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J Clin Epidemiol. 2008 Aug;61(8):763-9. doi: 10.1016/j.jclinepi.2007.10.007. Epub 2008 Apr 14.

Trial sequential analysis reveals insufficient information size and potentially false positive results in many meta-analyses.

Author information

  • 1Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Cochrane Hepato-Biliary Group, Dept. 3344, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. jbrok@ctu.rh.dk

Abstract

OBJECTIVES:

To evaluate meta-analyses with trial sequential analysis (TSA). TSA adjusts for random error risk and provides the required number of participants (information size) in a meta-analysis. Meta-analyses not reaching information size are analyzed with trial sequential monitoring boundaries analogous to interim monitoring boundaries in a single trial.

STUDY DESIGN AND SETTING:

We applied TSA on meta-analyses performed in Cochrane Neonatal reviews. We calculated information sizes and monitoring boundaries with three different anticipated intervention effects of 30% relative risk reduction (TSA(30%)), 15% (TSA(15%)), or a risk reduction suggested by low-bias risk trials of the meta-analysis corrected for heterogeneity (TSA(LBHIS)).

RESULTS:

A total of 174 meta-analyses were eligible; 79 out of 174 (45%) meta-analyses were statistically significant (P<0.05). In the significant meta-analyses, TSA(30%) showed firm evidence in 61%. TSA(15%) and TSA(LBHIS) found firm evidence in 33% and 73%, respectively. The remaining significant meta-analyses had potentially spurious evidence of effect. In the 95 statistically nonsignificant (P>or=0.05) meta-analyses, TSA(30%) showed absence of evidence in 80% (insufficient information size). TSA(15%) and TSA(LBHIS) found that 95% and 91% had absence of evidence. The remaining nonsignificant meta-analyses had evidence of lack of effect.

CONCLUSION:

TSA reveals insufficient information size and potentially false positive results in many meta-analyses.

PMID:
18411040
DOI:
10.1016/j.jclinepi.2007.10.007
[PubMed - indexed for MEDLINE]
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