Association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews: systematic review.
Association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews: systematic review.
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临床指南、咨询委员会报告、评论文章和叙述性综述中利益冲突与有利建议之间的联系：系统性综述。
DOI：
10.1136/bmj.m4234
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发表时间：
2020-12-09
期刊：
影响因子：
--
通讯作者：
Lundh A
中科院分区：
文献类型：
--
作者：
Nejstgaard CH;Bero L;Hróbjartsson A;Jørgensen AW;Jørgensen KJ;Le M;Lundh A
调查临床指南、咨询委员会报告、评论文章和叙述性综述中利益冲突与有利建议之间的联系。系统回顾。在临床指南、咨询委员会报告、评论文章(如社论)或叙述性评论中比较利益冲突与药物或设备的有利推荐(例如推荐一种药物)之间的关联的研究。PubMed、Embase、Cochrane方法学注册(从最初到2020年2月)、参考文献、科学网和灰色文献。两位作者独立提取了数据，并评估了研究的方法学质量。汇集的相对风险和95%的可信区间是使用随机效应模型估算的(相对风险1表明，与没有利益冲突的文件相比，有利益冲突的文件往往有更有利的建议)。财务和非财务利益冲突分别进行了分析，四类文件分别(预先计划)和合并(临时)进行了分析。纳入了21项研究，分析了106项临床指南、1809份咨询委员会报告、340篇评论文章和497篇叙述性综述。收到了11项研究的未发表数据(8个完整数据集和3个摘要数据集)。15项研究显示了混淆的风险，因为比较的文献可能在利益冲突以外的因素上不同(例如，不同人群使用的不同药物)。财务利益冲突与临床指南有利建议之间的关联的相对风险为1.26(95%可信区间0.93至1.69；四项研究86项临床指南)，咨询委员会报告为1.20(0.99至1.45；四项研究咨询委员会629份报告)，评论文章为2.62(0.91至7.55；四项研究284篇评论)，叙述性综述为1.20(0.97至1.49；四项研究457篇叙述性综述)。对所有四类文件的综合分析支持这些发现(1.26、1.09至1.44)。在一项调查专业兴趣的研究中，将放射科医生作为指南的作者与推荐常规乳腺癌之间的关联是：相对风险2.10，95%可信区间0.92至4.77；12个临床指南)。我们解释我们的发现是为了表明，财务利益冲突与临床指南、咨询委员会报告、评论文章和叙述性综述中对药物和设备的有利推荐有关。这项审查的局限性是纳入的研究有混淆的风险，以及对每种文件类型的单独分析在统计上不准确。不确定非财务利益冲突是否会影响建议。Cochrane方法学审查协议MR000040。
To investigate the association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. Systematic review. Studies that compared the association between conflicts of interest and favourable recommendations of drugs or devices (eg, recommending a drug) in clinical guidelines, advisory committee reports, opinion pieces (eg, editorials), or narrative reviews. PubMed, Embase, Cochrane Methodology Register (from inception to February 2020), reference lists, Web of Science, and grey literature. Two authors independently extracted data and assessed the methodological quality of the studies. Pooled relative risks and 95% confidence intervals were estimated using random effects models (relative risk >1 indicates that documents with conflicts of interest more often had favourable recommendations than documents with no conflicts of interest). Financial and non-financial conflicts of interest were analysed separately, and the four types of documents were analysed separately (preplanned) and combined (post hoc). 21 studies that analysed 106 clinical guidelines, 1809 advisory committee reports, 340 opinion pieces, and 497 narrative reviews were included. Unpublished data were received for 11 studies (eight full datasets and three summary datasets). 15 studies showed risk of confounding because the compared documents could differ in factors other than conflicts of interest (eg, different drugs used for different populations). The relative risk for associations between financial conflicts of interest and favourable recommendations for clinical guidelines was 1.26 (95% confidence interval 0.93 to 1.69; four studies of 86 clinical guidelines), for advisory committee reports was 1.20 (0.99 to 1.45; four studies of 629 advisory committee reports), for opinion pieces was 2.62 (0.91 to 7.55; four studies of 284 opinion pieces), and for narrative reviews was 1.20 (0.97 to 1.49; four studies of 457 narrative reviews). An analysis of all four types of documents combined supported these findings (1.26, 1.09 to 1.44). In one study that investigated specialty interests, the association between including radiologists as authors of guidelines and recommending routine breast cancer was: relative risk 2.10, 95% confidence interval 0.92 to 4.77; 12 clinical guidelines). We interpret our findings to indicate that financial conflicts of interest are associated with favourable recommendations of drugs and devices in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. Limitations of this review were risk of confounding in the included studies and the statistical imprecision of individual analyses of each document type. It is not certain whether non-financial conflicts of interest influence recommendations. Cochrane Methodology Review Protocol MR000040.
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影响因子：
1.4
作者：
George, James N.;Vesely, Sara K.;Woolf, Steven H.
通讯作者：
Woolf, Steven H.
影响因子：
1.6
作者：
Andreatos, Nikolaos;Zacharioudakis, Ioannis M.;Mylonakis, Eleftherios
通讯作者：
Mylonakis, Eleftherios
影响因子：
7.2
作者：
Akl, Elie A.;El-Hachem, Pierre;Guyatt, Gordon H.
通讯作者：
Guyatt, Gordon H.
影响因子：
9.8
作者：
Bero, Lisa A.;Grundy, Quinn
通讯作者：
Grundy, Quinn
影响因子：
7.2
作者：
Foroutan, Farid;Guyatt, Gordon;Iorio, Alfonso
通讯作者：
Iorio, Alfonso