Open AccessImportance of assessing and adjusting for cross-study heterogeneity in network meta-analysis: a case study of psoriasis
Author(s) -
Chris Cameron,
Brian Hutton,
C. Druchok,
Sean McElligott,
Sandhya Nair,
A Schubert,
Aaron Situ,
Abhishek Varu,
R. Villacorta
Publication year - 2018
Publication title -
journal of comparative effectiveness research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.567
H-Index - 23
eISSN - 2042-6313
pISSN - 2042-6305
DOI - 10.2217/cer-2018-0065
Subject(s) - medicine , psoriasis , psoriasis area and severity index , covariate , placebo , meta analysis , psychological intervention , clinical trial , physical therapy , statistics , alternative medicine , psychiatry , dermatology , pathology , mathematics
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.