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J Comp Eff Res. 2018 Nov;7(11):1037-1051. doi: 10.2217/cer-2018-0065. Epub 2018 Oct 2.

Importance of assessing and adjusting for cross-study heterogeneity in network meta-analysis: a case study of psoriasis.

Author information

1
Cornerstone Research Group, Inc., Burlington, Ontario, Canada.
2
Clinical Epidermology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
3
School of Epidemiology, Public Health & Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada.
4
Janssen Research & Development, LLC, Spring House, PA, 19477, USA.
5
Janssen Pharmaceutica NV, Turnhoutseweg 30, 2340 Beerse, Belgium.
6
Janssen-Cilag, Warsaw, Poland.

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.

KEYWORDS:

Psoriasis Area and Severity Index; biologic; heterogeneity; indirect comparison; network meta-analysis; placebo response; psoriasis

PMID:
30277080
DOI:
10.2217/cer-2018-0065
[Indexed for MEDLINE]
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