Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201, Ottawa, Ontario, K1H 8 L6, Canada.
University of Maryland School of Medicine, Baltimore, MD, USA.
Syst Rev. 2020 Apr 30;9(1):97. doi: 10.1186/s13643-020-01328-3.
Network meta-analysis (NMA) has rapidly grown in use during the past decade for the comparison of healthcare interventions. While its general use in the comparison of conventional medicines has been studied previously, to our awareness, its use to assess complementary and alternative medicines (CAM) has not been studied. A scoping review of the literature was performed to identify systematic reviews incorporating NMAs involving one or more CAM interventions.
An information specialist executed a multi-database search (e.g., MEDLINE, Embase, Cochrane), and two reviewers performed study selection and data collection. Information on publication characteristics, diseases studied, interventions compared, reporting transparency, outcomes assessed, and other parameters were extracted from each review.
A total of 89 SR/NMAs were included. The largest number of NMAs was conducted in China (39.3%), followed by the United Kingdom (12.4%) and the United States (9.0%). Reviews were published between 2010 and 2018, with the majority published between 2015 and 2018. More than 90 different CAM therapies appeared at least once, and the median number per NMA was 2 (IQR 1-4); 20.2% of reviews consisted of only CAM therapies. Dietary supplements (51.1%) and vitamins and minerals (42.2%) were the most commonly studied therapies, followed by electrical stimulation (31.1%), herbal medicines (24.4%), and acupuncture and related treatments (22.2%). A diverse set of conditions was identified, the most common being various forms of cancer (11.1%), osteoarthritis of the hip/knee (7.8%), and depression (5.9%). Most reviews adequately addressed a majority of the PRISMA NMA extension items; however, there were limitations in indication of an existing review protocol, exploration of network geometry, and exploration of risk of bias across studies, such as publication bias.
The use of NMA to assess the effectiveness of CAM interventions is growing rapidly. Efforts to identify priority topics for future CAM-related NMAs and to enhance methods for CAM comparisons with conventional medicine are needed. SYSTEMATIC REVIEW REGISTRATION: https://ruor.uottawa.ca/handle/10393/35658.
网络荟萃分析（NMA）在过去十年中在医疗干预措施比较中的应用迅速增长。虽然之前已经研究过它在常规药物比较中的一般应用，但据我们所知，它在评估补充和替代药物（CAM）方面的应用尚未得到研究。对文献进行了范围审查，以确定涉及一种或多种 CAM 干预措施的包含 NMA 的系统评价。
一名信息专家执行了多数据库搜索（例如，MEDLINE、Embase、Cochrane），两名审查员进行了研究选择和数据收集。从每个综述中提取有关出版物特征、研究疾病、比较的干预措施、报告透明度、评估结果和其他参数的信息。
共纳入 89 项 SR/NMA。进行 NMA 最多的国家是中国（39.3%），其次是英国（12.4%）和美国（9.0%）。综述发表于 2010 年至 2018 年之间，其中大多数发表于 2015 年至 2018 年之间。至少出现过 90 种不同的 CAM 疗法，每种 NMA 的中位数为 2（IQR 1-4）；20.2%的综述仅包含 CAM 疗法。膳食补充剂（51.1%）和维生素和矿物质（42.2%）是最常研究的疗法，其次是电刺激（31.1%）、草药（24.4%）和针灸及相关治疗（22.2%）。确定了一系列不同的病症，最常见的是各种形式的癌症（11.1%）、髋/膝骨关节炎（7.8%）和抑郁症（5.9%）。大多数综述都充分解决了 PRISMA NMA 扩展项目的大部分内容；然而，在现有综述方案的指示、网络几何结构的探索以及对研究间偏倚（如发表偏倚）的探索方面存在局限性。
使用 NMA 评估 CAM 干预措施的有效性正在迅速增长。需要努力确定未来与 CAM 相关的 NMAs 的优先主题，并增强与常规药物比较的 CAM 方法。
