EpiDermE EA 7379, Université Paris Est Créteil, Créteil, F-94010, France.
Ecole des Hautes Etudes en Santé Publique (EHESP), Rennes, F-35000, France.
Br J Dermatol. 2022 Jul;187(1):29-41. doi: 10.1111/bjd.20908. Epub 2022 Apr 12.
BACKGROUND: Network meta-analyses (NMAs) have become successful in addressing gaps in the comparative effectiveness of systemic treatments in moderate-to-severe psoriasis. However, their increasing number carries both a risk of overlap and reproducibility issues that can hamper clinical decision-making. OBJECTIVES: In this overview, we aimed to assess redundancy across these NMAs and to describe their characteristics. MATERIALS AND METHODS: We considered all systematic reviews with NMAs of randomized controlled trials that included adult patients with moderate-to-severe psoriasis and that evaluated the efficacy and/or safety of systemic treatments compared with placebo or with an active comparator. PubMed/MEDLINE, Epistemonikos, PROSPERO and the Evidence update of the Centre of Evidence-Based Dermatology of the University of Nottingham were searched up to 25 February 2021. Our main outcome was the number per year of redundant NMAs and the extent of their overlap. We also described their features, especially, the confidence in the results of the reviews, the funding of the studies and the presence of spin (a description that overstates efficacy and/or understates harm), reporting issues and methodological characteristics. RESULTS: In total, 47 redundant NMAs were included. Only two of 47 (4%) included all available treatments. Both efficacy and safety were evaluated in 14 of 47 (30%) NMAs and both short- and long-term evaluations were assessed in five of 47 (11%). Confidence in the results was critically low for 39 of 47 (83%) NMAs and only 10 of 47 (21·3%) registered a protocol. Twenty-six of 47 NMAs (55%) received pharmaceutical funding. Contract research organizations were involved in 19 of 47 (40%) NMAs. Reporting was poor across most of the NMA abstracts and spin was present in all of the abstracts. Almost half of the NMAs failed to consider important limitations such as heterogeneity (considered in 32%) or consistency (considered in 66%). CONCLUSIONS: In addition to a duplication of efforts, our overview showed heterogeneous methods and poor confidence in the results in a majority of the included NMAs, further distorted by reporting issues and spin. Clinicians need to interpret NMAs with caution when looking for the most reliable and comprehensive evidence.
背景：网络荟萃分析（NMAs）在解决中重度银屑病系统治疗的比较有效性方面取得了成功。然而，它们数量的增加既存在重叠的风险，也存在可阻碍临床决策的可重复性问题。
目的：在本次综述中，我们旨在评估这些 NMAs 之间的冗余性，并描述它们的特征。
材料和方法：我们考虑了所有包含中重度银屑病成年患者的、评估与安慰剂或阳性对照相比的系统治疗的有效性和/或安全性的、针对随机对照试验的 NMAs 的系统评价，这些系统评价均为 NMAs。我们检索了 PubMed/MEDLINE、Epistemonikos、PROSPERO 和诺丁汉大学循证皮肤病学中心的证据更新，检索时间截至 2021 年 2 月 25 日。我们的主要结局是每年重复的 NMAs 的数量以及它们重叠的程度。我们还描述了它们的特征，特别是综述结果的可信度、研究的资金来源、以及是否存在夸大疗效和/或淡化危害的“spin”（描述）问题、报告问题和方法学特征。
结果：共纳入 47 项重复的 NMAs。仅有两项 47 项中的 NMAs（4%）纳入了所有可用的治疗方法。14 项 NMAs（30%）同时评估了疗效和安全性，5 项 NMAs（11%）评估了短期和长期疗效。47 项 NMAs 中有 39 项（83%）的结果可信度极低，仅有 10 项（21.3%）注册了方案。26 项 NMAs（55%）接受了制药公司的资助。19 项 NMAs（40%）涉及合同研究组织。在大多数 NMAs 的摘要中报告都很差，并且所有摘要都存在“spin”。近一半的 NMAs 未能考虑重要的局限性，如异质性（32%考虑到了这一点）或一致性（66%考虑到了这一点）。
结论：除了重复工作之外，我们的综述还显示，大多数纳入的 NMAs 方法各异，结果可信度较低，进一步受到报告问题和“spin”的影响。当临床医生寻找最可靠和最全面的证据时，需要谨慎解读 NMAs。
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