Wagner Carina, Hirsch Caroline, Siemens Waldemar, Kapp Philipp, Iannizzi Claire
Department I of Internal Medicine, Evidence-based Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany.
Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany; Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany.
Z Evid Fortbild Qual Gesundhwes. 2024 Mar;184:90-95. doi: 10.1016/j.zefq.2023.11.004. Epub 2024 Jan 13.
Up-to-date systematic reviews (SRs) are essential for making evidence-based decisions. During the 2019 coronavirus (COVID-19) pandemic, there was a particular need for up-to-date evidence, making the living systematic review (LSR) approach an appropriate review type. However, this approach poses certain challenges.
We aim to provide practice insights and report challenges that we faced while conducting two Cochrane LSRs on COVID-19 treatments with (i) convalescent plasma and (ii) systemic corticosteroids. We address our objective with an experience report and share challenges of the following components based on Iannizzi et al. (2022): study design, publication types, intervention/comparator, outcomes, search strategy, review updates and transparent reporting of differences between review updates.
Regarding the study design, the plasma LSR included different study designs because RCT data were not available at the beginning of the pandemic, whereas for the corticosteroids LSR, which started several months later, RCT data were already available. The challenges in both LSRs included the publication types (preprints were included with caution) and the intervention/comparator, for instance the unavailability of standard of care for either LSR, or SARS-CoV-2 variants occurrence. Further challenges in both LSRs occurred in the components "outcome sets" (which had to be adjusted) and "literature search". The decision criteria for updating were based on important studies and available resources in both LSRs and policy relevance in the plasma LSR. Transparent reporting of the differences between the various update versions were discussed for both LSRs.
In summary, there are similarities and differences regarding challenges of review components for both LSRs. It is important to keep in mind that the two LSR examples presented here were conducted in the wake of the COVID-19 pandemic. Therefore, many of the challenges are attributable to the pandemic and are not specific to LSRs, such as constant adjustments of the outcome sets or changes in the database search. Nevertheless, we believe that some of these aspects are helpful for LSR authors and are applicable to other LSRs outside the pandemic context, particularly in areas where new evidence is rapidly emerging.
最新的系统评价（SRs）对于做出基于证据的决策至关重要。在2019冠状病毒病（COVID-19）大流行期间，对最新证据有特别需求，使得实时系统评价（LSR）方法成为一种合适的评价类型。然而，这种方法带来了某些挑战。
我们旨在提供实践见解，并报告在开展两项关于COVID-19治疗的Cochrane LSR时所面临的挑战，这两项LSR分别针对（i）康复期血浆和（ii）全身用糖皮质激素。我们通过一份经验报告来阐述我们的目标，并根据Iannizzi等人（2022年）的研究，分享以下几个部分所面临的挑战：研究设计、出版物类型、干预措施/对照、结局、检索策略、评价更新以及评价更新之间差异的透明报告。
关于研究设计，血浆LSR纳入了不同的研究设计，因为在大流行开始时随机对照试验（RCT）数据不可用，而对于几个月后开始的糖皮质激素LSR，RCT数据已经可用。两项LSR面临的挑战包括出版物类型（谨慎纳入预印本）和干预措施/对照，例如两项LSR均缺乏标准治疗方案，或者出现了严重急性呼吸综合征冠状病毒2（SARS-CoV-2）变体。两项LSR在“结局集”（必须进行调整）和“文献检索”部分还面临其他挑战。更新的决策标准在两项LSR中均基于重要研究和可用资源，在血浆LSR中还基于政策相关性。两项LSR都讨论了不同更新版本之间差异的透明报告。
总之，两项LSR在评价组成部分的挑战方面既有相似之处也有不同之处。重要的是要记住，这里展示的两个LSR实例是在COVID-19大流行之后进行的。因此，许多挑战可归因于大流行，并非LSR所特有，例如结局集的不断调整或数据库检索的变化。尽管如此，我们认为其中一些方面对LSR作者有帮助，并且适用于大流行背景之外的其他LSR，特别是在新证据迅速涌现的领域。
