Lau J, Chalmers T C
New England Medical Center, USA.
Int J Technol Assess Health Care. 1995 Summer;11(3):509-22. doi: 10.1017/s0266462300008709.
The use of randomized control trials to assess the usefulness of therapeutic drugs over the last half century has brought significant benefits to patient care. The full potential benefits, however, have been only partially fulfilled because available data are frequently poorly used. Meta-analysis has emerged as an important tool for combining clinical evidence. Several examples are presented that compared the results of cumulative meta-analysis of randomized control trials with clinical expert recommendations. These comparisons demonstrated that clinical expert recommendations are often not synchronized with accumulating evidence, and this lack of recognition often resulted in delays in the acceptance of effective drugs and the slow abandonment of possibly harmful therapeutic practices. The problems of inappropriate therapeutic drug use will only intensify as new drugs are introduced and new uses for established drugs are proposed. The rational use of therapeutic drugs can be achieved only through the routine use of meta-analysis on high-quality clinical data. Some suggestions are made to improve the quality of the original research and the ways of assembling meta-analyses and disseminating their results.
在过去的半个世纪里，使用随机对照试验来评估治疗药物的有效性给患者护理带来了显著益处。然而，由于现有数据常常未得到充分利用，其全部潜在益处仅得到了部分实现。荟萃分析已成为整合临床证据的重要工具。文中给出了几个例子，将随机对照试验的累积荟萃分析结果与临床专家建议进行了比较。这些比较表明，临床专家建议往往与不断积累的证据不同步，而这种认识的缺乏常常导致有效药物的接受延迟，以及可能有害的治疗方法被缓慢摒弃。随着新药的推出和现有药物新用途的提出，治疗药物使用不当的问题只会加剧。只有通过对高质量临床数据常规进行荟萃分析，才能实现治疗药物的合理使用。文中还提出了一些建议，以提高原始研究的质量、荟萃分析的汇总方式及其结果的传播方式。
