Centre for Evidence-Based Medicine Odense (CEBMO), Odense University Hospital, Odense, Denmark
Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
BMJ. 2020 Dec 9;371:m4234. doi: 10.1136/bmj.m4234.
To investigate the association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews.
Systematic review.
Studies that compared the association between conflicts of interest and favourable recommendations of drugs or devices (eg, recommending a drug) in clinical guidelines, advisory committee reports, opinion pieces (eg, editorials), or narrative reviews.
PubMed, Embase, Cochrane Methodology Register (from inception to February 2020), reference lists, Web of Science, and grey literature.
Two authors independently extracted data and assessed the methodological quality of the studies. Pooled relative risks and 95% confidence intervals were estimated using random effects models (relative risk >1 indicates that documents with conflicts of interest more often had favourable recommendations than documents with no conflicts of interest). Financial and non-financial conflicts of interest were analysed separately, and the four types of documents were analysed separately (preplanned) and combined (post hoc).
21 studies that analysed 106 clinical guidelines, 1809 advisory committee reports, 340 opinion pieces, and 497 narrative reviews were included. Unpublished data were received for 11 studies (eight full datasets and three summary datasets). 15 studies showed risk of confounding because the compared documents could differ in factors other than conflicts of interest (eg, different drugs used for different populations). The relative risk for associations between financial conflicts of interest and favourable recommendations for clinical guidelines was 1.26 (95% confidence interval 0.93 to 1.69; four studies of 86 clinical guidelines), for advisory committee reports was 1.20 (0.99 to 1.45; four studies of 629 advisory committee reports), for opinion pieces was 2.62 (0.91 to 7.55; four studies of 284 opinion pieces), and for narrative reviews was 1.20 (0.97 to 1.49; four studies of 457 narrative reviews). An analysis of all four types of documents combined supported these findings (1.26, 1.09 to 1.44). In one study that investigated specialty interests, the association between including radiologists as authors of guidelines and recommending routine breast cancer was: relative risk 2.10, 95% confidence interval 0.92 to 4.77; 12 clinical guidelines).
We interpret our findings to indicate that financial conflicts of interest are associated with favourable recommendations of drugs and devices in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. Limitations of this review were risk of confounding in the included studies and the statistical imprecision of individual analyses of each document type. It is not certain whether non-financial conflicts of interest influence recommendations.
Cochrane Methodology Review Protocol MR000040.
探讨利益冲突与临床指南、顾问委员会报告、观点文章和叙述性评论中有利推荐之间的关系。
系统评价。
比较药物或器械利益冲突与临床指南、顾问委员会报告、观点文章（如社论）或叙述性评论中有利推荐之间关系的研究。
PubMed、Embase、Cochrane 方法学登记册（从成立到 2020 年 2 月）、参考文献列表、Web of Science 和灰色文献。
两名作者独立提取数据，并评估研究的方法学质量。使用随机效应模型估计合并的相对风险和 95%置信区间（相对风险>1 表示与无利益冲突的文件相比，有利益冲突的文件更常给出有利的推荐）。分别分析财务和非财务利益冲突，并分别分析（预先计划）和合并（事后分析）四种类型的文件。
纳入了 21 项分析了 106 项临床指南、1809 项顾问委员会报告、340 项观点文章和 497 项叙述性评论的研究。收到了 11 项研究的未发表数据（八项完整数据集和三项汇总数据集）。15 项研究存在混杂风险，因为比较的文件在利益冲突以外的因素上可能存在差异（例如，不同的药物用于不同的人群）。财务利益冲突与临床指南中有利推荐之间的相对风险为 1.26（95%置信区间 0.93 至 1.69；86 项临床指南中的四项研究），顾问委员会报告为 1.20（0.99 至 1.45；629 项顾问委员会报告中的四项研究），观点文章为 2.62（0.91 至 7.55；284 篇观点文章中的四项研究），叙述性评论为 1.20（0.97 至 1.49；457 篇叙述性评论中的四项研究）。对所有四种类型文件的综合分析支持了这些发现（1.26，1.09 至 1.44）。在一项研究中，调查了专业利益，发现将放射科医生作为指南的作者并推荐常规乳腺癌的关联：相对风险为 2.10，95%置信区间为 0.92 至 4.77；12 项临床指南）。
我们的研究结果表明，财务利益冲突与临床指南、顾问委员会报告、观点文章和叙述性评论中药物和器械的有利推荐有关。本综述的局限性在于纳入研究中存在混杂风险以及对每种文件类型的单独分析的统计学不精确性。不确定非财务利益冲突是否会影响建议。
Cochrane 方法学评价协议 MR000040。
