间进行排序。数据合成：SUCRA的95%CrIs的中值宽度为65%（第一至第三四分位数，38%至80%）。在28%的网络中，排名最好的治疗实际上不是最好的可能性为50%或更高。在90%和71%的比较中，没有证据表明排名最好的干预措施与排名第二和第三的干预措施之间存在差异。在39个有6个或更多干预措施的网络中，前2个干预措施中的1个干预措施在后2个干预措施中的中位概率为35%。（第一至第三四分位数，14%至59%）。局限性：该分析未考虑可能影响排名可靠性的试验内偏倚风险或小研究效应等因素。来自网络荟萃分析的治疗等级有很大程度的不精确性。作者和读者应该非常谨慎地解释这样的排名。
Background: Ranking of interventions is one of the most appealing elements of network meta-analysis. There is, however, little evidence about the reliability of these rankings.Purpose: To empirically evaluate the extent of uncertainty in intervention rankings from network meta-analysis.Data Sources: Two previous systematic reviews that involved searches of the Cochrane Library, MEDLINE, and Embase up to July 2012 for articles that included networks of at least 3 interventions.Study Selection: 58 network meta-analyses involving 1308 randomized trials and 404 interventions with available aggregated outcome data.Data Analysis: Each network was analyzed with a Bayesian approach. For each intervention, the surface under the cumulative ranking curve (SUCRA) and its 95% credible interval (95% CrI) were estimated. Through use of the SUCRA values, the interventions were then rank-ordered between 0% (worst) and 100% (best).Data Synthesis: The median width of the 95% CrIs of the SUCRA was 65% (first to third quartile, 38% to 80%). In 28% of networks, there was a 50% or greater probability that the best-ranked treatment was actually not the best. No evidence showed a difference between the best-ranked intervention and the second and third best-ranked interventions in 90% and 71% of comparisons, respectively. In 39 networks with 6 or more interventions, the median probability that 1 of the top 2 interventions was among the bottom 2 was 35% (first to third quartile, 14% to 59%).Limitation: This analysis did not consider such factors as the risk of bias within trials or small-study effects that may affect the reliability of rankings.Conclusion: Treatment rankings derived from network metaanalyses have a substantial degree of imprecision. Authors and readers should interpret such rankings with great caution.