Method to draw conclusions from a network meta-analysis: a minimally contextualised framework_Chinese Journal of Evidence-Based Medicine

Authors：

LI Mengting ^1,2 , ZHU Hongfei ^1,2 , HOU Liangying ^1,2,3 , WANG Qi ^1,2 , TIAN Jinhui ^3,4,5,6,7 , CHEN Yaolong ^3,4,5,6,7 , YANG Kehu ^3,4,5,6,7 , DENG Hongyong ⁸ , ZENG Linan ^9,10,11 , ZHANG Lingli ^9,10,11 , Romina Brignardello-Petersen ¹² ,  GE Long ^1,2,4,5,6,7

1. Department of Social Science and Health Management, School of Public Health, Lanzhou University, Lanzhou 730000, P.R.China;
2. Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, P.R.China;
3. Evidence-Based Medicine Center of Lanzhou University, Lanzhou 730000, P.R.China;
4. Key Laboratory of Evidence-Based Medicine and Clinical Transformation in Gansu Province, Lanzhou 730000, P.R.China;
5. Lanzhou University Institute of Health Data Science, Lanzhou 73000, P.R.China;
6. WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou 730000, P.R.China;
7. Chinese GRADE Center, Lanzhou 73000, P.R.China;
8. TCM Health Service Collaborative Innovation Center, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P.R.China;
9. Department of Pharmacy, West China Second University Hospital, Sichuan University, Chengdu 610041, P.R.China;
10. Evidence Based Pharmacy Center, West China Second University Hospital, Sichuan University, Chengdu 610041, P.R.China;
11. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, P.R.China;
12. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton L8S4L8, Canada;

Corresponding?author：

GE Long, Email: gelong2009@163.com

Keywords：

Network meta-analysis; GRADE approach; Drawing conclusion; Minimally contextualised framework

DOI：

10.7507/1672-2531.202105068

Video：

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The primary advantage of network meta-analysis is the capability to quantify and compare different interventions for the same diseases and rank their benefits or harms according to a certain health outcome. The inclusion of a variety of interventions has increased the complexity of the conclusions drawing from a network meta-analysis, and based on the ranking results alone may lead to misleading conclusions. At present, there are no accepted standards for the conclusion drawing from a network meta-analysis. In November 2020, based on the evidence certainty results of network meta-analysis, the GRADE (Grades of Recommendations Assessment, Development and Evaluation) working group proposed two approaches to draw conclusions from a network meta-analysis: the partially contextualised framework and the minimally contextualised framework. This paper aimed to introduce principles and procedures of the minimal contextualised framework through a specific example to provide guidance for the network meta-analysis authors in China to present and interpret the results using minimally contextualised framework.

Citation： LI Mengting, ZHU Hongfei, HOU Liangying, WANG Qi, TIAN Jinhui, CHEN Yaolong, YANG Kehu, DENG Hongyong, ZENG Linan, ZHANG Lingli, Romina Brignardello-Petersen, GE Long. Method to draw conclusions from a network meta-analysis: a minimally contextualised framework. Chinese Journal of Evidence-Based Medicine, 2021, 21(9): 1102-1109. doi: 10.7507/1672-2531.202105068 Copy

1.	田金徽, Fujian Song, 李倫, 等. 間接比較方法簡介. 中國循證醫學雜志, 2014, 14(3): 365-368.
2.	田金徽, 李倫, 趙曄, 等. 網狀 Meta 分析的撰寫與報告. 中國藥物評價, 2013, 30(6): 321-323, 333.
3.	田金徽. 中藥注射劑聯合化療治療非小細胞肺癌的網狀 Meta 分析. 蘭州: 蘭州大學, 2012.
4.	Bucher HC, Guyatt GH, Griffith LE, et al. The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J Clin Epidemiol, 1997, 50(6): 683-691.
5.	Lumley T. Network meta-analysis for indirect treatment comparisons. Stat Med, 2002, 21(16): 2313-2324.
6.	Brignardello-Petersen R, Guyatt GH. β-Blockers in heart failure--are all created equal? Pol Arch Med Wewn, 2013, 123(5): 204-205.
7.	Neumann I, Brignardello-Petersen R, Guyatt G. ACP Journal Club. Review: novel oral anticoagulants reduce stroke more than ASA in nonvalvular atrial fibrillation. Ann Intern Med, 2014, 160(4): JC3.
8.	Andrews JC, Schünemann HJ, Oxman AD, et al. GRADE guidelines: 15. going from evidence to recommendation-determinants of a recommendation's direction and strength. J Clin Epidemiol, 2013, 66(7): 726-735.
9.	Puhan MA, Schünemann HJ, Murad MH, et al. A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis. BMJ, 2014, 349: g5630.
10.	Brignardello-Petersen R, Bonner A, Alexander PE, et al. Advances in the GRADE approach to rate the certainty in estimates from a network meta-analysis. J Clin Epidemiol, 2018, 93: 36-44.
11.	Brignardello-Petersen R, Murad MH, Walter SD, et al. GRADE approach to rate the certainty from a network meta-analysis: avoiding spurious judgments of imprecision in sparse networks. J Clin Epidemiol, 2019, 105: 60-67.
12.	Brignardello-Petersen R, Mustafa RA, Siemieniuk RAC, et al. GRADE approach to rate the certainty from a network meta-analysis: addressing incoherence. J Clin Epidemiol, 2019, 108: 77-85.
13.	王琪, 王建成, 潘蓓, 等. 網狀 Meta 分析證據質量分級: GRADE 方法學前沿與進展. 中國循證醫學雜志, 2020, 20(8): 979-985.
14.	王琪, 王韻華, 賴鴻皓, 等. 網狀 Meta 分析證據質量分級: CINeMA 在線應用程序簡介. 中國循證醫學雜志, 2020, 20(9): 1110-1116.
15.	Brignardello-Petersen R, Florez ID, Izcovich A, et al. GRADE approach to drawing conclusions from a network meta-analysis using a minimally contextualised framework. BMJ, 2020, 371: m3900.
16.	Brignardello-Petersen R, Izcovich A, Rochwerg B, et al. GRADE approach to drawing conclusions from a network meta-analysis using a partially contextualised framework. BMJ, 2020, 371: m3907.
17.	朱鴻飛, 栗夢婷, 后亮瑛, 等. 網狀 Meta 結論形成的方法: 部分背景化框架. 中國循證醫學雜志, 2021, 21(9): 1110-1116.
18.	Hultcrantz M, Rind D, Akl EA, et al. The GRADE Working Group clarifies the construct of certainty of evidence. J Clin Epidemiol, 2017, 87: 4-13.
19.	Hazlewood GS, Barnabe C, Tomlinson G, et al. Methotrexate monotherapy and methotrexate combination therapy with traditional and biologic disease modifying antirheumatic drugs for rheumatoid arthritis: abridged Cochrane systematic review and network meta-analysis. BMJ, 2016, 353: i1777.
20.	Florez ID, Veroniki AA, Al Khalifah R, et al. Comparative effectiveness and safety of interventions for acute diarrhea and gastroenteritis in children: a systematic review and network meta-analysis. PLoS One, 2018, 13(12): e0207701.
21.	Hutton B, Yazdi F, Bordeleau L, et al. Comparison of physical interventions, behavioral interventions, natural health products, and pharmacologics to manage hot flashes in patients with breast or prostate cancer: protocol for a systematic review incorporating network meta-analyses. Syst Rev, 2015, 4: 114.
22.	Ni?o-Serna LF, Acosta-Reyes J, Veroniki AA, et al. Antiemetics in children with acute gastroenteritis: a meta-analysis. Pediatrics, 2020, 145(4): e20193260.
23.	Noori A, Busse JW, Sadeghirad B, et al. Individual opioids, and long- versus short-acting opioids, for chronic noncancer pain: protocol for a network meta-analysis of randomized controlled trials. Medicine (Baltimore), 2019, 98(43): e17647.
24.	Zeng L, Qasim A, Neogi T, et al. Efficacy and safety of pharmacologic interventions in patients experiencing a gout flare: a systematic review and network meta-analysis. Arthritis Care Res (Hoboken), 2021, 73(5): 755-764.
25.	Lytvyn L, Zeraatkar D, Anbari AB, et al. Conservative intervention strategies for adult cancer-related lymphedema: a systematic review and network meta-analysis. Oncol Nurs Forum, 2020, 47(5): E171-E189.

1. 田金徽, Fujian Song, 李倫, 等. 間接比較方法簡介. 中國循證醫學雜志, 2014, 14(3): 365-368.
2. 田金徽, 李倫, 趙曄, 等. 網狀 Meta 分析的撰寫與報告. 中國藥物評價, 2013, 30(6): 321-323, 333.
3. 田金徽. 中藥注射劑聯合化療治療非小細胞肺癌的網狀 Meta 分析. 蘭州: 蘭州大學, 2012.
4. Bucher HC, Guyatt GH, Griffith LE, et al. The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J Clin Epidemiol, 1997, 50(6): 683-691.
5. Lumley T. Network meta-analysis for indirect treatment comparisons. Stat Med, 2002, 21(16): 2313-2324.
6. Brignardello-Petersen R, Guyatt GH. β-Blockers in heart failure--are all created equal? Pol Arch Med Wewn, 2013, 123(5): 204-205.
7. Neumann I, Brignardello-Petersen R, Guyatt G. ACP Journal Club. Review: novel oral anticoagulants reduce stroke more than ASA in nonvalvular atrial fibrillation. Ann Intern Med, 2014, 160(4): JC3.
8. Andrews JC, Schünemann HJ, Oxman AD, et al. GRADE guidelines: 15. going from evidence to recommendation-determinants of a recommendation's direction and strength. J Clin Epidemiol, 2013, 66(7): 726-735.
9. Puhan MA, Schünemann HJ, Murad MH, et al. A GRADE Working Group approach for rating the quality of treatment effect estimates from network meta-analysis. BMJ, 2014, 349: g5630.
10. Brignardello-Petersen R, Bonner A, Alexander PE, et al. Advances in the GRADE approach to rate the certainty in estimates from a network meta-analysis. J Clin Epidemiol, 2018, 93: 36-44.
11. Brignardello-Petersen R, Murad MH, Walter SD, et al. GRADE approach to rate the certainty from a network meta-analysis: avoiding spurious judgments of imprecision in sparse networks. J Clin Epidemiol, 2019, 105: 60-67.
12. Brignardello-Petersen R, Mustafa RA, Siemieniuk RAC, et al. GRADE approach to rate the certainty from a network meta-analysis: addressing incoherence. J Clin Epidemiol, 2019, 108: 77-85.
13. 王琪, 王建成, 潘蓓, 等. 網狀 Meta 分析證據質量分級: GRADE 方法學前沿與進展. 中國循證醫學雜志, 2020, 20(8): 979-985.
14. 王琪, 王韻華, 賴鴻皓, 等. 網狀 Meta 分析證據質量分級: CINeMA 在線應用程序簡介. 中國循證醫學雜志, 2020, 20(9): 1110-1116.
15. Brignardello-Petersen R, Florez ID, Izcovich A, et al. GRADE approach to drawing conclusions from a network meta-analysis using a minimally contextualised framework. BMJ, 2020, 371: m3900.
16. Brignardello-Petersen R, Izcovich A, Rochwerg B, et al. GRADE approach to drawing conclusions from a network meta-analysis using a partially contextualised framework. BMJ, 2020, 371: m3907.
17. 朱鴻飛, 栗夢婷, 后亮瑛, 等. 網狀 Meta 結論形成的方法: 部分背景化框架. 中國循證醫學雜志, 2021, 21(9): 1110-1116.
18. Hultcrantz M, Rind D, Akl EA, et al. The GRADE Working Group clarifies the construct of certainty of evidence. J Clin Epidemiol, 2017, 87: 4-13.
19. Hazlewood GS, Barnabe C, Tomlinson G, et al. Methotrexate monotherapy and methotrexate combination therapy with traditional and biologic disease modifying antirheumatic drugs for rheumatoid arthritis: abridged Cochrane systematic review and network meta-analysis. BMJ, 2016, 353: i1777.
20. Florez ID, Veroniki AA, Al Khalifah R, et al. Comparative effectiveness and safety of interventions for acute diarrhea and gastroenteritis in children: a systematic review and network meta-analysis. PLoS One, 2018, 13(12): e0207701.
21. Hutton B, Yazdi F, Bordeleau L, et al. Comparison of physical interventions, behavioral interventions, natural health products, and pharmacologics to manage hot flashes in patients with breast or prostate cancer: protocol for a systematic review incorporating network meta-analyses. Syst Rev, 2015, 4: 114.
22. Ni?o-Serna LF, Acosta-Reyes J, Veroniki AA, et al. Antiemetics in children with acute gastroenteritis: a meta-analysis. Pediatrics, 2020, 145(4): e20193260.
23. Noori A, Busse JW, Sadeghirad B, et al. Individual opioids, and long- versus short-acting opioids, for chronic noncancer pain: protocol for a network meta-analysis of randomized controlled trials. Medicine (Baltimore), 2019, 98(43): e17647.
24. Zeng L, Qasim A, Neogi T, et al. Efficacy and safety of pharmacologic interventions in patients experiencing a gout flare: a systematic review and network meta-analysis. Arthritis Care Res (Hoboken), 2021, 73(5): 755-764.
25. Lytvyn L, Zeraatkar D, Anbari AB, et al. Conservative intervention strategies for adult cancer-related lymphedema: a systematic review and network meta-analysis. Oncol Nurs Forum, 2020, 47(5): E171-E189.

Chinese Journal of Evidence-Based Medicine

Method to draw conclusions from a network meta-analysis: a minimally contextualised framework

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