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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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“network meta-analysis offers a methodological solution to provide more precise pooled head-to-head effect estimates than may otherwise be achieved 19, 20 .”
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Thorlund, K., Druyts, E., Mills, E. J., Fedorak, R. N., & Marshall, J. K. (2014) · Journal of Crohn s and Colitis · doi:10.1016/j.crohns.2014.01.010 · Cited by 77
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“22–24 Considerable research focused on methodological issues of NMA has been published in recent years; however, a limited number of simulation studies have been conducted.”
Issues in performing a network meta-analysis
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“An increasing volume of applied work is now being produced, some based on frequentist methods (Lumley, 2002), or more often on Bayesian Markov chain Monte Carlo (Caldwell et al., 2005; Lu and Ades, 2004, 2006).”
BackgroundMethodSelf-citationChambers, D., Paulden, M., Paton, F., Heirs, M. K., Duffy, S., Craig, D., Hunter, J. M., Wilson, J. T., Sculpher, M. J., & Woolacott, N. F. (2010) · Health Technology Assessment · doi:10.3310/hta14390 · Cited by 76
A selection model for accounting for publication bias in a full network meta‐analysis
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“NMA uses a single statistical model to combine both the direct and indirect evidence within a network to estimate intervention effects for every treatment combination, regardless of whether two interventions have been directly compared or not [4].”
MethodNaci, H., Brugts, J. J., Fleurence, R., & Ades, A. E. (2013) · European Journal of Preventive Cardiology · doi:10.1177/2047487313483600 · Cited by 74
“To determine the comparative effects of statins at different doses, we conducted network meta-analyses, which are generalizations of indirect comparisons with more than two (or multiple pairs of) treatments being compared indirectly and at least one pair of treatments compared both directly and indirectly.(13,14) This…”
MethodSelf-citationZheng, Q., Yang, H., Sun, L., Wei, R., Fu, X., Wang, Y., Huang, Y., Liu, Y., & Liu, W. J. (2020) · Pharmacological Research · doi:10.1016/j.phrs.2020.105020 · Cited by 77
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Cost-effectiveness of adjunct non-pharmacological interventions for osteoarthritis of the knee
Woods, B. S., Manca, A., Weatherly, H. L. A., Saramago, P., Sideris, E., Giannopoulou, C., Rice, S. J. C., Corbett, M. S., Vickers, A. J., Bowes, M., et al. (2017) · PLoS ONE · doi:10.1371/journal.pone.0172749 · Cited by 74
Abrahão, A. B. K., Ko, Y., Berry, S. R., & Chan, K. (2017) · Clinical Colorectal Cancer · doi:10.1016/j.clcc.2017.10.016 · Cited by 73
Phillippo, D., Dias, S., Welton, N. J., Caldwell, D. M., Taske, N., & Ades, A. E. (2019) · Annals of Internal Medicine · doi:10.7326/m18-3542 · Cited by 71
“Typically, such analyses are performed using Network Meta-Analysis (NMA), which provides a consistent set of treatment effect estimates so that coherent recommendations may be made (1-3).”
Self-citationMethods for managing miscarriage: a network meta-analysis
Ghosh, J., Papadopoulou, A., Devall, A., Jeffery, H. C., Beeson, L. E., Do, V., Price, M. J., Tobı́as, A., Tunçalp, Ö., Lavelanet, A. F., et al. (2021) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012602.pub2 · Cited by 74
Initial Oxygen Concentration for the Resuscitation of Infants Born at Less Than 32 Weeks’ Gestation
Sotiropoulos, J. X., Oei, J. L., Schmölzer, G. M., Libesman, S., Hunter, K. E., Williams, J. G., Webster, A. C., Vento, M., Kapadia, V., Rabi, Y., et al. (2024) · Archives of Pediatrics and Adolescent Medicine · doi:10.1001/jamapediatrics.2024.1848 · Cited by 75
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Perfect Study, Poor Evidence: Interpretation of Biases Preceding Study Design
Ioannidis, J. P. A. (2008) · Seminars in Hematology · doi:10.1053/j.seminhematol.2008.04.010 · Cited by 72
Antiamoebic drugs for treating amoebic colitis
Gonzales, M. L. M., Dans, L. F., & Sio-Aguilar, J. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006085.pub3 · Cited by 72
“…as a network meta-analysis, may be conducted in the future to incorporate information from a combination of all relevant direct and indirect treatment comparisons and to generate a ranking scheme of different drugs according to best treatment outcomes (Caldwell 2005; Catalla-Lopez 2014).”
BackgroundRégnier, S. A., Malcolm, W., Allen, F., Wright, J., & Bezlyak, V. (2014) · PLoS ONE · doi:10.1371/journal.pone.0102309 · Cited by 71
“This analysis compares the reported efficacy of laser photocoagulation therapy, ranibizumab IVT injection, ranibizumab IVT injection plus laser, aflibercept IVT injection and sham injections plus rescue laser therapy, within a network meta-analysis framework [37].”
MethodAchana, F. A., Cooper, N. J., Bujkiewicz, S., Hubbard, S., Kendrick, D., Jones, D. R., & Sutton, A. J. (2014) · BMC Medical Research Methodology · doi:10.1186/1471-2288-14-92 · Cited by 70
“NMA methods extend standard pairwise meta-analysis to enable simultaneous comparison of multiple treatments while maintaining randomisation of individual studies [18].”
BackgroundMethodInfluentialAimo, A., Pateras, K., Stamatelopoulos, K. S., Bayés‐Genís, A., Lombardi, C., Passino, C., Emdin, M., & Georgiopoulos, G. A. (2020) · Cardiovascular Drugs and Therapy · doi:10.1007/s10557-020-07099-2 · Cited by 72
Tocolytics for delaying preterm birth: a network meta-analysis (0924)
Wilson, A., Morton, V. H., Marson, E. J., Markland, A. D., Larkai, E., Papadopoulou, A., Coomarasamy, A., Tobı́as, A., Chou, D., Oladapo, O. T., et al. (2022) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd014978.pub2 · Cited by 74
den Bruel, A. V., Gailly, J., Devriese, S., Welton, N. J., Shortt, A. J., & Vrijens, F. (2009) · British Journal of Ophthalmology · doi:10.1136/bjo.2009.158360 · Cited by 69
“When the number of treatment options becomes large, a classic meta-analysis on all observed head to head comparisons has some drawbacks. First, with a large number of treatments, not all treatments are compared head to head, resulting in blanks in the evidence matrix. Second, this approach does not take all informatio…”
BackgroundNagayama, A., Hayashida, T., Jinno, H., Takahashi, M., Seki, T., Matsumoto, A., Murata, T., Ashrafian, H., Athanasiou, T., Okabayashi, K., et al. (2014) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/dju203 · Cited by 69
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“This latter point is of particular interest, especially in situations where there is little direct and a large amount of indirect evidence, such as the comparison of induction chemotherapy and concurrent chemotherapy inHNCs [11,31].”
BackgroundSystematic review and network meta-analysis of resective surgery for mesial temporal lobe epilepsy
Jain, P., TOMLINSON, G. A., Snead, C., Sander, B., & Widjaja, E. (2018) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp-2017-317783 · Cited by 68
“There were no significant differences between direct and indirect comparisons for the three pairwise comparisons (ATL vs SAH, ATL vs MM, and SAH vs MM) (all p>0.05) (figure 6).”
BackgroundInfluentialDatta, N. R., Stutz, E., Gómez, S., & Bodis, S. B. (2018) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/j.ijrobp.2018.09.037 · Cited by 68
Obesity in pregnancy: outcomes and economics
Rowlands, I. J., Graves, N., de Jersey, S., McIntyre, D. H., & Callaway, L. K. (2009) · Seminars in Fetal and Neonatal Medicine · doi:10.1016/j.siny.2009.09.003 · Cited by 67
Bash, L. D., Buono, J. L., Davies, G., Martin, A., Fahrbach, K. R., Phatak, H. M., Avetisyan, R., & Mwamburi, M. (2012) · Cardiovascular Drugs and Therapy · doi:10.1007/s10557-012-6374-4 · Cited by 66
“This analysis used Bayesian mixed-treatment comparison (MTC) methods to quantify the relative effectiveness of treatment modalities that have not yet been directly compared in head-to-head trials [32].”
MethodNo role for initial severity on the efficacy of antidepressants: results of a multi-meta-analysis
Fountoulakis, K. Ν., Veroniki, A. A., Siamouli, M., & Möller, H. (2013) · Annals of General Psychiatry · doi:10.1186/1744-859x-12-26 · Cited by 67
“All approaches have been undertaken under the RE model [28-30], so as to account for between-study heterogeneity due to the differences in the true effect sizes, rather than chance.”
Evidence for analgesic effect in acute pain – 50 years on
McQuay, H. J., Derry, S., Eccleston, C., Wiffen, P. J., & Moore, A. R. (2012) · Pain · doi:10.1016/j.pain.2012.01.024 · Cited by 66
“One further methodological step would be to use network meta-analysis to confirm the assessment of relative efficacy in the overview, and to further explore methodological issues in this highly standardised and homogeneous data set [4,20].”
Choy, E., Marshall, D. A. S., Gabriel, Z., Mitchell, S., Gylee, E., & Dakin, H. (2011) · Seminars in Arthritis and Rheumatism · doi:10.1016/j.semarthrit.2011.06.003 · Cited by 66
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“To synthesize the results of the included studies, Bayesian network meta-analysis models were used [29-32].”
MethodAntibiotic treatment of metritis in dairy cows—A meta-analysis
Haimerl, P., Arlt, S., Borchardt, S., & Heuwieser, W. (2017) · Journal of Dairy Science · doi:10.3168/jds.2016-11834 · Cited by 64
Scott, D. A., Boye, K. S., Timlin, L., Clark, J. F., & Best, J. H. (2012) · Diabetes Obesity and Metabolism · doi:10.1111/dom.12007 · Cited by 65
Giovane, C. D., Vacchi, L., Mavridis, D., Filippini, G., & Salanti, G. (2012) · Statistics in Medicine · doi:10.1002/sim.5512 · Cited by 65
Direct versus indirect comparisons: A summary of the evidence
Gartlehner, G., & Moore, C. G. (2008) · International Journal of Technology Assessment in Health Care · doi:10.1017/s0266462308080240 · Cited by 66
“More complex methods, such as network meta-analysis (23) or Bayesian methods (6;22), were not evaluated by Glenny and colleagues (13).”
BackgroundMethodAchana, F. A., Cooper, N. J., Dias, S., Lu, G., Rice, S. J. C., Kendrick, D., & Sutton, A. J. (2012) · Statistics in Medicine · doi:10.1002/sim.5539 · Cited by 65
“The fundamental assumption underlying random-effects NMA is that the treatments effects are exchangeable across the entire network of trials regardless of whether or not treatments b and k are included in trial i [22, 24].”
BackgroundDirected acyclic graphs can help understand bias in indirect and mixed treatment comparisons
Jansen, J. P., Schmid, C. H., & Salanti, G. (2012) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2012.01.002 · Cited by 62
Zhao, J., Wang, J., Meng, X.-H., Zeng, X., & Kan, S. (2017) · PLoS ONE · doi:10.1371/journal.pone.0173634 · Cited by 66
Goudie, A. C., Sutton, A. J., Jones, D. R., & Donald, A. (2010) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.01.022 · Cited by 63
“A mixed treatment comparison meta-analysis [14] would facilitate simultaneous comparisons among the four diet types and allow for the differences in treatments given in the trials combined in the meta-analysis and allow the inclusion of all four arms of the new trial.”
MethodComparative efficacy of long-acting bronchodilators for COPD - a network meta-analysis
Cope, S. F., Donohue, J. F., Jansen, J. P., Kraemer, M., Capkun-Niggli, G., Baldwin, M., Buckley, F., Ellis, A. G., & Jones, P. (2013) · Respiratory Research · doi:10.1186/1465-9921-14-100 · Cited by 63
“Network meta-analysis Bayesian network meta-analysis (NMA) models were used [15-18] to simultaneously synthesize the results of the included studies for each outcome of interest.”
MethodCohen, D., Raffin, M., Canitano, R., Bodeau, N., Bonnot, O., Périsse, D., Consoli, A., & Laurent‐Levinson, C. (2012) · Research in Autism · doi:10.1016/j.rasd.2012.08.001 · Cited by 64
Rice, D., Corace, K., Wolfe, D., Esmaeilisaraji, L., Michaud, A., Grima, A., Austin, B., Douma, R., Barbeau, P., Butler, C., et al. (2020) · PLOS ONE · doi:10.1371/journal.pone.0244401 · Cited by 64
“Studies using control groups of either OAT-only or ‘standard medical management’ were eligible, as they were expected sources of indirect evidence [28] for NMAs.”
MethodResearch strategies to discern active psychological therapy components: A scoping review
Leijten, P., Weisz, J. R., & Gardner, F. (2021) · Clinical Psychological Science · doi:10.1177/2167702620978615 · Cited by 55
“…2019) can be extended to identify combinations of therapy components that yield the strongest effects, using, for example, network meta-analysis (Caldwell et al., 2005; Pompoli et al., 2018), qualitative comparative analysis (Rihoux & Ragin, 2009; Thongseiratch et al., 2020), or meta-analytic…”
Naci, H., Dias, S., & Ades, A. E. (2014) · BMJ · doi:10.1136/bmj.g5741 · Cited by 61
Brown, T. J., Pilkington, G., Bagust, A., Boland, A., Oyee, J., Smith, C. T., Blundell, M., Lai, M., Saborido, C. M., Greenhalgh, J., et al. (2013) · Health Technology Assessment · doi:10.3310/hta17310 · Cited by 64
Uterotonic agents for first-line treatment of postpartum haemorrhage: a network meta-analysis
Parry‐Smith, W., Papadopoulou, A., Thomas, E., Tobı́as, A., Price, M. J., Meher, S., Alfirević, Ž., Weeks, A. D., Hofmeyr, G. J., Gülmezoglu, A. M., et al. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012754.pub2 · Cited by 66
Quilici, S., Abrams, K. R., Nicolas, A., Martin, M., Petit, C., Lleu, P.-L., & Finnern, H. W. (2008) · Sleep Medicine · doi:10.1016/j.sleep.2007.11.020 · Cited by 63
“Indirect comparison Due to the absence of comparative trials for pramipexole and ropinirole in the treatment of RLS, an indirect meta-analysis using placebo as the common comparator was performed using a Bayesian meta-analysis approach [16,17] (see Technical Appendix (B & D) for model details and WinBUGS code).”
MethodVergel, Y. B., Hawkins, N., Claxton, K., Asseburg, C., Palmer, S., Woolacott, N. F., Bruce, I. N., & Sculpher, M. J. (2007) · Lara D. Veeken · doi:10.1093/rheumatology/kem221 · Cited by 62
Mease, P. J., McInnes, I. B., Tam, L., Eaton, K., Peterson, S., Schubert, A., Chakravarty, S. D., Parackal, A., Karyekar, C. S., Nair, S. C., et al. (2021) · Rheumatology · doi:10.1093/rheumatology/keab119 · Cited by 63
Immunoenhancing Enteral and Parenteral Nutrition for Gastrointestinal Surgery
Mazaki, T., Ishii, Y., & Murai, I. (2014) · Annals of Surgery · doi:10.1097/sla.0000000000000935 · Cited by 61
Guo, L., Wang, W., Zhao, N., Guo, L., Chi, C., Hou, W., Wu, A., Tong, H., Wang, Y., Wang, C., et al. (2016) · Critical Care · doi:10.1186/s13054-016-1396-0 · Cited by 68
“Additionally, network meta-analysis has the potential to reduce the uncertainty in treatment effect estimates [9, 10].”
BackgroundRicci, C., Casadei, R., Taffurelli, G., Pacilio, C. A., Ricciardiello, M., & Minni, F. (2017) · World Journal of Surgery · doi:10.1007/s00268-017-4180-7 · Cited by 63
“Briefly, frequentist network meta-analysis was used to compare all available surgical approaches for performing PD, generating a network for each endpoint [18].”
MethodHuang, W., Wang, L., Zhang, B., Zhou, L., Zhang, T., & Quan, C. (2019) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2019.08.009 · Cited by 60
Lu, Z., Sun, Y., Zhang, Y., Chen, Y., Guo, L., Liao, Y., Kang, Z., Feng, X., & Yue, W. (2022) · Translational Psychiatry · doi:10.1038/s41398-022-02027-4 · Cited by 60
“Because there were some head-to-head RCTs which compared different dosage of ARI and switching to different antipsychotics, so we conducted the NMA included 12 options (adjunctive 5 mg ARI, adjunctive 10 mg ARI, adjunctive more than 10mg ARI, switch_ARI_fixed_im, switch_ARI_fixed_ta, switch_ARI_ti_ta, switching to OLA…”
MethodInfluentialEvidence‐Based Surgery: Barriers, Solutions, and the Role of Evidence Synthesis
Garas, G., Ibrahim, A., Ashrafian, H., Ahmed, K., Patel, V., Okabayashi, K., Skapinakis, P., Darzi, A. W., & Athanasiou, T. (2012) · World Journal of Surgery · doi:10.1007/s00268-012-1597-x · Cited by 61
“In this way, network meta-analysis overcomes many of the barriers of conventional metaanalysis [19, 24].”
BackgroundMethodMultiparameter evidence synthesis in epidemiology and medical decision-making
Ades, A. E., Welton, N. J., Caldwell, D. M., Price, M. J., Goubar, A., & Lu, G. (2008) · Journal of Health Services Research & Policy · doi:10.1258/jhsrp.2008.008020 · Cited by 59
Self-citationSoares, M. O., Bojke, L., Dumville, J. C., Iglesias, C. P., Cullum, N. A., & Claxton, K. (2011) · Statistics in Medicine · doi:10.1002/sim.4288 · Cited by 60
“Moreover, the results regarding the synthesis of existing evidence (the IMTC) used to generate existing evidence were not available to the public.”
MethodWelton, N. J., Cooper, N. J., Ades, A. E., Lu, G., & Sutton, A. J. (2008) · Statistics in Medicine · doi:10.1002/sim.3377 · Cited by 60
Self-citationEfthimiou, O., Mavridis, D., Cipriani, A., Leucht, S., Bagos, P. G., & Salanti, G. (2014) · Statistics in Medicine · doi:10.1002/sim.6117 · Cited by 59
Dressings and topical agents for treating venous leg ulcers
Norman, G., Dumville, J. C., Westby, M. J., Stubbs, N. C., & Soares, M. O. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd012583 · Cited by 62
Comparing new treatments for idiopathic pulmonary fibrosis – a network meta-analysis
Loveman, E., Copley, V. R., Scott, D. A., Colquitt, J. L., Clegg, A. J., & O’Reilly, K. M. (2015) · BMC Pulmonary Medicine · doi:10.1186/s12890-015-0034-y · Cited by 59
“We synthesised data in a narrative review and a Bayesian NMA [14,15].”
MethodHao, C.-P., Cao, N., Zhu, Y., & Wang, W. (2021) · Scientific Reports · doi:10.1038/s41598-021-93307-4 · Cited by 64
Meader, N. (2010) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2009.12.008 · Cited by 59
Meulenkamp, B., Woolnough, T., Cheng, W., Shorr, R., Stacey, D., Richards, M., Gupta, A. A., Fergusson, D. A., & Graham, I. D. (2021) · Clinical Orthopaedics and Related Research · doi:10.1097/corr.0000000000001861 · Cited by 59
Sun, F., Yu, K., Yang, Z., Wu, S., Zhang, Y., Shi, L., Ji, L., & Zhan, S. (2012) · Experimental Diabetes Research · doi:10.1155/2012/230624 · Cited by 58
“Second, because the MTC meta-analysis complements traditional meta-analysis and systematic reviews, faced with multiple treatment options, allows dissection of the individual drug to evaluate GI AEs, especially faced with that very few RCTs have directly compared competing different dosing of GLP-1s in T2DM, we applie…”
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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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