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Incorporating adjustments for variability in control group response rates in network meta-analysis: a case study of biologics for rheumatoid arthritis.
Cameron, Chris; Varu, Abhishek; Lau, Arthur; Gharaibeh, Mahdi; Paulino, Marcelo; Rogoza, Raina.
Afiliação
  • Cameron C; Data Analytics & Evidence Synthesis, Cornerstone Research Group, Inc., Burlington, ON, Canada. ccameron@cornerstone-research.com.
  • Varu A; Data Analytics & Evidence Synthesis, Cornerstone Research Group, Inc., Burlington, ON, Canada.
  • Lau A; Division of Rheumatology, McMaster University, Hamilton, ON, Canada.
  • Gharaibeh M; Amgen Inc., Thousand Oaks, CA, USA.
  • Paulino M; Amgen Canada, Inc., Mississauga, ON, Canada.
  • Rogoza R; Amgen Canada, Inc., Mississauga, ON, Canada.
BMC Med Res Methodol ; 19(1): 193, 2019 10 16.
Article em En | MEDLINE | ID: mdl-31619175
BACKGROUND: The importance of adjusting for cross-study heterogeneity in control group response rates when conducting network meta-analyses (NMA) was demonstrated using a case study involving a comparison of biologics for the treatment of moderate-to-severe rheumatoid arthritis. METHODS: Bayesian NMAs were conducted for American College of Rheumatology (ACR) 50 treatment response based upon a set of randomized controlled trials (RCTs) identified by a recently completed systematic review of the literature. In addition to the performance of an unadjusted NMA, a model adjusting for cross-study heterogeneity of control group response rates using meta-regression was fit to the data. Model fit was evaluated, and findings from both analyses were compared with regard to clinical interpretations. RESULTS: ACR 50 response data from a total of 51 RCTs and 16,223 patients were analyzed. Inspection of cross-study variability in control group response rates identified considerable differences between studies. NMA incorporating adjustment for this variability was associated with an average change of 38.1% in the magnitude of the ORs between treatment comparisons, and over 64% of the odds ratio changed by 15% or more. Important changes in the clinical interpretations drawn from treatment comparisons were identified with this improved modeling approach. CONCLUSIONS: In comparing biologics for moderate to severe rheumatoid arthritis, failure to adjust for cross-trial differences in the control arm response rates in NMA can lead to biased estimates of comparative efficacy between treatments.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Artrite Reumatoide / Produtos Biológicos / Metanálise como Assunto / Antirreumáticos / Metanálise em Rede Tipo de estudo: Clinical_trials / Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Revista: BMC Med Res Methodol Assunto da revista: MEDICINA Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Canadá

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Artrite Reumatoide / Produtos Biológicos / Metanálise como Assunto / Antirreumáticos / Metanálise em Rede Tipo de estudo: Clinical_trials / Prognostic_studies / Systematic_reviews Limite: Humans Idioma: En Revista: BMC Med Res Methodol Assunto da revista: MEDICINA Ano de publicação: 2019 Tipo de documento: Article País de afiliação: Canadá