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J Clin Mov Disord. 2017 Nov 22;4:19. doi: 10.1186/s40734-017-0067-x. eCollection 2017.

Meta-research metrics matter: letter regarding article "indirect tolerability comparison of Deutetrabenazine and Tetrabenazine for Huntington disease".

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Huntington's Disease Centre, Institute of Neurology, University College London, Russell Square 10-12, London, WC1B 5EH UK.
Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
Clinical Pharmacology Unit, Instituto de Medicina Molecular, Lisbon, Portugal.
Cochrane Movement Disorders Group, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
Center for Evidence-Based Medicine, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.


Here we discuss the report by Claassen and colleagues describing an indirect treatment comparison between tetrabenazine and deutetrabenazine for chorea in Huntington's disease using individual patient data. We note the potential for discrepancies in apparently statistically significant findings, due to the rank reversal phenomenon. We provide some cautionary observations and suggestions concerning the limitations of indirect comparisons and the low likelihood that good quality evidence will become available to guide clinical decision comparing these two agents.


Deutratrabenazine; Huntington’s disease; Indirect treatment comparison; Tetrabenazine

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