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The role of C ochrane reviews in informing international guidelines: a case study of using the G rading of R ecommendations, A ssessment, D evelopment and E valuation system to develop World Health Organization guidelines for the psychosocially assisted pharmacological treatment of opioid dependence
Author(s) -
Davoli Marina,
Amato Laura,
Clark Nicolas,
Farrell Michael,
Hickman Matthew,
Hill Suzanne,
Magrini Nicola,
Poznyak Vladimir,
Schünemann Holger J.
Publication year - 2015
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.12788
Subject(s) - medicine , guideline , grading (engineering) , quality of evidence , buprenorphine , evidence based medicine , methadone , evidence based practice , family medicine , psychiatry , alternative medicine , opioid , randomized controlled trial , surgery , civil engineering , receptor , pathology , engineering
Background and Aims The World Health Organization ( WHO ), and a growing number of other organizations, have adopted the G rading of R ecommendations, A ssessment, D evelopment and E valuation ( GRADE ) system in order to both assess the quality of research evidence and develop clinical practice guidelines. In 2009 WHO published a guideline on psychosocially assisted pharmacological treatment of opioid dependence, based on the results of C ochrane R eviews summarized using the GRADE methodology. The main features of this system are an a priori definition of outcomes and their relevance, and distinction between the quality of evidence (also referred to as confidence in the estimate of intervention effect) and the strength of recommendations. We consider how successful this approach has been. Analysis and Evidence We discuss the merits and limitations of using C ochrane R eviews and GRADE framework in developing guidelines in the field of drug addiction. In 2009 a panel of multi‐disciplinary international experts identified 15 clinical questions and eight relevant outcomes. C ochrane reviews were available for each clinical question and four outcomes. The panel formulated 15 recommendations. Eight recommendations were classified as strong, two of which were based on high‐quality evidence and three on very low‐quality evidence. For example, the strong recommendation to use methadone in adequate doses in preference to buprenorphine was based on high‐quality evidence, while the strong recommendation not to use the combination of opioid antagonists with heavy sedation in the management of opioid withdrawal was based on low‐quality evidence. Conclusions An explicit stepwise process of moving from evaluation of the quality of evidence to the definition of the strength of recommendations is important in providing practical and clear clinical guidance for practitioners and policy‐makers in addiction.