Ann Intern Med. 2016 May 17;164(10):666-73. doi: 10.7326/M15-2521. Epub 2016 Apr 19.
Ranking of interventions is one of the most appealing elements of network meta-analysis. There is, however, little evidence about the reliability of these rankings.
To empirically evaluate the extent of uncertainty in intervention rankings from network meta-analysis.
Two previous systematic reviews that involved searches of the Cochrane Library, MEDLINE, and Embase up to July 2012 for articles that included networks of at least 3 interventions.
58 network meta-analyses involving 1308 randomized trials and 404 interventions with available aggregated outcome data.
Each network was analyzed with a Bayesian approach. For each intervention, the surface under the cumulative ranking curve (SUCRA) and its 95% credible interval (95% CrI) were estimated. Through use of the SUCRA values, the interventions were then rank-ordered between 0% (worst) and 100% (best).
The median width of the 95% CrIs of the SUCRA was 65% (first to third quartile, 38% to 80%). In 28% of networks, there was a 50% or greater probability that the best-ranked treatment was actually not the best. No evidence showed a difference between the best-ranked intervention and the second and third best-ranked interventions in 90% and 71% of comparisons, respectively. In 39 networks with 6 or more interventions, the median probability that 1 of the top 2 interventions was among the bottom 2 was 35% (first to third quartile, 14% to 59%).
This analysis did not consider such factors as the risk of bias within trials or small-study effects that may affect the reliability of rankings.
Treatment rankings derived from network meta-analyses have a substantial degree of imprecision. Authors and readers should interpret such rankings with great caution.
Cochrane France.
干预措施的排名是网络荟萃分析最吸引人的元素之一。然而，关于这些排名的可靠性的证据很少。
从网络荟萃分析中实证评估干预措施排名的不确定性程度。
两项之前的系统评价，涉及 Cochrane 图书馆、MEDLINE 和 Embase 的搜索，截至 2012 年 7 月，包括至少 3 个干预措施的网络的文章。
58 项网络荟萃分析，涉及 1308 项随机试验和 404 项具有可用汇总结局数据的干预措施。
每个网络均采用贝叶斯方法进行分析。对于每个干预措施，均估计累积排序曲线下面积（SUCRA）及其 95%可信区间（95% CrI）。通过使用 SUCRA 值，干预措施在 0%（最差）和 100%（最佳）之间进行排序。
SUCRA 的 95% CrI 的中位数宽度为 65%（第一至第三四分位数，38%至 80%）。在 28%的网络中，最佳排序治疗实际上并非最佳的可能性为 50%或更高。在 90%和 71%的比较中，分别没有证据表明最佳排序的干预措施与第二和第三最佳排序的干预措施之间存在差异。在 39 个有 6 个或更多干预措施的网络中，排在前 2 位的干预措施中有 1 个排在最后 2 位的中位数概率为 35%（第一至第三四分位数，14%至 59%）。
本分析未考虑试验内偏倚风险或可能影响排名可靠性的小样本效应等因素。
从网络荟萃分析得出的治疗排名具有很大的不准确性。作者和读者应谨慎解释此类排名。
Cochrane 法国。
