Importance of assessing and adjusting for cross-study heterogeneity in network meta-analysis: a case study of psoriasis. (2nd October 2018)

• Record Type: Journal Article
• Authors: Cameron, Chris; Hutton, Brian; Druchok, Cheryl; McElligott, Sean; Nair, Sandhya; Schubert, Agata; Situ, Aaron; Varu, Abhishek; Villacorta, Reggie
• Is Part Of: Journal of comparative effectiveness research. Volume 7:Number 11(2018)
• Page Start: 1037
• Page End: 1051
• Publication Date: 2018-10-02
• Subjects: biologic -- heterogeneity -- indirect comparison -- network meta-analysis -- placebo response -- psoriasis -- Psoriasis Area and Severity Index; Medical care -- Research -- Periodicals; Medical care -- Research -- Evaluation -- Periodicals; Medical care -- Decision making -- Periodicals; Evidence-based medicine -- Periodicals; Medicine, Comparative -- Periodicals; 362.1072
• DOI: 10.2217/cer-2018-0065
• Languages: English
• ISSNs: 2042-6305

Abstract

Aim: The importance of adjusting for cross-study heterogeneity when conducting network meta-analyses (NMAs) was demonstrated using a case study of biologic therapies for moderate-to-severe plaque psoriasis.Methods: Bayesian NMAs were conducted for Psoriasis Area and Severity Index 90 response. Several covariates were considered to account for cross-trial differences: baseline risk (i.e., placebo response), prior biologic use, body weight, psoriasis duration, age, race and baseline Psoriasis Area and Severity Index score. Model fit was evaluated.Results: The baseline risk-adjusted NMA, which adjusts for multiple observed and unobserved effect modifiers, was associated with the best model fit. Lack of adjustment for cross-trial differences led to different clinical interpretations of findings.Conclusion: Failure to adjust for cross-trial differences in NMA can have important implications for clinical interpretations when studying the comparative efficacy of healthcare interventions.