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Adjusted indirect comparison may be less biased than direct comparison for evaluating new pharmaceutical
1School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK. fujian.song@uea.ac.uk
Journal of Clinical Epidemiology
|April 9, 2008
Summary
Direct comparisons in drug meta-analyses may overestimate new drug effects. Adjusted indirect comparisons might offer less biased results, warranting further investigation into their validity against head-to-head trials.
Area of Science:
- Pharmacology and Clinical Trials
- Biostatistics and Meta-Analysis
Background:
- Meta-analyses comparing new versus conventional pharmaceutical interventions often use direct (head-to-head) and indirect comparison methods.
- Discrepancies between these methods can impact treatment efficacy conclusions.
Purpose of the Study:
- To investigate discrepancies between direct and adjusted indirect comparison meta-analyses for new pharmaceutical interventions.
- To evaluate the potential for adjusted indirect comparison to yield less biased results.
Main Methods:
- Three case studies involving meta-analyses of new versus conventional drugs were analyzed: bupropion vs. nicotine replacement therapy (smoking cessation), risperidone vs. haloperidol (schizophrenia), and fluoxetine vs. imipramine (depression).
- Results from direct comparisons were contrasted with adjusted indirect comparisons.
Main Results:
- In all three cases, direct comparisons tended to show greater effects for new drugs compared to adjusted indirect comparisons.
- Discrepancies were not adequately explained by chance, bias, or heterogeneity in indirect comparisons.
- Analysis suggested adjusted indirect comparisons might provide less biased results, potentially counterbalancing bias under specific conditions.
Conclusions:
- Adjusted indirect comparison can serve as a method to cross-examine the validity of head-to-head randomized trial results.
- Further research is needed to investigate the hypothesis that adjusted indirect comparisons may offer less biased results than direct head-to-head trials.
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