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Meta-analyses involving cross-over trials: methodological issues.

Diana R Elbourne1, Douglas G Altman, Julian P T Higgins

  • 1Medical Statistics Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. diana.elbourne@lshtm.ac.uk

International Journal of Epidemiology
|March 27, 2002
PubMed
Summary
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Synthesizing data from two-period, two-treatment cross-over trials into meta-analyses is possible. However, inconsistent reporting in these randomized controlled trials (RCTs) often hinders effective data synthesis.

Area of Science:

  • Biostatistics
  • Clinical Trials Methodology
  • Evidence Synthesis

Background:

  • Meta-analysis typically focuses on parallel-group randomized controlled trials (RCTs).
  • This study specifically examines two-period, two-treatment cross-over trial designs.
  • Cross-over trials represent a significant portion of research but are often analyzed differently.

Purpose of the Study:

  • To outline methods for analyzing and synthesizing data from two-period, two-treatment cross-over trials.
  • To assess current practices for incorporating cross-over trials into meta-analyses.
  • To provide guidance for researchers conducting meta-analyses of cross-over studies.

Main Methods:

  • Detailed analytical methods for continuous and binary data in cross-over trials.

Related Experiment Videos

  • Extension of case studies to meta-analysis context.
  • Survey of the Cochrane Library to evaluate current synthesis practices for cross-over trials.

    • Main Results:

    • Methods are presented for handling both provided and calculated/imputed paired data.
    • Approximately 8% of trials in the Cochrane Library were cross-over trials, and 18% of reviews mentioned them.
    • A lack of consistent methodology was observed in the synthesis of cross-over trial data within reviews.

    Conclusions:

    • Established methods exist to incorporate data from two-period, two-treatment cross-over trials into quantitative reviews.
    • Poor reporting standards in cross-over trials present a significant barrier to performing robust meta-analyses.
    • Improved reporting is crucial for maximizing the utility of cross-over trial data in evidence synthesis.