Cited by 522Meta-analysis and systematic reviewsStatistical Methods in Clinical TrialsMental Health Research Topics

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Using network meta‐analysis to evaluate the existence of small‐study effects in a network of interventions

Chaimani, Anna, Salanti, Georgia·2012·Research Synthesis Methods

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Abstract

Suggested methods for exploring the presence of small‐study effects in a meta‐analysis and the possibility of publication bias are associated with important limitations. When a meta‐analysis comprises only a few studies, funnel plots are difficult to interpret, and regression‐based approaches to test and account for small‐study effects have low power. Assuming that the cause of funnel plot asymmetry is likely to affect an entire research field rather than only a particular comparison of interventions, we suggest that network meta‐regression is employed to account for small‐study effects in a set of related meta‐analyses. We present several possible models for the direction and distribution of small‐study effects and we describe the methods by re‐analysing two published networks. Copyright © 2012 John Wiley & Sons, Ltd.

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Best, L. M., Leung, J., Freeman, S. C., Sutton, A. J., Cooper, N. J., Milne, E., Cowlin, M., Payne, A., Walshaw, D., Thorburn, D., et al. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013203.pub2 · Cited by 24
“…funnel plot, it is necessary to rank the studies in a meaningful way as asymmetry may be due to small sample sizes in newer studies (comparing newer treatments with older treatments) or higher risk of bias in older studies (comparing older treatments with placebo) (Chaimani 2012).”
MethodResultInfluential
Different Acupuncture Therapies for Allergic Rhinitis: Overview of Systematic Reviews and Network Meta‐Analysis
Zhang, J., Zhang, Y., Huang, X., Lan, K., Hu, L., Chen, Y., & Yu, H. (2020) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2020/8363027 · Cited by 23
“Potential small study effects within the network were detected using comparison-adjusted funnel plots [17].”
Method
Multivariate network meta‐analysis to mitigate the effects of outcome reporting bias
Hwang, H., & DeSantis, S. M. (2018) · Statistics in Medicine · doi:10.1002/sim.7815 · Cited by 22
Comparative efficacy and safety of PD-1/PD-L1 inhibitors in triple negative breast cancer: a systematic review and network meta-analysis of randomized controlled trials
Elmakaty, I., Abdo, R., Elsabagh, A. A., Elsayed, A., & Malki, M. I. (2023) · Cancer Cell International · doi:10.1186/s12935-023-02941-7 · Cited by 22
“Visual inspection of comparison-adjusted funnel plots for NMA was used to assess publication bias [27].”
Method
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“(7 )”
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“The comparison-adjusted funnel plot was used for the presence of small-study effects (Chaimani and Salanti, 2012).”
Method
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Network meta-analysis reaches nutrition research
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Self-citation
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“An asymmetric ‘comparison-adjusted’ funnel plot may indicate the existence of small study effects (Chaimani and Salanti, 2012; Chaimani et al., 2013).”
Background
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“Publication bias was visually inspected with a funnel plot and Egger ’ s test [23] for the co-primary outcomes.”
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“Publication bias We will explore the association between study size and effect size with a comparison-adjusted funnel plot and with a contour enhanced funnel plot of all active drugs versus placebo (when at least 10 studies are available per outcome) [52].”
MethodSelf-citation
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“Publication bias was assessed by visual inspection of the funnel plot and Egger ’ s test [25].”
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Bonovas, S., Nikolopoulos, G. K., Piovani, D., González‐Lorenzo, M., Pantavou, K. G., Lytras, T., Peyrin‐Biroulet, L., & Danese, S. (2019) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.14051 · Cited by 19
“Small‐study effects or publication bias were examined with funnel graphs appropriately adjusted for inclusion of studies that compare different pairs of treatments.(19,20,31)”
Method
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“Examples of parameters to which randomeffects have been applied include: comparison-specific meta-regression slopes [34, 38, 41, 42, 50], comparisonspecific between-trial variances [39, 40], and studyspecific baseline-risks [34, 54].”
Method
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“…and the closer the value is to 100%, the better the efficacy of the intervention is indicated, with a value of P < 0.05,and P < 0.05 as the difference is significant, and finally a comparative corrective funnel was performed on the outcome indicators to test for small sample effects [22].”
Influential
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“If feasible, we will also employ the statistical model, suggested by Chaimani,[38] to explore the possible existence of small-study effects in the network.”
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Self-citation
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“…for the primary outcomes will be tested by analysing 1 only studies with low RoB (as reported in RoB section) 2 only studies with head to head comparison of two different CA ablation approaches excluding studies that have drugs as comparing arm 3 Only studies that include patients with non-PAF.”
MethodSelf-citation
Effectiveness of AI-assisted rehabilitation for musculoskeletal disorders: a network meta-analysis of pain, range of motion, and functional outcomes
Luo, Z., Wang, Y., Zhang, T., & Wang, J. (2025) · Frontiers in Bioengineering and Biotechnology · doi:10.3389/fbioe.2025.1660524 · Cited by 21
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Self-citation
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“The small-study effect and publication bias were judged using comparison-adjusted funnel plots [26] with Egger’s test [27].”
Method
Which Training Intensity Distribution Intervention will Produce the Greatest Improvements in Maximal Oxygen Uptake and Time-Trial Performance in Endurance Athletes? A Systematic Review and Network Meta-analysis of Individual Participant Data
Rosenblat, M. A., Watt, J. A., Arnold, J. I., Treff, G., Sandbakk, Ø. B., Esteve-Lanao, J., Festa, L., Filipas, L., Galloway, S. D. R., Muñoz‐Pérez, I., et al. (2025) · Sports Medicine · doi:10.1007/s40279-024-02149-3 · Cited by 25
“A comparison adjusted funnel plot was used to visually assess small study effects for the NMA [43].”
Cognitive-Behavioural Analysis System of Psychotherapy (CBASP), a drug, or their combination: differential therapeutics for persistent depressive disorder: a study protocol of an individual participant data network meta-analysis
Furukawa, T. A., Schramm, E., Weitz, E. S., Salanti, G., Efthimiou, O., Michalak, J., Watanabe, N., Cipriani, A., Keller, M. B., Kocsis, J. H., et al. (2016) · BMJ Open · doi:10.1136/bmjopen-2016-011769 · Cited by 16
“meta-analyses if more than 10 studies per treatment comparison are available,(48) and comparison-adjusted funnel plots for network meta-analyses.(49) If evidence of publication bias is found, we will incorporate this in the”
BackgroundSelf-citation
Multi-targeted tyrosine kinase inhibitors as third-line regimen in advanced non-small cell lung cancer: a network meta-analysis
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Authors: Chaimani, A., & Salanti, G.
Affiliations: University of Ioannina (GR)
Corresponding author: Salanti, Georgia
ORCID: Chaimani, Anna
Salanti, Georgia
Venue: Research Synthesis Methods
Publisher: Wiley
Published: 2012-06
Volume: 3
Issue: 2
Pages: 161-176
ISSN: 1759-2879 (ISSN-L)
1759-2887
DOI: 10.1002/jrsm.57
OpenAlex: W2121796373
Cited by: 521
References: 35
Citations by year: 2026: 59 · 2025: 48 · 2024: 55 · 2023: 59 · 2022: 50 · 2021: 60 · 2020: 58 · 2019: 37 · 2018: 28 · 2017: 29 · 2016: 17 · 2015: 4 · 2014: 8 · 2013: 7 · 2012: 2
FWCI: 8.03
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Research Synthesis Methods (publishedVersion)
PubMed (publishedVersion)
Funders: uropean Research Council (IMMA 260559)
Topics: Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
Keywords: small-study effects, publication bias, network meta-regression, network meta-analysis, funnel plot asymmetry

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Using network meta‐analysis to evaluate the existence of small‐study effects in a network of interventions

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