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J Comp Eff Res. 2019 Nov;8(15):1265-1298. doi: 10.2217/cer-2019-0064. Epub 2019 Sep 5.

A criterion-based approach to systematic and transparent comparative effectiveness: a case study in psoriatic arthritis.

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Purple Squirrel Economics, 4 Lexington Avenue, Suite 15K, New York, NY 10010, USA.
Celgene Corporation, 86 Morris Avenue, Summit, NJ 07901, USA.
Health Economics & Health Technology Assessment, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK.


Aim: Indirect treatment comparisons are used when no direct comparison is available. Comparison networks should satisfy the transitivity assumption, that is, equal likelihood of treatment assignment for a given patient based on comparability of studies. Materials & methods: Seven criteria were evaluated across 18 randomized controlled trials in psoriatic arthritis: inclusion/exclusion criteria, clinical trial design and follow-up, patient-level baseline characteristics, disease severity, prior therapies, concomitant and extended-trial treatment and placebo response differences. Results: Across studies, placebo was a common comparator, and key efficacy end points were reported. Collectively, several potential sources of insufficient transitivity were identified, most often related to trial design and population differences. Conclusion: Potential challenges in satisfying transitivity occur frequently and should be evaluated thoroughly.


apremilast; effect modification; indirect treatment comparison; network meta-analysis; psoriatic arthritis; transitivity

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