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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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Yokoe, T., Hayashida, T., Nagayama, A., Nakashoji, A., Maeda, H., Seki, T., Takahashi, M., Takano, T., Abe, T., & Kitagawa, Y. (2018) · The Oncologist · doi:10.1634/theoncologist.2018-0140 · Cited by 57
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MethodComparative efficacy and safety of lipid-lowering agents in patients with hypercholesterolemia
Zhao, Z., Du, S., Shen, S., Luo, P., Ding, S., Wang, G., & Wang, L. (2019) · Medicine · doi:10.1097/md.0000000000014400 · Cited by 55
“The recommended tool for assessing the risk of bias in the Cochrane Collaboration guidelines was utilized to assess the quality of the eligible studies.([23])”
MethodThe number needed to treat in pairwise and network meta-analysis and its graphical representation
Veroniki, A. A., Bender, R., Glasziou, P., Straus, S. E., & Tricco, A. C. (2019) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2019.03.007 · Cited by 52
“NMA combi nes the results of trials that 54 undertake different treatment comparisons [18-20] a nd is being conducted with increasing 55 frequency in the healthcare literature [21, 22].”
BackgroundChen, Y., Li, X., Pan, B., Wang, B., Jing, G., Liu, Q., Li, Y., Bing, Z., Yang, K., Han, X., et al. (2019) · Aging & Mental Health · doi:10.1080/13607863.2019.1704219 · Cited by 57
Extending Treatment Networks in Health Technology Assessment: How Far Should We Go?
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“[17] Caldwell DM, Ades AE, Higgins JPT.”
BackgroundResultSelf-citationDakin, H., Welton, N. J., Ades, A. E., Collins, S., Orme, M. E., & Kelly, S. (2011) · Statistics in Medicine · doi:10.1002/sim.4284 · Cited by 53
“16) And the lines d[1]<-0 for (k in 2:NTrt)f d[k] dnorm(0,.”
BackgroundInfluentialSelf-citationLin, L., Zhao, Y. J., Chew, P., Sng, C. C. A., Wong, H. T., Yip, L. W. L., Wu, T. S., Bautista, D., Teng, M., Khoo, A. L., et al. (2014) · Annals of Pharmacotherapy · doi:10.1177/1060028014548569 · Cited by 53
“A network meta-analysis compares multiple treatments and their alternatives simultaneously and is useful to compare treatments for which head-to-head trials do not exist.(21) It integrates evidence from direct (when treatments are compared within a RCT) and indirect comparisons (when treatments are compared between tr…”
BackgroundAmiche, M. A., Albaum, J. M., Tadrous, M., Pechlivanoglou, P., Lévesque, L. E., Adachi, J. D., & Cadarette, S. M. (2016) · Osteoporosis International · doi:10.1007/s00198-015-3476-4 · Cited by 53
Ling, J., Peng, C., Ge, L., Ding-hua, Z., Shi, A., Tian, J., Chen, Y., Li, X., Zhang, J., & Yang, K. (2018) · Acta Diabetologica · doi:10.1007/s00592-018-1222-z · Cited by 56
Held, S., Speer, K., Rappelt, L., Wicker, P. V., & Donath, L. (2022) · Frontiers in Physiology · doi:10.3389/fphys.2022.926972 · Cited by 51
“Specifically, this method allows estimating comparative effects of treatment arms that have not been directly compared in randomized trials (Caldwell et al., 2005).”
MethodApplying Multiple Criteria Decision Analysis to Comparative Benefit-Risk Assessment
Tervonen, T., Naci, H., van Valkenhoef, G., Ades, A. E., Angelis, A., Hillege, H. L., & Postmus, D. (2015) · Medical Decision Making · doi:10.1177/0272989x15587005 · Cited by 52
“For criteria measurements that are derived from randomized controlled trials, the use of network meta-analysis is now commonplace (12-15).”
MethodSelf-citationLoveman, E., Copley, V. R., Colquitt, J. L., Scott, D. A., Clegg, A. J., Jones, J., O’Reilly, K. M., Singh, S., Bausewein, C., & Wells, A. U. (2014) · BMC Pharmacology and Toxicology · doi:10.1186/2050-6511-15-63 · Cited by 54
“A NMA focusing on pharmacological treatments for IPF and assessing forced vital capacity (FVC) endpoints was undertaken [12].”
Burr, N. E., Lummis, K., Sood, R., Kane, J. S., & Subramanian, V. (2016) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(16)30162-5 · Cited by 55
Node-making process in network meta-analysis of nonpharmacological treatment are poorly reported
James, A., Yavchitz, A., Ravaud, P., & Boutron, I. (2017) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2017.11.018 · Cited by 53
Loos, A. M., Liu, S., Segel, C., Ollendorf, D. A., Pearson, S. D., & Linder, J. A. (2018) · Journal of the American Academy of Dermatology · doi:10.1016/j.jaad.2018.02.027 · Cited by 52
“We performed quantitative indirect comparisons using a bayesian NMA for PASI outcomes.(9) An ordinal multinomial model with a probit link for PASI 50, PASI 75, and PASI 90 was used, which assumes that the treatment effect is the same regardless of the PASI cutoff to use data efficiently, even when some PASI outcomes w…”
MethodAhmadzai, N., Kilty, S., Cheng, W., Esmaeilisaraji, L., Wolfe, D. M., Bonaparte, J. P., Schramm, D., Fitzpatrick, E. M., Lin, V., Skidmore, B., et al. (2019) · PLoS ONE · doi:10.1371/journal.pone.0221713 · Cited by 57
Kwon, J. K., Cho, K. S., Oh, C. K., Kang, D. H., Lee, H., Ham, W. S., Choi, Y. D., & Lee, J. Y. (2015) · BMC Urology · doi:10.1186/s12894-015-0050-5 · Cited by 52
“Newly introduced network meta-analysis is a metaanalysis in which multiple treatments are compared using direct comparisons of interventions within RCTs and indirect comparisons across trials based on a common comparator [8–10].”
MethodYuan, J.-Q., Liu, Y., Yang, Z., Qin, X. S., Yang, K., & Mao, C. (2013) · Current Medical Research and Opinion · doi:10.1185/03007995.2013.766594 · Cited by 51
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“In the absence of a head-to-head or direct comparison, indirect treatment comparisons provide a useful alternative [2,5-9].”
BackgroundContinuously updated network meta-analysis and statistical monitoring for timely decision-making
Nikolakopoulou, A., Mavridis, D., Egger, M., & Salanti, G. (2016) · Statistical Methods in Medical Research · doi:10.1177/0962280216659896 · Cited by 49
“Summary estimates of comparative effectiveness for all treatment options are thus obtained, including treatments that have not been compared directly in head-to-head comparisons.(20,21) In line with recent calls for comparative evidence at the time of market authorization,(22,23) Naci and O’Connor suggested the use of…”
Elborn, J. S., Vataire, A. L., Fukushima, A., Aballéa, S., Khemiri, A., Moore, C., Medić, G., & Hemels, M. E. H. (2016) · Clinical Therapeutics · doi:10.1016/j.clinthera.2016.08.014 · Cited by 50
Acupuncture for chronic pain and depression in primary care: a programme of research
MacPherson, H., Vickers, A. J., Bland, M., Torgerson, D. J., Corbett, M. S., Spackman, E., Saramago, P., Woods, B. S., Weatherly, H. L. A., Sculpher, M., et al. (2017) · Programme Grants for Applied Research · doi:10.3310/pgfar05030 · Cited by 53
Lee, Y. H., & Song, G. G. (2020) · Zeitschrift für Rheumatologie · doi:10.1007/s00393-020-00750-1 · Cited by 49
“Network metaanalysis integrates all available data to allow for simultaneous comparisons of different treatment options that lack direct head-to-head comparisons [28, 35].”
BackgroundMethodDigital interventions in mental health: Evidence syntheses and economic modelling
Gega, L., Jankovic, D., Saramago, P., Marshall, D., Dawson, S., Brabyn, S., Nikolaidis, G. F., Melton, H., Churchill, R., & Bojke, L. (2022) · Health Technology Assessment · doi:10.3310/rcti6942 · Cited by 48
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“age, dose of drug, menopausal status) on treatment benefits and harms, and enhancing the ability to make reliable indirect comparisons and network analysis (see [23], [24,25] for example) which should be considered as the bedrock for decisions when several treatments are available [26].”
BackgroundGuyot, P., Welton, N. J., Ouwens, M., & Ades, A. E. (2011) · Value in Health · doi:10.1016/j.jval.2011.01.008 · Cited by 49
Self-citationMarsden, G., Perry, M., Bradbury, A. W., Hickey, N. C., Kelley, K., Trender, H., Wonderling, D. E., & Davies, A. H. (2015) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2015.07.034 · Cited by 49
Philip, F., STEWART, S. L., & Southard, J. A. (2016) · Catheterization and Cardiovascular Interventions · doi:10.1002/ccd.26458 · Cited by 49
Lee, Y. H., & Song, G. G. (2016) · Rheumatology International · doi:10.1007/s00296-016-3468-5 · Cited by 49
“On the other hand, network meta-analysis assesses the comparative effectiveness of multiple interventions and combines evidence across a network of randomized controlled trials (RCTs), even if there are no headto-head comparisons [17, 18].”
BackgroundMethodYang, M. G., Wang, H.-T., Zhao, M., Meng, W., Ou, J.-Q., He, J., Zou, B., & Lei, P. (2015) · Medicine · doi:10.1097/md.0000000000001592 · Cited by 49
“Network meta-analysis, in the context of a systematic review, is a metaanalysis in which multiple treatments are compared using both direct comparisons of interventions within trials and indirect comparisons across trials based on a common comparator.(16,17) In this study, we carried out a network meta-analysis to ind…”
MethodLuo, Y., Li, X., Dong, J., & Sun, W. (2016) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-016-4190-3 · Cited by 49
“Given the availability of three different hemostatic modalities, it is of value to investigate and compare the evidenced-based efficacy across the procedures [9].”
BackgroundLikelihood and model selection
Richards, S. A. (2015) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780199672547.003.0004 · Cited by 50
Assessing Confidence in the Results of Network Meta-Analysis (Cinema)Preprint
Nikolakopoulou, A., Higgins, J. P. T., Papakonstantinou, T., Chaimani, A., Giovane, C. D., Egger, M., & Salanti, G. (2019) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/597047 · Cited by 49
“BACKGROUND AND DEFINITIONS 267 One of the key advantages of network meta-analysis compared to pairwise meta268 analysis is the ability to gain precision (36): adding indirect evidence on a particular 269 treatment comparison on top of direct evidence leads to narrower confidence intervals than 270 using the direct evi…”
BackgroundSelf-citationMarcucci, M., Etxeandia‐Ikobaltzeta, I., Yang, S. S., Germini, F., Gupta, S., Agarwal, A., Ventresca, M., Tang, S., Morgano, G. P., Wang, M., et al. (2022) · BMJ · doi:10.1136/bmj-2021-066785 · Cited by 48
A Comparison of National Guidelines for Network Meta-Analysis
Laws, A., Kendall, R., & Hawkins, N. (2014) · Value in Health · doi:10.1016/j.jval.2014.06.001 · Cited by 47
“* M en ti o n ed ex p li ci tl y in th e 20 08 N IC E gu id e to th e m et h o d s o f te ch n o lo gy ap p ra is al [3 1] .”
BackgroundBrown, T. J., Pilkington, G., Boland, A., Oyee, J., Smith, C. T., Dundar, Y., Richards, E., Yang, R., & Dickson, R. (2013) · Health Technology Assessment · doi:10.3310/hta17060 · Cited by 48
Graves, N., Wloch, C., Wilson, J. A., Barnett, A. G., Sutton, A. J., Cooper, N. J., Merollini, K. M. D., McCreanor, V., Cheng, Q., Burn, E., et al. (2016) · Health Technology Assessment · doi:10.3310/hta20540 · Cited by 48
“The model assumes that the relative effect of one treatment compared with another is the same across the entire set of trials for the fixed-effect analysis,(80) and the odds ratios (ORs) in each trial are different, but form a single common distribution that is the same across all sets of the trials for the random-eff…”
BackgroundMethodInfluentialSensitivity of Treatment Recommendations to Bias in Network Meta-Analysis
Phillippo, D., Dias, S., Ades, A. E., Didelez, V., & Welton, N. J. (2017) · Journal of the Royal Statistical Society Series A (Statistics in Society) · doi:10.1111/rssa.12341 · Cited by 50
“Network meta-analysis (NMA) compares the relative effectiveness of multiple treatments by combining the evidence from randomized controlled trials (RCTs), each of which compares only a subset of the treatments of interest (Lumley, 2002; Caldwell et al. , 2005; Lu and Ades, 2006).”
Self-citationFranken, M. G., Leeneman, B., Gheorghe, M., Groot, C. A. U., Haanen, J. B. A. G., & van Baal, P. H. M. (2019) · European Journal of Cancer · doi:10.1016/j.ejca.2019.08.032 · Cited by 48
Miller, K. J., Areerob, P., Hennessy, D., Gonçalves-Bradley, D. C., Mesagno, C., & Grace, F. (2020) · F1000Research · doi:10.12688/f1000research.27123.1 · Cited by 41
Future Directions for Cardiovascular Disease Comparative Effectiveness Research
Hlatky, M. A., Douglas, P. S., Cook, N. L., Wells, B. L., Benjamin, E. J., Dickersin, K., Goff, D. C., Hirsch, A. T., Hylek, E. M., Peterson, E. D., et al. (2012) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2011.12.057 · Cited by 46
“Network meta-analysis (mixed treatment comparison meta-analysis) may be used to compare interventions even when direct “head-to-head” trials are not available (24).”
MethodGray, L. J., Cooper, N. J., Dunkley, A. J., Warren, F. C., Ara, R., Abrams, K. R., Davies, M. J., Khunti, K. K., & Sutton, A. J. (2012) · Obesity Reviews · doi:10.1111/j.1467-789x.2011.00981.x · Cited by 47
“Initially, all outcome measures and time points were checked to make sure they formed closed networks (26).”
BackgroundCooper, N. J., Kendrick, D., Achana, F. A., Dhiman, P., He, Z., Wynn, P. M., Cozannet, É. L., Saramago, P., & Sutton, A. J. (2011) · Epidemiologic Reviews · doi:10.1093/epirev/mxr015 · Cited by 47
“Relatively recently, networkmeta-analysis (NMA)methods (7) (also known as mixed treatment comparison (8, 9)) have been developed.”
BackgroundMethodInfluentialLittlewood, K. J., Higashi, K., Jansen, J. P., Capkun-Niggli, G., Balp, M., Doering, G., Tiddens, H. A. W. M., & Angyalosi, G. (2012) · Journal of Cystic Fibrosis · doi:10.1016/j.jcf.2012.03.010 · Cited by 47
“The choice between a fixed or random effects model for reported outcomes was based on model fit criteria (Deviance Information Criteria (DIC)) which penalise greater model complexity [8].”
MethodTsikopoulos, K., Vasiliadis, H. S., & Mavridis, D. (2016) · British Journal of Sports Medicine · doi:10.1136/bjsports-2015-095437 · Cited by 47
Kang, D. H., Cho, K. S., Ham, W. S., Lee, H., Kwon, J. K., Choi, Y. D., & Lee, J. Y. (2016) · PLoS ONE · doi:10.1371/journal.pone.0158661 · Cited by 48
Baron, R., Allegri, M., Correa‐Illanes, G., Hans, G. H., Serpell, M. G., Mick, G., & Mayoral, V. (2016) · Pain and Therapy · doi:10.1007/s40122-016-0060-3 · Cited by 47
“allowing parameters such as efficacy and safety—which have not been investigated in head to head clinical trials—to be compared [68].”
BackgroundBonovas, S., Nikolopoulos, G. K., Lytras, T., Fiorino, G., Peyrin‐Biroulet, L., & Danese, S. (2017) · British Journal of Clinical Pharmacology · doi:10.1111/bcp.13456 · Cited by 49
Nagendrababu, V., Pulikkotil, S. J., Jinatongthai, P., Veettil, S. K., Teerawattanapong, N., & Gutmann, J. L. (2019) · Journal of Endodontics · doi:10.1016/j.joen.2018.10.016 · Cited by 48
Contributions of Modifiable Risk Factors to Dementia Incidence: A Bayesian Network Analysis
Liang, J., Lü, L., Li, J., Qu, X.-Y., Li, J., Qian, S., Wang, Y., Jia, R., Wang, C., & Xu, Y. (2020) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2020.04.006 · Cited by 51
Jansen, J. P., Bergman, G., Huels, J., & Olson, M. S. (2009) · Current Medical Research and Opinion · doi:10.1185/03007990903035281 · Cited by 48
Abdel-Rahman, O., & Fouad, M. (2016) · Immunotherapy · doi:10.2217/imt-2015-0020 · Cited by 46
Duan, L., Zhang, S., Yan, Q., & Hu, X. (2025) · Psycho-Oncology · doi:10.1002/pon.70078 · Cited by 47
“Network meta‐analysis (NMA) can overcome the limitations of existing studies, by combining the results of different studies to assess the relative effectiveness of multiple treatments [34, 35].”
Meta-analysis and The Cochrane Collaboration: 20 years of the Cochrane Statistical Methods Group
McKenzie, J. E., Salanti, G., Lewis, S. C., & Altman, D. G. (2013) · Systematic Reviews · doi:10.1186/2046-4053-2-80 · Cited by 46
“SMG members have contributed many methodological and applied publications on this topic in the scientific literature (see, for example, [60-69]).”
Liang, J., Shen, W.-T., Li, J., Qu, X.-Y., Li, J., Jia, R., Wang, Y., Wang, S., Wu, R.-K., Zhang, H., et al. (2019) · Ageing Research Reviews · doi:10.1016/j.arr.2019.01.009 · Cited by 52
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Hien, D. A., Papini, S., Saavedra, L. M., Bauer, A. G., Ruglass, L. M., Ebrahimi, C. T., Fitzpatrick, S., López‐Castro, T., Norman, S. B., Killeen, T. K., et al. (2023) · Psychological Bulletin · doi:10.1037/bul0000409 · Cited by 46
Karabis, A., Lindner, L., Mocarski, M., Huisman, & Greening (2013) · International Journal of COPD · doi:10.2147/copd.s48967 · Cited by 45
Planning future studies based on the precision of network meta‐analysis results
Nikolakopoulou, A., Mavridis, D., & Salanti, G. (2015) · Statistics in Medicine · doi:10.1002/sim.6608 · Cited by 44
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“In this systematic review, upon comparing the efficacy of different acupuncture interventions for AR, we yielded reliable results [77, 78].”
ResultLewis, S. R., Macey, R., Lewis, J., Stokes, J. R., Gill, J. R., Cook, J. A., Eardley, W., Parker, M. J., & Griffin, X. L. (2022) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013405.pub2 · Cited by 46
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Ismaila, A., Haeussler, K., Czira, A., Youn, J.-H., Malmenäs, M., Risebrough, N. A., Agarwal, J., Nassim, M., Sharma, R. K., Compton, C. H., et al. (2022) · Advances in Therapy · doi:10.1007/s12325-022-02231-0 · Cited by 44
González‐Lorenzo, M., Ridley, B., Minozzi, S., Giovane, C. D., Peryer, G., Piggott, T., Foschi, M., Filippini, G., Tramacere, I., Baldin, E., et al. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011381.pub3 · Cited by 51
A general framework for comparative Bayesian meta-analysis of diagnostic studies
Menten, J., & Lesaffre, E. M. E. H. (2015) · BMC Medical Research Methodology · doi:10.1186/s12874-015-0061-7 · Cited by 44
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Stent Thrombosis With Second-Generation Drug-Eluting Stents Compared With Bare-Metal Stents
Philip, F., Agarwal, S., Bunte, M. C., Goel, S. S., Tuzcu, E. M., Ellis, S. G., & Kapadia, S. R. (2013) · Circulation Cardiovascular Interventions · doi:10.1161/circinterventions.113.000412 · Cited by 44
“This statistical method is particularly relevant when there are multiple treatment evidence structures with limited direct evidence addressing the research question at hand.(45) A network meta-analysis allows us to create a cyclic evidence network where indirect evidence can augment evidence from direct comparisons.”
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“The probability that estimates which treatment is the most effective can also be calculated [19, 20] using fixed or random effect models.”
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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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