A Bayesian Mixed-Treatment Comparison Meta-analysis of Treatments for Alcohol Dependence and Implications for Planning Future Trials
A Bayesian Mixed-Treatment Comparison Meta-analysis of Treatments for Alcohol Dependence and Implications for Planning Future Trials
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DOI：
10.1177/0272989x14537558
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发表时间：
2014-10-01
影响因子：
3.6
通讯作者：
Zhu, Huirong
中科院分区：
文献类型：
--
作者：
DeSantis, Stacia M.;Zhu, Huirong
背景酒精依赖的几种治疗方法已经在随机对照试验中进行了测试，从而产生了具有证据结构网络或混合治疗比较（MTCs）的系统评价。在网络中，很少有直接比较积极的治疗。到目前为止，这个网络还没有得到充分的分析。例如，治疗之间的“间接比较”（e。例如，在一个实施例中，通过A：B和A：C试验的估计值获得的治疗B：C的比较）尚未纳入治疗效果的估计值中。这对未来随机对照试验的计划具有影响。方法.我们应用贝叶斯MTC元分析的最新发展来分析证据网络。利用这些结果，我们提出了一种方法，以通知，设计和功率的假设试验的背景下，更新的荟萃分析的治疗，已经很少比较，因此，其效果大小是不是很好地通知荟萃分析。结果MTC荟萃分析提供了比成对荟萃分析更准确的估计，并揭示了很少直接比较的活性治疗之间的决定性差异。所有结果的加权表明，组合（纳洛酮1阿坎酸）治疗具有最高的后验概率成为"最佳"治疗。如果要进行一项新的联合治疗与阿坎酸单药治疗的临床试验，则没有可行的样本量可以进行决定性的荟萃分析。结论. MTC荟萃分析应用于评估直接和间接证据一致的网络中的治疗效果，并为未来研究的设计提供信息。
Background. Several treatments for alcohol dependence have been tested in randomized controlled trials, giving rise to systematic reviews with a network of evidence structure, or mixed treatment comparisons (MTCs). Within the network, there are few direct comparisons of active treatments. Thus far, this network has not been adequately analyzed. For example, "indirect comparisons" between treatments (e. g., the comparison of treatments B: C obtained via estimates from A: B and A: C trials) have not been incorporated into estimates of treatment effects. This has implications for the planning of future randomized controlled trials. Methods. We applied recent developments in Bayesian MTC meta-analysis to analyze the network of evidence. Using these results, we proposed a methodology to inform, design, and power a hypothetical trial in the context of an updated meta-analysis for treatments that have been infrequently compared and therefore whose effect sizes are not well informed by a meta-analysis. Results. An MTC meta-analysis provides more accurate estimates than a pairwise meta-analysis and uncovers decisive differences between active treatments that have been infrequently directly compared. Weighting across all outcomes indicates that a combination (naltrexone 1 acamprosate) treatment has the highest posterior probability of being the "best'' treatment. If a new clinical trial were to be conducted of a combination therapy versus acamprosate alone, there is no feasible sample size that would result in a decisive meta-analysis. Conclusions. An MTC meta-analysis should be used to estimate treatment effects in networks in which direct and indirect evidence are consistent and to inform the design of future studies.