Network meta-analyses (NMA) are being incorporated into more and more systematic reviews. A special thanks to Areti Veroniki who provided a 101 on NMA prior to the journal club discussion. In brief, the increasing popularity is because NMA can:
1. comprehensively use all available data
2. avoid selective use of indirect evidence
3. compare interventions which have not been directly compared in any experiment
4. increase the precision in the estimated treatment effects, and
5. rank all competing treatments for the same condition.
In the April 2016 journal club, the following network meta-analysis was discussed:
da Costa BR, Reichenbach S, Keller N, Nartey L, Wandel S, Jüni P, Trelle S. Effectiveness of non-steroidal anti-inflammatory drugs for the treatment of pain in knee and hip osteoarthritis: a network meta-analysis. Lancet. 2016 [Epub ahead of print] PMID: 26997557
While there were concerns about the level of commercial influence in the included studies, the overall young age of the patients, the lack of inclusion of other treatment modalities (exercise, narcotics), and the absence of analysis of harm; this paper brought forth important doubts about effectiveness of acetaminophen. How to reconcile the known harms of NSAIDs and the clinical effectiveness on pain and function is the essence of ongoing discussion.
Missed the tweetchat? Access the archived discussion here:
Don’t forget to join us May 27, 2016 (08:00 ET / noon GMT) for the next #GeriMedJC!