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Living network meta-analysis compared with pairwise meta-analysis in comparative effectiveness research: empirical

Adriani Nikolakopoulou1, Dimitris Mavridis2,3, Toshi A Furukawa4

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Living network meta-analyses provide stronger evidence against the null hypothesis earlier than conventional pairwise meta-analyses in comparative effectiveness research. This approach accelerates the discovery of effective medical interventions.

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Area of Science:

  • Medical research methodology
  • Comparative effectiveness research
  • Evidence synthesis

Background:

  • Network meta-analysis (NMA) is a statistical technique used to compare multiple treatments simultaneously.
  • Living meta-analyses are continuously updated as new evidence emerges.
  • Comparative effectiveness research (CER) aims to determine which treatments work best in real-world settings.

Purpose of the Study:

  • To evaluate if continuously updated
  • living
  • network meta-analyses (LNMA) provide earlier and stronger evidence against the null hypothesis in CER compared to conventional pairwise meta-analyses.
  • To compare the time and frequency of achieving strong statistical evidence between LNMA and living pairwise meta-analyses.

Main Methods:

  • An empirical study analyzed accumulating evidence from published network meta-analyses of randomized controlled trials (RCTs).
  • Data sources included Medline, Embase, and Cochrane Database of Systematic Reviews up to April 2015.
  • Cumulative pairwise and network meta-analyses were performed, with monitoring boundaries for statistical significance set at α=5% and 90% power.

Main Results:

  • 49 comparisons from 44 networks were analyzed, primarily involving active drugs in cardiology, endocrinology, psychiatry, and rheumatology.
  • LNMA provided strong evidence against the null hypothesis more often (10 additional comparisons) and earlier (median 19 years vs. 23 years) than pairwise meta-analyses.
  • Statistical significance was reached more frequently with LNMA (P=0.002), with a hazard ratio of 2.78 (P=0.05) for earlier evidence.

Conclusions:

  • Prospectively planned living network meta-analyses are more effective in comparative effectiveness research.
  • LNMA generate stronger evidence against the null hypothesis more frequently and sooner than conventional pairwise meta-analyses.
  • This methodology enhances the timely identification of effective medical interventions.