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Network Meta-analysis Incorporating Randomized Controlled Trials And Non-randomized Comparative Cohort Studies For Assessing The Safety And Effectiveness Of Medical Treatments: Challenges And Opportunities

C. Cameron, B. Fireman, B. Hutton, T. Clifford, D. Coyle, G. Wells, C. Dormuth, R. Platt, S. Toh
Published 2015 · Medicine

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Network meta-analysis is increasingly used to allow comparison of multiple treatment alternatives simultaneously, some of which may not have been compared directly in primary research studies. The majority of network meta-analyses published to date have incorporated data from randomized controlled trials (RCTs) only; however, inclusion of non-randomized studies may sometimes be considered. Non-randomized studies can complement RCTs or address some of their limitations, such as short follow-up time, small sample size, highly selected population, high cost, and ethical restrictions. In this paper, we discuss the challenges and opportunities of incorporating both RCTs and non-randomized comparative cohort studies into network meta-analysis for assessing the safety and effectiveness of medical treatments. Non-randomized studies with inadequate control of biases such as confounding may threaten the validity of the entire network meta-analysis. Therefore, identification and inclusion of non-randomized studies must balance their strengths with their limitations. Inclusion of both RCTs and non-randomized studies in network meta-analysis will likely increase in the future due to the growing need to assess multiple treatments simultaneously, the availability of higher quality non-randomized data and more valid methods, and the increased use of progressive licensing and product listing agreements requiring collection of data over the life cycle of medical products. Inappropriate inclusion of non-randomized studies could perpetuate the biases that are unknown, unmeasured, or uncontrolled. However, thoughtful integration of randomized and non-randomized studies may offer opportunities to provide more timely, comprehensive, and generalizable evidence about the comparative safety and effectiveness of medical treatments.
This paper references
The central role of the propensity score in observational studies for causal effects
P. Rosenbaum (1983)
Confounding by indication?
S. Shapiro (1997)
Randomized, controlled trials, observational studies, and the hierarchy of research designs.
J. Concato (2000)
Comparison of evidence of treatment effects in randomized and nonrandomized studies.
J. Ioannidis (2001)
Bayesian methods in meta-analysis and evidence synthesis.
A. Sutton (2001)
Bias and causal associations in observational research
D. Grimes (2002)
Evaluating non-randomised intervention studies.
J. Deeks (2003)
Simultaneous comparison of multiple treatments: combining direct and indirect evidence
D. Caldwell (2005)
Results of multivariable logistic regression, propensity matching, propensity adjustment, and propensity-based weighting under conditions of nonuniform effect.
T. Kurth (2006)
Beyond randomized controlled trials: A critical comparison of trials with nonrandomized studies
H. Sørensen (2006)
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
E. von Elm (2007)
Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies
E. Elm (2007)
Guidelines for good pharmacoepidemiology practices (GPP)
Ispe (2008)
Observational Studies Analyzed Like Randomized Experiments: An Application to Postmenopausal Hormone Therapy and Coronary Heart Disease
M. Hernán (2008)
Benefits and risks of drug treatments: how to combine the best evidence on benefits with the best data about adverse effects.
J. Vandenbroucke (2008)
Integration of evidence from multiple meta-analyses: a primer on umbrella reviews, treatment networks and multiple treatments meta-analyses
J. Ioannidis (2009)
The importance of adjusting for potential confounders in Bayesian hierarchical models synthesising evidence from randomised and non-randomised studies: an application comparing treatments for abdominal aortic aneurysms
C. E. McCarron (2010)
Coordinating Cancer Care: Patient and Practice Management Processes Among Surgeons Who Treat Breast Cancer
S. Katz (2010)
Distributed Health Data Networks: A Practical and Preferred Approach to Multi-Institutional Evaluations of Comparative Effectiveness, Safety, and Quality of Care
Jeffrey S. Brown (2010)
Culprit vessel only versus multivessel and staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction: a pairwise and network meta-analysis.
P. Vlaar (2011)
Developing the Sentinel System--a national resource for evidence development.
R. Behrman (2011)
Bayesian Hierarchical Models Combining Different Study Types and Adjusting for Covariate Imbalances: A Simulation Study to Assess Model Performance
C. E. McCarron (2011)
Combining electronic healthcare databases in Europe to allow for large‐scale drug safety monitoring: the EU‐ADR Project
P. Coloma (2011)
Risks of harms using antifibrinolytics in cardiac surgery: systematic review and network meta-analysis of randomised and observational studies
B. Hutton (2012)
A protocol for active surveillance of acute myocardial infarction in association with the use of a new antidiabetic pharmaceutical agent
B. Fireman (2012)
CNODES: the Canadian Network for Observational Drug Effect Studies
S. Suissa (2012)
Adaptive Licensing: Taking the Next Step in the Evolution of Drug Approval
H. Eichler (2012)
Beyond the intention-to-treat in comparative effectiveness research
M. Hernán (2012)
Comparative risk for angioedema associated with the use of drugs that target the renin-angiotensin-aldosterone system.
S. Toh (2012)
Making inferences on treatment effects from real world data: propensity scores, confounding by indication, and other perils for the unwary in observational research
N. Freemantle (2013)
Inter-jurisdictional cooperation on pharmaceutical product listing agreements: views from Canadian provinces
S. Morgan (2013)
Is network meta-analysis as valid as standard pairwise meta-analysis? It all depends on the distribution of effect modifiers
J. Jansen (2013)
Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis
B. H. Stegeman (2013)
Incorporating data from various trial designs into a mixed treatment comparison model.
S. Schmitz (2013)
Proton pump inhibitors and the risk of hospitalisation for community-acquired pneumonia: replicated cohort studies with meta-analysis
K. Filion (2013)
Relative effectiveness of robot‐assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of localised prostate cancer: a systematic review and mixed treatment comparison meta‐analysis
C. Robertson (2013)
Use of high potency statins and rates of admission for acute kidney injury: multicenter, retrospective observational analysis of administrative databases
C. Dormuth (2013)
The Asian Pharmacoepidemiology Network (AsPEN): promoting multi‐national collaboration for pharmacoepidemiologic research in Asia
M. Andersen (2013)
An Analytic Framework for Aligning Observational and Randomized Trial Data: Application to Postmenopausal Hormone Therapy and Coronary Heart Disease
S. Toh (2013)
Evidence Synthesis for Decision Making 2
S. Dias (2013)
ADDIS: A decision support system for evidence-based medicine
G. V. Valkenhoef (2013)
Evidence Synthesis for Decision Making 4: Inconsistency in Networks of Evidence Based on Randomized Controlled Trials
S. Dias (2013)
Characteristics of Networks of Interventions: A Description of a Database of 186 Published Networks
A. Nikolakopoulou (2014)
Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration.
J. Vandenbroucke (2014)
A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis
M. Puhan (2014)
Higher potency statins and the risk of new diabetes: multicentre, observational study of administrative databases
C. Dormuth (2014)
Mini-Sentinel Distributed Database Summary Report-Year 4
Mini-Sentinel Data Core (2014)
The PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-analyses of Health Care Interventions: Checklist and Explanations
B. Hutton (2015)
Combining randomized and non-randomized evidence in clinical research: a review of methods and applications.
P. Verde (2015)

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Common Problems, Common Data Model Solutions: Evidence Generation for Health Technology Assessment
S. Kent (2020)
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P. Reynolds (2020)
Comparative effectiveness of catheter ablation devices in the treatment of atrial fibrillation: a network meta-analysis.
D. Gupta (2020)
Comparative efficacy and safety of pharmacological interventions for the treatment of COVID-19: A systematic review and network meta-analysis.
Min Seo Kim (2020)
'Real-world' observational studies in arrhythmia research: data sources, methodology, and interpretation. A position document from European Heart Rhythm Association (EHRA), endorsed by Heart Rhythm Society (HRS), Asia-Pacific HRS (APHRS), and Latin America HRS (LAHRS).
C. Torp-Pedersen (2019)
Corticosteroids and Cognition: A Meta-Analysis
C. E. Prado (2019)
Efficacy and safety of pharmacological treatments for Patent Ductus Arteriosus closure: a systematic review and network meta-analysis of clinical trials and observational studies.
Ettore Marconi (2019)
Extracranial Trigger Site Surgery for Migraine: A Systematic Review With Meta-Analysis on Elimination of Headache Symptoms
A. J. Vincent (2019)
Characteristics and methods of incorporating randomized and nonrandomized evidence in network meta-analyses: a scoping review.
Kathryn Zhang (2019)
Effectiveness of Renin-Angiotensin-Aldosterone System Blockade on Residual Kidney Function and Peritoneal Membrane Function in Peritoneal Dialysis Patients: A Network Meta-Analysis
Sirayut Phatthanasobhon (2019)
Abaloparatide for risk reduction of nonvertebral and vertebral fractures in postmenopausal women with osteoporosis: a network meta-analysis
J. Reginster (2019)
Incorporating single-arm evidence into a network meta-analysis using aggregate level matching: Assessing the impact.
J. Leahy (2019)
The Impact of Performing a Network Meta-Analysis with Imperfect Evidence
J. Leahy (2019)
A systematic literature review and network meta-analysis of effectiveness and safety outcomes in advanced melanoma.
M. Franken (2019)
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