scholarly journals Perspective: Network Meta-analysis Reaches Nutrition Research: Current Status, Scientific Concepts, and Future Directions

2019 ◽  
Vol 10 (5) ◽  
pp. 739-754 ◽  
Author(s):  
Lukas Schwingshackl ◽  
Guido Schwarzer ◽  
Gerta Rücker ◽  
Joerg J Meerpohl
Keyword(s):  
Evidence Synthesis ◽  
Meta Analysis ◽  
Indirect Evidence ◽  
Current Status ◽  
Scientific Concepts ◽  
Assessment Development ◽  
Nutrition Research ◽  
Dissemination Bias ◽  
Pubmed Search ◽  
Design Type

ABSTRACTTraditional pairwise meta-analysis (PMA) is a very useful method that pools evidence from one study design type if appropriate; its widespread use in nutrition research is an important phenomenon. Recently, a promising method for more advanced evidence-synthesis, called network meta-analysis (NMA), was introduced. NMA is an extension of PMA that enables simultaneous comparison of multiple interventions. NMA combines direct evidence (i.e., trials comparing 2 interventions directly) and indirect evidence (i.e., from a connected route via ≥1 comparators, e.g. placebo) in a network of studies. NMAs have the potential to advance knowledge in the field of nutrition as they provide insights that cannot be obtained by individual 2-arm randomized controlled trials or PMA. Thus, in this perspective paper, we aim to summarize the current (methodologic) status of published NMAs in nutrition research and emphasize advances and strengths in comparison with traditional PMA through specific examples, and highlight potential pitfalls and limitations. NMA is an emerging methodology in the field of nutrition research. A PubMed search identified only 23 nutrition research-related NMAs published since the inception of journals up to January 8, 2019 (61% of them published since 2017), compared with >5000 published PMAs. Moreover, we aim to highlight the scientific concepts and standards through the use of the following NMA example: “Which type of oils/solid fats offers the greatest impact on blood lipids?” In this regard, we discuss intervention definitions, transitivity/similarity, statistical methods, description and visualization of results, inconsistency, ranking, dissemination bias, assessing the certainty of evidence by Grading of Recommendations Assessment, Development and Evaluation, and reporting guidelines. We expect that rigorously conducted NMAs based on high-quality systematic reviews will become the new evidence synthesis benchmark in nutrition research. However, caution is warranted because abuse and misinterpretations of PMA and NMA findings could hamper the scientific field and possibly decision-making regarding public policy.

scholarly journals Introduction to network meta-analysis for evidence synthesis

Medwave ◽  
2021 ◽  
Vol 21 (06) ◽  
pp. e8315-e8315
Author(s):  
Catalina Gracia González-Xuriguera ◽  
Laura Vergara-Merino ◽  
Luis Garegnani ◽  
Luis Ortiz-Muñoz ◽  
Nicolás Meza
Keyword(s):  
Graphical Representation ◽  
Clinical Epidemiology ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Distinctive Features ◽  
Assessment Development ◽  
Analysis Of Results ◽  
Multiple Treatments ◽  
Therapeutic Alternatives ◽  
Grade Approach

This article belongs to a collaborative methodological series of narrative reviews about biostatistics and clinical epidemiology. The goal is to present basics concepts concerning the systematics reviews of multiple treatments comparisons with network meta-analysis. For clinical ques-tions with several therapeutic alternatives to be compared, the central question is how to classify or rank their effectiveness (benefit and harm) to choose the best option. The network meta-analysis aims to answer questions related to the effectiveness and safety of comparing multiple treatments by the simultaneous analysis of results raised from direct and indirect comparisons. The network geometry is the general graphical representation of the network meta-analysis and allows to understand and assess the strength of comparisons. The network meta-analysis should check several assumptions to be valid, especially the transitivity assumption, which allows assuming that there are no systematic differences among the included comparisons, except their compared interventions. Thus, it is possible to know the relative therapeutic effectiveness of each pair of interventions included in the network meta-analysis and their ranking in terms of categorization. It has been proposed to use a modified Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach considering the distinctive features of network meta-analysis to assess the certainty of the evidence for each comparison and the ranking of interventions.

scholarly journals Network meta-analyses in reproductive medicine: challenges and opportunities

2020 ◽  
Vol 35 (8) ◽  
pp. 1723-1731
Author(s):  
Rui Wang ◽  
Anna Lene Seidler ◽  
Lisa Askie ◽  
Robert J Norman ◽  
Siladitya Bhattacharya ◽  
...  
Keyword(s):  
Reproductive Medicine ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Indirect Evidence ◽  
Future Research ◽  
Challenges And Opportunities ◽  
Recent Addition ◽  
Simultaneous Comparisons ◽  
Multiple Treatments ◽  
Meta Analyses

Abstract Network meta-analysis allows researchers to synthesise both direct and indirect evidence, thus enabling simultaneous comparisons of multiple treatments. A relatively recent addition to evidence synthesis in reproductive medicine, this approach has become increasingly popular. Yet, the underlying assumptions of network meta-analyses, which drive the validity of their findings, have been frequently ignored. In this article, we discuss the strengths and limitations of network meta-analyses. In addition, we present an overview of published network meta-analyses in reproductive medicine, summarize their challenges and provide insights into future research opportunities.

scholarly journals Biomarkers in Diagnosis of Sepsis and Systemic Infection in Adult Patients: A Systematic Review and Bayesian Network Meta-Analysis

2020 ◽  
Author(s):  
Hao-Min Lan ◽  
Chin‐Chieh Wu ◽  
Su-Hsun Liu ◽  
Chih-Huang Li ◽  
Yu-Kang Tu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Reference Group ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Indirect Evidence ◽  
Systemic Infection ◽  
Relative Sensitivity ◽  
Credible Interval ◽  
Adult Patients ◽  
Suspected Infection

Abstract Background Sepsis is estimated to affect over 30 million people worldwide and to result in six million deaths every year. The definition of sepsis has been heavily revised in recent years, resulting in the need for a comprehensive comparison for clinicians to choose among the current biomarkers for sepsis. PurposeWe conducted a systematic review and synthesized both direct and indirect evidence by using network meta-analyses with bivariate hierarchical random-effects arm-based model in a Bayesian framework. We applied the Quality Assessment of Diagnostic Accuracy Studies-2 criteria to assess the risk of bias, investigated heterogeneity using Bayesian network meta-regression models, and estimated optimal adjusted cutoff values for each included biomarker. Data sources PubMed, EMBASE, and Scopus from their inception to May 2019 Study Selection, Data ExtractionStudies assessing the diagnostic performance of biomarkers in adult patients with suspected infection were included. We excluded studies not detecting systemic infection or sepsis, only including burns patients, or with non-systemic inflammatory response syndrome patients as the reference group.Data SynthesisWe identified 336 unique studies and included 134 studies representing 20,564 patients for evidence synthesis. Among the seven most-studied biomarkers, presepsin displayed the significantly better pooled sensitivities than procalcitonin to detect systemic infection and sepsis (0.85 and 0.83; 95% credible interval [CrI]: 0.79-0.89 and 0.77-0.88; relative sensitivity 1.13 and 1.10, 95% CrI: 1.04-1.20 and 1.01-1.18). However, CD64 showed the significantly better pooled specificities than presepsin in detecting systemic infection and sepsis (0.87 and 0.99; 95% CrI: 0.81-0.92 and 0.92-1.00, relative specificity 1.19 and 1.49, 95% CrI: 1.07-1.34 and 1.31-1.70). After adjusting for study quality, study populations, types of specimens, year of the study conducted and sponsorship, CD64 showed the best-pooled sensitivities and specificities. However, owing to the lack of a unifiable measuring unit, we cannot provide optimal cutoffs for CD64.ConclusionsCD64 performed the best in detecting both systemic infection and sepsis in adult patients. Further investigations will be needed to assess the potential risks of biases and the use of post-hoc cutoffs.RegistrationPROSPERO number: CRD42018086545

Treatment of acute migraine attacks in children with analgesics on the World Health Organization Essential Medicines List: A systematic review and GRADE evidence synthesis

Cephalalgia ◽  
2017 ◽  
Vol 38 (9) ◽  
pp. 1592-1607 ◽  
Author(s):  
Milka Jeric ◽  
Nives Surjan ◽  
Antonia Jelicic Kadic ◽  
Nicoletta Riva ◽  
Livia Puljak
Keyword(s):  
World Health Organization ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
Indirect Evidence ◽  
Essential Medicines ◽  
World Health ◽  
Acute Migraine ◽  
Essential Medicines List ◽  
The World ◽  
Health Organization

Background The World Health Organization Essential Medicines List (WHO EML) contains two analgesics for treatment of acute migraine attacks in children, ibuprofen and paracetamol. Methods The Embase, CDSR, CENTRAL, DARE and MEDLINE databases were searched up to 18 April 2017. We analyzed randomized controlled trials (RCTs) and systematic reviews (SRs) that investigate the efficacy and safety of ibuprofen or paracetamol for treatment of acute migraine attacks in children. We conducted meta-analysis and assessments of evidence with GRADE, Cochrane risk of bias tool, and AMSTAR. Results Three RCTs (201 children) and 10 SRs on ibuprofen and/or paracetamol for acute migraine attacks in children were included. Meta-analysis indicated that ibuprofen was superior to placebo for pain-free at 2 h or pain relief at 2 h, without difference in adverse events. There were no differences between paracetamol and placebo, or ibuprofen and paracetamol. Ten SRs that analyzed various therapies for migraine in children were published between 2004 and 2016, with discordant conclusions. Conclusion Limited data from poor quality RCTs indicate that ibuprofen and paracetamol might be effective analgesics for treating migraine attacks in children. Inclusion of ibuprofen and paracetamol as antimigraine medicines for children in the WHO EML is supported by indirect evidence from studies in adults.

scholarly journals Respiratory syncytial virus prophylaxis for prevention of recurrent childhood wheeze and asthma: a protocol for a systematic review

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Lauren Alexandra Quinn ◽  
Michael D. Shields ◽  
Helen E. Groves
Keyword(s):  
Systematic Review ◽  
Monoclonal Antibody ◽  
Monoclonal Antibodies ◽  
Respiratory Syncytial Virus ◽  
Meta Analysis ◽  
Recurrent Wheezing ◽  
Assessment Development ◽  
Recurrent Wheeze ◽  
Syncytial Virus ◽  
Design Type

Abstract Background Lower respiratory tract infection (LRTI) caused by respiratory syncytial virus (RSV) has been associated with greater risk of recurrent wheezing and subsequent asthma. However, it is still unclear whether this association is causal or not. RSV-specific monoclonal antibodies have been shown to reduce RSV-related hospitalisations in high-risk infants, i.e. those born pre-term, but the longer term follow-up has given conflicting evidence for the prevention of recurrent wheeze or asthma. Objective We aim to perform a systematic review and meta-analysis to determine whether or not prophylaxis with a monoclonal antibody for prevention of RSV-bronchiolitis reduces the risk of subsequent recurrent wheeze or asthma. If so, this would support the hypothesis that the association between RSV and recurrent wheeze and/or asthma is causative. Methods To identify relevant studies, we will search a number of databases including Medline, Embase, PubMed and Web of Science and will also manually look for unpublished data by contacting the manufacturers of monoclonal antibodies. The intervention being investigated is RSV-specific monoclonal antibody prophylaxis, and the outcome being measured is recurrent wheeze and/or asthma. Studies will be screened according to inclusion/exclusion criteria, to include primary studies of any study design type. Eligible studies will then be evaluated for quality and assessed for bias independently by three reviewers using the ‘Grading of Recommendations Assessment, Development and Evaluation’ (GRADE) approach. The results of the studies will be extracted into 2 × 2 outcome tables, and a meta-analysis will be carried out to produce forest plots based on relative risk. Heterogeneity will be assessed using the I2 statistic. The statistical software we will use is StatsDirect. Discussion This review will aid in determining if the relationship between RSV and asthma development is a causal one, by showing the effect (if any) of RSV prophylaxis on subsequent recurrent wheeze/asthma. If this study shows RSV prophylaxis to have no effect on the outcome of recurrent wheeze/asthma, the question of causality remains.

Interventions for students with autism in inclusive settings: A best-evidence synthesis and meta-analysis.

2019 ◽  
Vol 145 (5) ◽  
pp. 490-507 ◽  
Author(s):  
Laci Watkins ◽  
Katherine Ledbetter-Cho ◽  
Mark O'Reilly ◽  
Lucy Barnard-Brak ◽  
Pau Garcia-Grau
Keyword(s):  
Evidence Synthesis ◽  
Meta Analysis ◽  
Best Evidence Synthesis ◽  
Inclusive Settings ◽  
Students With Autism

Efficacy of Alprostadil in Preventing Contrast-Induced Nephropathy: A Systematic Review and Meta-Analysis

Angiology ◽  
2021 ◽  
pp. 000331972110044
Author(s):  
Hongling Xu ◽  
Hongye Wang ◽  
Chuang Zhang ◽  
Jun Xiao ◽  
Ning Hua ◽  
...  
Keyword(s):  
Meta Analysis ◽  
China National Knowledge Infrastructure ◽  
Contrast Induced Nephropathy ◽  
Serum Cystatin ◽  
Assessment Development ◽  
Neutrophil Gelatinase Associated Lipocalin ◽  
Knowledge Infrastructure ◽  
Evidence Evaluation ◽  
Biological Medicine ◽  
Neutrophil Gelatinase

This study aimed to determine the efficacy of alprostadil in preventing contrast-induced nephropathy (CIN). Eligible studies were searched using the keywords through the databases of PubMed, Cochrane, Embase, China Biological Medicine Database, China National Knowledge Infrastructure, and Vanfun. Quality evaluation of the included studies was conducted according to international evidence evaluation and recommended Grades of Recommendations Assessment, Development, and Evaluation standards. We included 29 studies with 5623 patients. Compared with hydration, 10 µg/d alprostadil or 20 µg/d alprostadil plus hydration significantly decreased the incidence of CIN. Compared with hydration, alprostadil plus hydration significantly reduced serum creatinine and blood urea nitrogen at 24, 48, and 72 hours and 7 days after coronary angiography (CAG). Alprostadil (20 µg/d) plus hydration significantly decreased serum cystatin versus hydration at 24, 48, and 72 hours after CAG. Compared with hydration, alprostadil plus hydration significantly increased glomerular filtration rate at 24 and 72 hours after CAG. Alprostadil plus hydration significantly decreased neutrophil gelatinase-associated lipocalin levels compared to hydration at 24, 48, and 72 hours after CAG. Alprostadil plus hydration significantly decreased urine macroglobulin versus hydration at 24 and 48 hours after CAG.

scholarly journals Zumba®, Fat Mass and Maximum Oxygen Consumption: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 18 (1) ◽  
pp. 105
Author(s):  
Manuel Chavarrias ◽  
Santos Villafaina ◽  
Ana Myriam Lavín-Pérez ◽  
Jorge Carlos-Vivas ◽  
Eugenio Merellano-Navarro ◽  
...  
Keyword(s):  
Systematic Review ◽  
Oxygen Consumption ◽  
Body Mass ◽  
Fat Mass ◽  
Evidence Synthesis ◽  
Meta Analysis ◽  
P Value ◽  
Maximum Oxygen Consumption ◽  
Mass Percentage ◽  
Large Heterogeneity

Background and objectives: Obesity or overweight is associated with many health risk factors and preventable mortality. Even people with normal weight and without history of obesity or overweight should avoid weight gain to reduce health risks factors. In this regard Latin aerobic dances involved in Zumba® practice make this modality motivating for people. Apart from weight loss and VO2peak benefits, Zumba practice is also interesting by the increase in adherence which can also avoid weight regain. The aim was to systematically review the scientific literature about the effects of any randomized intervention of Zumba® practice on total fat mass (%) and maximum oxygen consumption (VO2peak), besides establishing directions for the clinical practice. Evidence acquisition: Two systematic searches were conducted in two electronic databases following the PRISMA guidelines. The eligibility criteria were (a) outcomes: body mass or VO2peak data including mean and standard deviation (SD) before and after Zumba® intervention, (b) study design: randomized controlled trial (RCT) and (c) language: English. GRADE guidelines were used to assess the quality of evidence. A meta-analysis was performed to determine mean differences. Nine and four studies were selected for fat mass percentage and VO2peak in the systematic review, respectively. However, only eight studies for fat mass percentage and three for VO2peak could be included in the meta-analysis. Evidence synthesis: The overall standardized mean difference for fat mass was −0.25 with a 95% CI from −0.67 to 0.16 with a p-value of 0.69, with large heterogeneity. On the other hand, the overall effect size for VO2peak was 0.53 (95% CI from 0.04 to 1.02 with a p-value of 0.03) with large heterogeneity. Conclusions: Based on the evidence, we cannot conclude that Zumba® is effective at reducing body mass but it may improve VO2peak. However, the limited number of studies that met the inclusion criteria makes it too early to reach a definite conclusion, so more research is needed.

scholarly journals Conditional power of antidepressant network meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lisa Holper
Keyword(s):  
Meta Analysis ◽  
Indirect Evidence ◽  
Dropout Rate ◽  
Conclusive Evidence ◽  
Effect Sizes ◽  
Current Evidence ◽  
Hamilton Depression Scale ◽  
Conditional Power ◽  
Sample Sizes ◽  
Antidepressant Treatments

Abstract Background Conditional power of network meta-analysis (NMA) can support the planning of randomized controlled trials (RCTs) assessing medical interventions. Conditional power is the probability that updating existing inconclusive evidence in NMA with additional trial(s) will result in conclusive evidence, given assumptions regarding trial design, anticipated effect sizes, or event probabilities. Methods The present work aimed to estimate conditional power for potential future trials on antidepressant treatments. Existing evidence was based on a published network of 502 RCTs conducted between 1979-2018 assessing acute antidepressant treatment in major depressive disorder (MDD). Primary outcomes were efficacy in terms of the symptom change on the Hamilton Depression Scale (HAMD) and tolerability in terms of the dropout rate due to adverse events. The network compares 21 antidepressants consisting of 231 relative treatment comparisons, 164 (efficacy) and 127 (tolerability) of which are currently assumed to have inconclusive evidence. Results Required sample sizes to achieve new conclusive evidence with at least 80% conditional power were estimated to range between N = 894 - 4190 (efficacy) and N = 521 - 1246 (tolerability). Otherwise, sample sizes ranging between N = 49 - 485 (efficacy) and N = 40 - 320 (tolerability) may require stopping for futility based on a boundary at 20% conditional power. Optimizing trial designs by considering multiple trials that contribute both direct and indirect evidence, anticipating alternative effect sizes or alternative event probabilities, may increase conditional power but required sample sizes remain high. Antidepressants having the greatest conditional power associated with smallest required sample sizes were identified as those on which current evidence is low, i.e., clomipramine, levomilnacipran, milnacipran, nefazodone, and vilazodone, with respect to both outcomes. Conclusions The present results suggest that conditional power to achieve new conclusive evidence in ongoing or future trials on antidepressant treatments is low. Limiting the use of the presented conditional power analysis are primarily due to the estimated large sample sizes which would be required in future trials as well as due to the well-known small effect sizes in antidepressant treatments. These findings may inform researchers and decision-makers regarding the clinical relevance and justification of research in ongoing or future antidepressant RCTs in MDD.

scholarly journals Comparative Efficacy of Antifungal Agents Used in the Treatment of Oropharyngeal Candidiasis among HIV-Infected Adults: A Systematic Review and Network Meta-Analysis

2021 ◽  
Vol 7 (8) ◽  
pp. 637
Author(s):  
Shamala Gopal Rajadurai ◽  
Mari Kannan Maharajan ◽  
Sajesh K. Veettil ◽  
Divya Gopinath
Keyword(s):  
Antifungal Agents ◽  
Meta Analysis ◽  
Oropharyngeal Candidiasis ◽  
Mycological Cure ◽  
Comparative Efficacy ◽  
Assessment Development ◽  
Randomized Controlled ◽  
Favorable Safety ◽  
Grade Approach

The objective of this study was to assess the comparative efficacy and safety of different antifungal agents used for the treatment of oropharyngeal candidiasis (OPC) in adult patients with HIV. A systematic search was performed on the four major databases (Medline, Embase, CENTRAL and Scopus) to identify randomized controlled trials (RCTs) that evaluated the efficacy of antifungal agents in HIV patients with OPC. A network meta-analysis was performed from the data extracted from the selected studies. The agents were ranked according using surface under the cumulative ranking (SUCRA). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to determine the quality of evidence. A total of 15 trials were included in the quantitative analysis involving the data from a total of 2883 participants. Fluconazole was ranked as the most effective antifungal agent to achieve clinical cure (SUCRA = 0.87) in OPC followed by posaconazole and itraconazole. Posaconazole was ranked the most efficacious agent in achieving mycological cure (SUCRA = 0.81), followed by fluconazole. While nystatin was ranked the safest, the effect estimates of none of the other systemic antifungal agents were significantly higher than fluconazole. Based on the available evidence, fluconazole can be considered as the most effective drug in the treatment of OPC among HIV-infected adults and has a favorable safety profile, followed by posaconazole.

Sign in / Sign up

Export Citation Format

Share Document