Créquit Perrine, Trinquart Ludovic, Yavchitz Amélie, Ravaud Philippe
Centre de Recherche Epidémiologie et Statistique Sorbonne Paris Cité, INSERM U1153, Paris, France.
Université Paris Descartes - Sorbonne Paris Cité, Paris, France.
BMC Med. 2016 Jan 20;14:8. doi: 10.1186/s12916-016-0555-0.
Multiple treatments are frequently available for a given condition, and clinicians and patients need a comprehensive, up-to-date synthesis of evidence for all competing treatments. We aimed to quantify the waste of research related to the failure of systematic reviews to provide a complete and up-to-date evidence synthesis over time.
We performed a series of systematic overviews and networks of randomized trials assessing the gap between evidence covered by systematic reviews and available trials of second-line treatments for advanced non-small cell lung cancer. We searched the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, MEDLINE, EMBASE, and other resources sequentially by year from 2009 to March 2, 2015. We sequentially compared the amount of evidence missing from systematic reviews to the randomized evidence available for inclusion each year. We constructed cumulative networks of randomized evidence over time and evaluated the proportion of trials, patients, treatments, and treatment comparisons not covered by systematic reviews on December 31 each year from 2009 to 2015.
We identified 77 trials (28,636 patients) assessing 47 treatments with 54 comparisons and 29 systematic reviews (13 published after 2013). From 2009 to 2015, the evidence covered by existing systematic reviews was consistently incomplete: 45 % to 70 % of trials; 30 % to 58 % of patients; 40 % to 66 % of treatments; and 38 % to 71 % of comparisons were missing. In the cumulative networks of randomized evidence, 10 % to 17 % of treatment comparisons were partially covered by systematic reviews and 55 % to 85 % were partially or not covered.
We illustrate how systematic reviews of a given condition provide a fragmented, out-of-date panorama of the evidence for all treatments. This waste of research might be reduced by the development of live cumulative network meta-analyses.
对于某一特定病症，通常有多种治疗方法可供选择，临床医生和患者需要全面、最新的关于所有相互竞争治疗方法的证据综合。我们旨在量化因系统评价未能随时间提供完整和最新的证据综合而导致的研究浪费情况。
我们进行了一系列系统综述和随机试验网络，评估系统评价所涵盖的证据与晚期非小细胞肺癌二线治疗的可用试验之间的差距。我们从2009年至2015年3月2日按年份依次检索了Cochrane系统评价数据库、效果评价文摘数据库、MEDLINE、EMBASE及其他资源。我们依次将系统评价中缺失的证据量与每年可纳入的随机证据量进行比较。我们构建了随时间推移的随机证据累积网络，并评估了2009年至2015年每年12月31日系统评价未涵盖的试验、患者、治疗方法及治疗比较的比例。
我们识别出77项试验（28636名患者），评估了47种治疗方法，有54项比较，以及29篇系统评价（13篇于2013年后发表）。从2009年至2015年，现有系统评价所涵盖的证据一直不完整：45%至70%的试验；30%至58%的患者；40%至66%的治疗方法；以及38%至71%的比较缺失。在随机证据的累积网络中，10%至17%的治疗比较被系统评价部分涵盖，55%至85%被部分或未被涵盖。
我们说明了针对某一特定病症的系统评价如何提供了关于所有治疗方法的零散、过时的证据全景。通过开展实时累积网络荟萃分析，这种研究浪费情况可能会减少。
Zotero 插件
