TY - JOUR
T1 - Network Meta-analysis for clinical practice guidelines
T2 - A case study on first-line medical therapies for primary open-angle glaucoma
AU - Rouse, Benjamin
AU - Cipriani, Andrea
AU - Shi, Qiyuan
AU - Coleman, Anne L.
AU - Dickersin, Kay
AU - Li, Tianjing
N1 - Funding Information:
National Eye Institute, National Institutes of Health. The authors thank Laurie Bagley for providing the 1989-2006 versions of the American Academy of Ophthalmology's Primary Open Angle Glaucoma Preferred Practice Patterns; Hwanhee Hong for her help in developing the models used in this study; Alfred Sommer for providing information about the history of the Primary Open-Angle Glaucoma Preferred Practice Pattern guidelines; Roberta Scherer for her feedback on previous versions of the manuscript; and Georgia Salanti, Huseyin Naci, Deborah Caldwell, Stefan K. Leucht, and Toshiaki A. Furukawa for contributing insights to the design of the project. By grant 1 RC1 EY020140 and grant 1 U01 EY020522, National Eye Institute, National Institutes of Health (principal investigator: Dr. Kay Dickersin). Dr. Andrea Cipriani is supported by the National Institute for Health Research Oxford Cognitive Health Clinical Research Facility. Mr. Rouse and Mr. Shi report grants from the National Eye Institute, National Institutes of Health, during the conduct of the study. Dr. Dickersin reports grants from National Eye Institute during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors /icmje/ConflictOfInterestForms.do?msNum=M15-2367.
Publisher Copyright:
© 2016 American College of Physicians.
PY - 2016/5/17
Y1 - 2016/5/17
N2 - Background: Network meta-analysis compares multiple treatment options for the same condition and may be useful for developing clinical practice guidelines. Purpose: To compare treatment recommendations for first-line medical therapy for primary open angle-glaucoma (POAG) from major updates of American Academy of Ophthalmology (AAO) guidelines with the evidence available at the time, using network meta-analysis. Data Sources: MEDLINE, Embase, and the Cochrane Library were searched on 11 March 2014 for randomized, controlled trials (RCTs) of glaucoma monotherapies compared with placebo, vehicle, or no treatment or other monotherapies. The AAO Web site was searched in August 2014 to identify AAO POAG guidelines. Study Selection: Eligible RCTs were selected by 2 independent reviewers, and guidelines were selected by 1 person. Data Extraction: One person abstracted recommendations from guidelines and a second person verified. Two people independently abstracted data from included RCTs. Data Synthesis: Guidelines were grouped together on the basis of literature search dates, and RCTs that existed at 1991, 1995, 1999, 2004, and 2009 were analyzed. The outcome of interest was intraocular pressure (IOP) at 3 months. Only the latest guideline made a specific recommendation: prostaglandins. Network meta-analyses showed that all treatments were superior to placebo in decreasing IOP at 3 months. The mean reductions (95% credible intervals [CrIs]) for the highest-ranking class compared with placebo were as follows: 1991: β-blockers, 4.01 (CrI, 0.48 to 7.43); 1995: α2-adrenergic agonists, 5.64 (CrI, 1.73 to 9.50); 1999: prostaglandins, 5.43 (CrI, 3.38 to 7.38); 2004: prostaglandins, 4.75 (CrI, 3.11 to 6.44); 2009: prostaglandins, 4.58 (CrI, 2.94 to 6.24). Limitation: When comparisons are informed by a small number of studies, the treatment effects and rankings may not be stable. Conclusion: For timely recommendations when multiple treatment options are available, guidelines developers should consider network meta-analysis.
AB - Background: Network meta-analysis compares multiple treatment options for the same condition and may be useful for developing clinical practice guidelines. Purpose: To compare treatment recommendations for first-line medical therapy for primary open angle-glaucoma (POAG) from major updates of American Academy of Ophthalmology (AAO) guidelines with the evidence available at the time, using network meta-analysis. Data Sources: MEDLINE, Embase, and the Cochrane Library were searched on 11 March 2014 for randomized, controlled trials (RCTs) of glaucoma monotherapies compared with placebo, vehicle, or no treatment or other monotherapies. The AAO Web site was searched in August 2014 to identify AAO POAG guidelines. Study Selection: Eligible RCTs were selected by 2 independent reviewers, and guidelines were selected by 1 person. Data Extraction: One person abstracted recommendations from guidelines and a second person verified. Two people independently abstracted data from included RCTs. Data Synthesis: Guidelines were grouped together on the basis of literature search dates, and RCTs that existed at 1991, 1995, 1999, 2004, and 2009 were analyzed. The outcome of interest was intraocular pressure (IOP) at 3 months. Only the latest guideline made a specific recommendation: prostaglandins. Network meta-analyses showed that all treatments were superior to placebo in decreasing IOP at 3 months. The mean reductions (95% credible intervals [CrIs]) for the highest-ranking class compared with placebo were as follows: 1991: β-blockers, 4.01 (CrI, 0.48 to 7.43); 1995: α2-adrenergic agonists, 5.64 (CrI, 1.73 to 9.50); 1999: prostaglandins, 5.43 (CrI, 3.38 to 7.38); 2004: prostaglandins, 4.75 (CrI, 3.11 to 6.44); 2009: prostaglandins, 4.58 (CrI, 2.94 to 6.24). Limitation: When comparisons are informed by a small number of studies, the treatment effects and rankings may not be stable. Conclusion: For timely recommendations when multiple treatment options are available, guidelines developers should consider network meta-analysis.
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U2 - 10.7326/M15-2367
DO - 10.7326/M15-2367
M3 - Article
C2 - 27088551
AN - SCOPUS:84969969921
SN - 0003-4819
VL - 164
SP - 674
EP - 682
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 10
ER -