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Simultaneous comparison of multiple treatments: Combining direct and indirect evidence.
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A randomized comparison between rasburicase and allopurinol in children with lymphoma or
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“If multiple treatments are of interest and the evidence consists of different pairwise RCTs across the range of interventions, indirect treatment comparisons or network meta-analyses need to be performed (Caldwell et al., 2005; Higgins and Whitehead, 1996; Lu and Ades, 2004; Lumley, 2002).”
BackgroundMethodSmoking cessation interventions in COPD: a network meta-analysis of randomised trials
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Cost-effectiveness of psychological treatments for post-traumatic stress disorder in adults
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“Network meta-analysis using multivariate random-effects metaregression was used to compare the three treatment groups on the primary end point.(17,21) Separate pairwise random-effects metaanalyses of direct treatment comparisons only were also conducted to determine the effect of indirect evidence in the network-metaa…”
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“placebo (cognitive interventions comparison: physical exercise vs musical therapy vs computerized cognitive training vs nutrition therapy vs placebo) combining all the descriptive data from various studies.([34,35,38,42]) In the Bayesian framework, all parameters are treated as random variables.”
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Introducing the Treatment Hierarchy Question in Network Meta-Analysis
Salanti, G., Nikolakopoulou, A., Efthimiou, O., Mavridis, D., Egger, M., & White, I. R. (2021) · American Journal of Epidemiology · doi:10.1093/aje/kwab278 · Cited by 123
Topical therapies for the treatment of plaque psoriasis: systematic review and network meta-analyses
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Antiamoebic drugs for treating amoebic colitis
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“Even when the results of the direct evidence are conclusive, combining them with the results of indirect estimates in a mixed treat-ment comparison may yield more precise estimates as a greater evidence base is considered [8,10,12].”
Simulation and Matching-Based Approaches for Indirect Comparison of Treatments
Ishak, K. J., Proskorovsky, I., & Benedict, Á. (2015) · PharmacoEconomics · doi:10.1007/s40273-015-0271-1 · Cited by 110
“A range of other approaches are also available, relying on (Bayesian) hierarchical models [2–7] and incorporating data from studies with differing comparators, including head-to-head (i.”
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“Since such a trial is very unlikely to become available, a network meta-analysis or individual patient data metaanalysis can be very informative [15].”
Which Hemostatic Device in Thyroid Surgery? A Network Meta-Analysis of Surgical Technologies
Garas, G., Okabayashi, K., Ashrafian, H., Shetty, K., Palazzo, F. F., Tolley, N., Darzi, A. W., Athanasiou, T., & Zacharakis, E. D. (2013) · Thyroid · doi:10.1089/thy.2012.0588 · Cited by 108
“Through the sophisticated modeling that it employs (which includes Bayesian approaches and specialized software), network meta-analysis overcomes many of the limitations of traditional meta-analysis (5,8).”
Oral or transdermal opioids for osteoarthritis of the knee or hip
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“This results in a coherent set of relative effect estimates (11).”
Self-citationNikolakopoulou, A., Mavridis, D., Furukawa, T. A., Cipriani, A., Tricco, A. C., Straus, S. E., Siontis, G. C. M., Egger, M., & Salanti, G. (2018) · BMJ · doi:10.1136/bmj.k585 · Cited by 109
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Self-citationDressings and topical agents for treating pressure ulcers
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BackgroundSelf-citationIMPRoving Outcomes for children exposed to domestic ViolencE (IMPROVE): an evidence synthesis
Howarth, E., Moore, T. H., Welton, N. J., Lewis, N. V., Stanley, N., MacMillan, H. L., Shaw, A. R. G., Hester, M., Bryden, P. A., & Feder, G. S. (2016) · Public Health Research · doi:10.3310/phr04100 · Cited by 112
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“For instance, if there are reports comparing treatment A versus B and A versus C and we do not have a head to head comparison between B and C, then NMA can provide the relative efficacy of B and C by establishing A as a reference [38,39].”
BackgroundAntihypertensive treatment and risk of cancer: an individual participant data meta-analysis
Copland, E., Canoy, D., Nazarzadeh, M., Bidel, Z., Ramakrishnan, R., Woodward, M., Chalmers, J. P., Teo, K. K., Pepine, C. J., Davis, B. R., et al. (2021) · The Lancet Oncology · doi:10.1016/s1470-2045(21)00033-4 · Cited by 103
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Progestogens for preventing miscarriage: a network meta-analysis
Devall, A., Papadopoulou, A., Podesek, M., Haas, D. M., Price, M. J., Coomarasamy, A., & Gallos, I. D. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013792.pub2 · Cited by 111
“Caldwell 2005 Caldwell DM, Ades AE, Higgins JP. Simultaneous comparison of multiple treatments: combining direct and indirect evidence.”
BackgroundTwenty years of network meta‐analysis: Continuing controversies and recent developments
Ades, A. E., Welton, N. J., Dias, S., Phillippo, D., & Caldwell, D. M. (2024) · Research Synthesis Methods · doi:10.1002/jrsm.1700 · Cited by 115
“183,184 The way estimates are derived from NRS has received little attention in the synthesis literature (Supplement Note 8).”
InfluentialSelf-citationMeta-analyses: what they can and cannot do
Nordmann, A. J., Kasenda, B., & Briel, M. (2012) · Swiss Medical Weekly · doi:10.4414/smw.2012.13518 · Cited by 102
Evidence Synthesis for Decision Making 7
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“Models were run using 10 000 burn-in iterations followed by 10 000 sampling iterations [29].”
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A Bayesian network meta-analysis for binary outcome: how to do it
Greco, T., Landoni, G., Biondi‐Zoccai, G., D’Ascenzo, F., & Zangrillo, A. (2013) · Statistical Methods in Medical Research · doi:10.1177/0962280213500185 · Cited by 96
“A network where some pairwise contrasts have both direct and indirect evidence can be analysed performing an MTC analysis.(6,8) Actually, all connected networks can be examined using NMA, as even pairwise meta-analysis is only a special case of NMA, and can be analysed using the exact same model.”
BackgroundResultAbsolute or relative effects? Arm‐based synthesis of trial data
Dias, S., & Ades, A. E. (2015) · Research Synthesis Methods · doi:10.1002/jrsm.1184 · Cited by 94
“…to the standard model for pair-wise meta-analysis (Higgins and Green, 2008), extended to NMA (Higgins and Green, 2008, Dias et al., 2013a, Lu and Ades, 2004, Cooper et al., 2009, Lu and Ades, 2006, Caldwell et al., 2005), (b) “Contrast-Based plus Baseline” (CB + Baseline), and (c) “Arm Based” (AB).”
BackgroundMethodSelf-citationBuckley, F., Finckh, A., Huizinga, T. W. J., Dejonckheere, F., & Jansen, J. P. (2015) · Journal of Managed Care & Specialty Pharmacy · doi:10.18553/jmcp.2015.21.5.409 · Cited by 97
“To synthesize the results of the included studies, Bayesian network meta-analysis models were used.(13,14,18,19) For the analysis, we grouped the different aTNFs.”
MethodCharacteristics and knowledge synthesis approach for 456 network meta-analyses: a scoping review
Zarin, W., Veroniki, A. A., Nincic, V., Vafaei, A., Reynen, E., Motiwala, S. S., Antony, J., Sullivan, S. M., Rios, P. D. L., Daly, C., et al. (2017) · BMC Medicine · doi:10.1186/s12916-016-0764-6 · Cited by 98
“on previously described NMA approaches (n = 76, 17%) [9], and a paper on a statistical approach to generate indirect evidence as an extension to pairwise meta-analysis (n = 71, 16%; Additional file 1: Appendix 5) [7].”
BackgroundMethodA Framework for Addressing Structural Uncertainty in Decision Models
Jackson, C. H., Bojke, L., Thompson, S. G., Claxton, K., & Sharples, L. D. (2011) · Medical Decision Making · doi:10.1177/0272989x11406986 · Cited by 97
Multiple treatment comparisons in epilepsy monotherapy trials
Smith, C. T., Marson, A. G., Chadwick, D. W., & Williamson, P. R. (2007) · Trials · doi:10.1186/1745-6215-8-34 · Cited by 96
“Comparing multiple treatments should be considered as the bedrock for decisions when several treatments are available [18].”
BackgroundInfluentialHopkins, R. B., Goeree, R. A., Pullenayegum, E., Adachi, J. D., Παπαϊωάννου, Α., Xie, F., & Thabane, L. (2011) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-12-209 · Cited by 95
“A number of steps were taken to assess the integrity of the ITC analysis [10,17-20].”
Multiple treatment and indirect treatment comparisons: An overview of network meta-analysis
Bhatnagar, N., Lakshmi, P. V. M., & Jeyashree, K. (2014) · Perspectives in Clinical Research · doi:10.4103/2229-3485.140550 · Cited by 97
“Network meta-analysis (NMA) are studies that combine results from more than two RCTs connecting more than or equal to three interventions.[7] Scientifi c literature is witnessing an increasing number of studies using indirect comparison of interventions.”
MethodZeng, C., Li, H., Yang, T., Deng, Z., Yang, Y., Zhang, Y., Ding, X., & Lei, G. (2014) · Osteoarthritis and Cartilage · doi:10.1016/j.joca.2014.06.028 · Cited by 99
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Bozzini, G., Verze, P., Arcaniolo, D., Dalpiaz, O., Buffi, N. M., Guazzoni, G. F., Provenzano, M., Osmolorskij, B., Sanguedolce, F., Montanari, E., et al. (2017) · World Journal of Urology · doi:10.1007/s00345-017-2084-7 · Cited by 95
“Firstly, a cost-efficacy comparison can differ greatly between hospitals and there is a considerable variation in the practice patterns of urologist as confirmed by several studies [31, 32].”
BackgroundPedder, H., Dias, S., Bennetts, M., Boucher, M., & Welton, N. J. (2019) · Research Synthesis Methods · doi:10.1002/jrsm.1351 · Cited by 95
“d2;1;k e D2;class; τ(2)class for k ∈ class f g: (10)”
Evidence synthesis as the key to more coherent and efficient research
Sutton, A. J., Cooper, N. J., & Jones, D. R. (2009) · BMC Medical Research Methodology · doi:10.1186/1471-2288-9-29 · Cited by 95
Indirect comparisons: the mesh and mess of clinical trials
Ioannidis, J. P. A. (2006) · The Lancet · doi:10.1016/s0140-6736(06)69615-3 · Cited by 94
Network meta‐analysis of individual and aggregate level data
Jansen, J. P. (2012) · Research Synthesis Methods · doi:10.1002/jrsm.1048 · Cited by 94
“…can be synthesized by means of a network meta-analysis if each trial has at least one intervention in common with another trial (Bucher et al., 1997; Lumley, 2002; Ades, 2003; Lu and Ades, 2004; Caldwell et al., 2005; Salanti et al., 2008, 2010; Hoaglin et al., 2011; Jansen et al., 2011).”
MethodMcCartney, M., Nevitt, S., Lloyd, A., Hill, R., White, R., & Duarte, R. (2021) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13242 · Cited by 93
Palmer, S. C., Tunnicliffe, D. J., Singh‐Grewal, D., Mavridis, D., Tonelli, M. A., Johnson, D. W., Craig, J. C., Tong, A., & Strippoli, G. F. (2017) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2016.12.008 · Cited by 94
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“In addition, in the absence of strong direct evidence, indirect comparisons would yield inconclusive results (Caldwell et al., 2005).”
Jansen, J. P., & Cope, S. F. (2012) · BMC Medical Research Methodology · doi:10.1186/1471-2288-12-152 · Cited by 94
“Even when direct evidence is available, combining consistent direct and indirect estimates will result in more precise treatment effect estimates [2-6].”
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“Statistical techniques have been developed to establish the relative efficacies of different treatment strategies even when these treatments have not been directly compared.(1,2) The so-called”
Choice of implant combinations in total hip replacement: systematic review and network meta-analysis
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Self-citationEffects of light emitting diode lights on plant growth, development and traits a meta-analysis
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How Valuable are Multiple Treatment Comparison Methods in Evidence-Based Health-Care Evaluation?
Cooper, N. J., Peters, J., Lai, M. C. W., Jüni, P., Wandel, S., Palmer, S., Paulden, M., Conti, S., Welton, N. J., Abrams, K. R., et al. (2011) · Value in Health · doi:10.1016/j.jval.2010.09.001 · Cited by 90
“[4] Caldwell DM, Ades AE, Higgins JPT.”
Misoprostol for medical treatment of missed abortion: a systematic review and network meta-analysis
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“Network meta-analyses (also called multiple or mixed treatment comparison meta-analyses, or MTCs) permit the evaluation of the comparative effectiveness of multiple interventions even when some pairs have not been directly compared and can potentially reduce uncertainty in treatment effect estimates [9, 10].”
MethodNetwork Meta-Analysis with Competing Risk Outcomes
Ades, A. E., Mavranezouli, I., Dias, S., Welton, N. J., Whittington, C. J., & Kendall, T. (2010) · Value in Health · doi:10.1111/j.1524-4733.2010.00784.x · Cited by 86
Self-citationEffects of Antidiabetic Drugs on Muscle Mass in Type 2 Diabetes Mellitus
Ida, S., Kaneko, R., Imataka, K., Okubo, K., Shirakura, Y., Azuma, K., Fujiwara, R., & Murata, K. (2021) · Current Diabetes Reviews · doi:10.2174/1573399816666200705210006 · Cited by 85
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“Network meta-analysis [4, 5], which takes advantage of both direct and indirect comparisons, is therefore needed to determine reliably which is the optimal treatment(s), and so to inform patients, clinicians and policy makers.”
BackgroundSheng, M., Wang, F., Zhao, Y., Li, S., Wang, X., Shou, T., Luo, Y., & Tang, W. (2015) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-015-1966-0 · Cited by 85
“In the Bayesian framework, it incorporated both direct and indirect evidence to obtain estimate of the relative treatment effects between all the comparisons [18].”
MethodLinear inference for mixed treatment comparison meta‐analysis: a two‐stage approach
Lu, G., Welton, N. J., Higgins, J. P. T., White, I. R., & Ades, A. E. (2012) · Research Synthesis Methods · doi:10.1002/jrsm.1059 · Cited by 85
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“…network of comparisons: mixed treatment comparison (MTC) synthesis, which is also known as network meta-analysis or multipletreatment meta-analysis (Ades, 2003; Caldwell et al., 2005; Gleser and Olkin, 1994, 2000; Higgins and Whitehead, 1996; Lu and Ades, 2004; Lumley, 2002; Salanti et al., 2008).”
BackgroundSelf-citationWeng, Q., Goh, S.-L., Wu, J., Persson, M. S. M., Wei, J., Sarmanova, A., Li, X., Hall, M., Doherty, M., Jiang, T., et al. (2023) · British Journal of Sports Medicine · doi:10.1136/bjsports-2022-105898 · Cited by 84
“34 35 The Markov Chain Monte Carlo method was used to estimate posterior densities for unknown variables.”
Jordan, R. E., Majothi, S., Heneghan, N. R., Blissett, D. B., Riley, R. D., Sitch, A. J., Price, M. J., Bates, E. J., Turner, A. M., Bayliss, S. E., et al. (2015) · Health Technology Assessment · doi:10.3310/hta19360 · Cited by 84
“In particular, the large heterogeneity in follow-up time, the included patient population and the study design suggested that the consistency assumption required was unlikely to be sensible.(107) Therefore, no mixed-treatment comparisons were explored.”
ResultThe ISPOR Good Practices for Quality Improvement of Cost-Effectiveness Research Task Force Report
McGhan, W. F., Al, M., Doshi, J. A., Kamae, I., Marx, S. E., & Rindress, D. (2009) · Value in Health · doi:10.1111/j.1524-4733.2009.00605.x · Cited by 86
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How to Conduct a Bayesian Network Meta-Analysis
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“The transitivity assumption is that studies can be combined only when they are clinically and methodologically similar (41, 42).”
BackgroundTai, C., Gan, T., Zou, L., Sun, Y., Zhang, Y., Chen, W., Li, J., Zhang, J., Xu, Y., Lu, H.-H., et al. (2017) · BMC Cardiovascular Disorders · doi:10.1186/s12872-017-0686-z · Cited by 88
“Overall effect was estimated using the Mantel-Haenszel method for RRs [20, 21].”
MethodRuyssen‐Witrand, A., Perry, R., Watkins, C. J., Braileanu, G., Kumar, G., Kiri, S., Nott, D., Liu-Léage, S., Hartz, S., & Sapin, C. (2020) · RMD Open · doi:10.1136/rmdopen-2019-001117 · Cited by 83
Faggion, C. M., Chambrone, L., Listl, S., & Tu, Y. (2011) · Clinical Implant Dentistry and Related Research · doi:10.1111/j.1708-8208.2011.00384.x · Cited by 83
Liu, J., Dong, J., Wang, L., Su, Y., Yan, P., & Sun, S. (2013) · PLoS ONE · doi:10.1371/journal.pone.0076651 · Cited by 83
“treatments have not been directly compared [7].”
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'Third wave' cognitive and behavioural therapies versus treatment as usual for depression
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“Finally, a third analysis was performed to conduct a NMA comparing the effects of all forms of cognitive and/or behavioral therapies in tinnitus, as this allowed us to compare the direct and indirect relationships between therapies (23).”
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“3 (MRC Biostatistics Unit, Cambridge, United Kingdom).(13) The mixed treatment comparison or network analysis allows for comparisons of devices not directly addressed within any of the individual trials by incorporating the indirect comparisons constructed from 2 trials that have 1 stent type in common (such as compar…”
MethodWang, H., Huang, T.-J., Jing, J., Jin, J., Wang, P., Yang, M., Cui, W., Zheng, Y., & Shen, H. (2010) · Journal of Hospital Infection · doi:10.1016/j.jhin.2010.04.025 · Cited by 81
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“By borrowing strength from indirect evidence to gain certainty about all treatment comparisons, network metaanalysis allows comparative effects that have not been investigated directly in randomized clinical trials to be estimated and ranked [23, 24].”
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The attractiveness of network meta-analysis: a comprehensive systematic and narrative review.
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Owen, R. K., Tincello, D. G., & Keith, R. A. (2015) · Value in Health · doi:10.1016/j.jval.2014.10.006 · Cited by 80
“[3] Caldwell DM, Ades AE, Higgins JPT.”
Percutaneous Coronary Interventions for the Treatment of Stenoses in Small Coronary Arteries
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“0 60 8; 62 8 39 (65) 37 (62) 24 (40); 21 (35) 5 (8); 7 (12) 24 (40); 27 (45) 9 (15); 6 (10) 49 (82); 48 (80)”
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“Background The validity of results from network meta-analysis depends on the plausibility of the transitivity assumption; that is the comparability of studies informing the treatment comparisons with respect to the distribution of effect modifiers [1-3].”
BackgroundSelf-citationAn overview of conducting systematic reviews with network meta-analysis
Caldwell, D. M. (2014) · Systematic Reviews · doi:10.1186/2046-4053-3-109 · Cited by 79
“NMA is the simultaneous comparison of multiple competing treatments in a single statistical model [23].”
BackgroundSelf-citationIndirect comparisons of treatments based on systematic reviews of randomised controlled trials
Edwards, S. J., Clarke, M. J., Wordsworth, S., & Borrill, J. (2009) · International Journal of Clinical Practice · doi:10.1111/j.1742-1241.2009.02072.x · Cited by 78
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Metadata
- Authors
- Caldwell, D. M., Ades, A. E., & Higgins, J. P. T.
- Affiliations
- University of Bristol (GB)
- MRC Biostatistics Unit (GB)
- Corresponding author
- Caldwell, Deborah M
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2005-10-13
- Volume
- 331
- Issue
- 7521
- Pages
- 897-900
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC1255806
- OpenAlex
- W1967385770
- Cited by
- 1,600
- References
- 37
- Citations by year
- 2026: 53 · 2025: 63 · 2024: 72 · 2023: 67 · 2022: 91 · 2021: 105 · 2020: 136 · 2019: 115 · 2018: 115 · 2017: 108 · 2016: 95 · 2015: 107 · 2014: 101 · 2013: 79 · 2012: 80
- FWCI
- 16.23
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Explore Bristol Research (submittedVersion)
- Topics
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Clinical Trials
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Health Sciences › Medicine › Hematology › Methemoglobinemia and Tumor Lysis Syndrome
- Keywords
- rasburicase, allopurinol, hyperuricemia, lymphoma, pediatric oncology, direct and indirect evidence, treatment comparison
- MeSH terms
- Data Interpretation, Statistical, Decision Making, Humans, Meta-Analysis as Topic, Bias, Randomized Controlled Trials as Topic, Evidence-Based Medicine
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