Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial.

OBJECTIVE To present some simple graphical and quantitative ways to assist interpretation and improve presentation of results from multiple-treatment meta-analysis (MTM). STUDY DESIGN AND SETTING We reanalyze a published network of trials comparing various antiplatelet interventions regarding the incidence of serious vascular events using Bayesian approaches for random effects MTM, and we explore the advantages and drawbacks of various traditional and new forms of quantitative displays and graphical presentations of results. RESULTS We present the results under various forms, conventionally based on the mean of the distribution of the effect sizes; based on predictions; based on ranking probabilities; and finally, based on probabilities to be within an acceptable range from a reference. We show how to obtain and present results on ranking of all treatments and how to appraise the overall ranks. CONCLUSIONS Bayesian methodology offers a multitude of ways to present results from MTM models, as it enables a natural and easy estimation of all measures based on probabilities, ranks, or predictions.

[1]  R. Baumgartner.  Network meta-analysis of antiplatelet treatments for secondary stroke prevention. , 2008, European heart journal.

[2]  John P.A. Ioannidis,et al.  Integration of evidence from multiple meta-analyses: a primer on umbrella reviews, treatment networks and multiple treatments meta-analyses , 2009, Canadian Medical Association Journal.

[3]  Steffen Fieuws,et al.  Network meta-analysis: simultaneous meta-analysis of common antiplatelet regimens after transient ischaemic attack or stroke. , 2008, European heart journal.

[4]  A E Ades,et al.  Mixed treatment comparison with multiple outcomes reported inconsistently across trials: Evaluation of antivirals for treatment of influenza A and B , 2008, Statistics in medicine.

[5]  G. Lu,et al.  Assessing Evidence Inconsistency in Mixed Treatment Comparisons , 2006 .

[6]  J. Geddes,et al.  Comparative efficacy and acceptability of 12 new-generation antidepressants: a multiple-treatments meta-analysis , 2009, The Lancet.

[7]  Georgia Salanti,et al.  Evaluation of networks of randomized trials , 2008, Statistical methods in medical research.

[8]  J. Ioannidis,et al.  Immunogenicity and adverse events of avian influenza A H5N1 vaccine in healthy adults: multiple-treatments meta-analysis. , 2009, The Lancet. Infectious diseases.

[9]  Gordon H Guyatt,et al.  Methods to explain the clinical significance of health status measures. , 2002, Mayo Clinic proceedings.

[10]  David J Spiegelhalter,et al.  A re-evaluation of random-effects meta-analysis , 2009, Journal of the Royal Statistical Society. Series A,.

[11]  Julian P T Higgins,et al.  A case study of multiple-treatments meta-analysis demonstrates that covariates should be considered. , 2009, Journal of clinical epidemiology.

[12]  A. Owen,et al.  Incident diabetes in clinical trials of antihypertensive drugs , 2007, The Lancet.

[13]  N. Welton,et al.  Addressing between‐study heterogeneity and inconsistency in mixed treatment comparisons: Application to stroke prevention treatments in individuals with non‐rheumatic atrial fibrillation , 2009, Statistics in medicine.

[14]  Is the finding of the PROFESS study consistent with predictions of network meta-analysis? , 2008, European heart journal.

[15]  Stuart G Baker,et al.  The transitive fallacy for randomized trials: If A bests B and B bests C in separate trials, is A better than C? , 2002, BMC medical research methodology.

[16]  Deborah M Caldwell,et al.  Simultaneous comparison of multiple treatments: combining direct and indirect evidence , 2005, BMJ : British Medical Journal.

[17]  Andrew Thomas,et al.  WinBUGS - A Bayesian modelling framework: Concepts, structure, and extensibility , 2000, Stat. Comput..

[18]  Simon Wandel,et al.  Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis , 2007, The Lancet.

[19]  Nicky J Welton,et al.  Mixed treatment comparison meta-analysis of complex interventions: psychological interventions in coronary heart disease. , 2009, American journal of epidemiology.

[20]  G. Lu,et al.  Combination of direct and indirect evidence in mixed treatment comparisons , 2004, Statistics in medicine.

[21]  William J. Elliott.  Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis , 2008 .

[22]  John Ioannidis,et al.  Exploring the Geometry of Treatment Networks , 2008, Annals of Internal Medicine.

[23]  H. Diener.  The PRoFESS trial: future impact on secondary stroke prevention , 2007, Expert review of neurotherapeutics.

[24]  Georgia Salanti,et al.  Multiple-treatments meta-analysis of chemotherapy and targeted therapies in advanced breast cancer. , 2008, Journal of the National Cancer Institute.