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Cochrane系统评价在临床指南中应用网络荟萃分析的影响：一项系统评价。

The impact of Cochrane Reviews that apply network meta-analysis in clinical guidelines: A systematic review.

作者信息

Donegan Sarah, Connor James, Alfirevic Zarko, Tudur-Smith Catrin

机构信息

Department for Health Data Science, University of Liverpool, Liverpool, United Kingdom.

Department of Women and Children's Health, University of Liverpool and Liverpool Women's Hospital, Liverpool, United Kingdom.

出版信息

PLoS One. 2024 Dec 26;19(12):e0315563. doi: 10.1371/journal.pone.0315563. eCollection 2024.

DOI:10.1371/journal.pone.0315563
PMID:39724181
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11671017/
Abstract

BACKGROUND

Systematic reviews, such as those prepared by Cochrane, are the strongest evidence on which to base recommendations in clinical guidelines. Network meta-analysis (NMA) can be used to combine the results of studies to compare multiple treatments, which is advantageous over pair-wise meta-analysis (PW-MA) that compares two treatments. We aimed to summarise which, when, where, who, and why Cochrane Reviews that applied NMA were cited in guidelines; and to compare the citation of NMA reviews in guidelines with PW-MA reviews.

METHODS AND FINDINGS

We carried out a systematic review of Cochrane reviews that applied NMA and we summarised their citation in guidelines. The Cochrane Database of Systematic Reviews was searched (15th January 2024). Additionally, a cohort of Cochrane reviews that applied PW-MA was matched to the NMA reviews. Two authors assessed eligibility and extracted data. We summarised review and guideline characteristics, and the use of the review in guidelines.

RESULTS

Of the 60 included NMA reviews, 26 reviews (43%) were cited in 89 guidelines (1-13 per review). 15 NMA reviews (58%) were first cited within two years of publication, with the remaining 11 reviews (42%) cited 2-6 years later. 52 guideline developers authored the guidelines. The number of citations was higher for NMA than PW-MA reviews (rate ratio 1.53 (1.08 to 2.19), p = 0.02). The number of times reviews were commissioned or cited alongside a recommendation was also higher for NMA than PW-MA reviews (rate ratio 4.40 (1.80 to 13.14), p = 0.003). NMA reviews were more likely to be cited in the text surrounding a recommendation or used for NICE guideline development (1.94 (1.08 to 3.63), p = 0.03).

CONCLUSIONS

Cochrane NMA reviews appear to have more impact than PW-MA reviews, but many are not cited in guidelines. Further work is needed to explore the barriers to use of NMAs and promote their use.

摘要

背景

系统评价，如Cochrane所编制的那些，是临床指南中制定推荐意见的最有力证据。网状Meta分析（NMA）可用于合并研究结果以比较多种治疗方法，这比比较两种治疗方法的成对Meta分析（PW-MA）更具优势。我们旨在总结应用NMA的Cochrane系统评价在指南中被引用的时间、地点、人物及原因；并比较指南中NMA系统评价与PW-MA系统评价的被引用情况。

方法与结果

我们对应用NMA的Cochrane系统评价进行了系统评价，并总结了它们在指南中的引用情况。检索了Cochrane系统评价数据库（2024年1月15日）。此外，将一组应用PW-MA的Cochrane系统评价与NMA系统评价进行匹配。两名作者评估纳入标准并提取数据。我们总结了系统评价和指南的特征，以及系统评价在指南中的使用情况。

结果

在纳入的60篇NMA系统评价中，26篇（43%）在89篇指南中被引用（每篇系统评价被引用1 - 13次）。15篇NMA系统评价（58%）在发表后两年内首次被引用，其余11篇（42%）在2 - 6年后被引用。52名指南制定者撰写了这些指南。NMA系统评价的被引用次数高于PW-MA系统评价（率比1.53（1.08至2.19），p = 0.02）。系统评价被委托或与推荐意见一起被引用的次数，NMA系统评价也高于PW-MA系统评价（率比4.40（1.80至13.14），p = 0.003）。NMA系统评价更有可能在推荐意见周围的文本中被引用或用于英国国家卫生与临床优化研究所（NICE）指南的制定（1.94（1.08至3.63），p = 0.03）。

结论

Cochrane的NMA系统评价似乎比PW-MA系统评价有更大的影响力，但许多未在指南中被引用。需要进一步开展工作以探索使用NMA的障碍并促进其应用。

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