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GRADE approach to rate the certainty from a network meta-analysis: addressing incoherence
Romina Brignardello-Petersen1, Reem A Mustafa2, Reed A C Siemieniuk1
1Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8, Canada.
Journal of Clinical Epidemiology
|December 12, 2018
Summary
This guidance addresses incoherence in network meta-analysis, explaining its causes and how to judge its impact on evidence certainty using the GRADE framework.
Area of Science:
- Medical Research Methodology
- Evidence Synthesis
- Health Technology Assessment
Background:
- Network meta-analysis (NMA) synthesizes evidence from multiple treatment comparisons.
- Assessing the certainty of evidence in NMA is crucial for decision-making.
- Incoherence, or inconsistency between direct and indirect evidence, poses a challenge in NMA.
Purpose of the Study:
- To provide official guidance on addressing incoherence in NMA.
- To clarify the role of incoherence in GRADE certainty assessments.
- To offer practical strategies for reviewers evaluating NMA.
Main Methods:
- The article outlines the Grading of Recommendations Assessments, Development, and Evaluation (GRADE) approach.
- It details potential sources of incoherence, including bias, indirectness, and intransitivity.
- Guidance is provided on judging the impact of incoherence on the network estimate.
Main Results:
- Incoherence arises from significant discrepancies between direct and indirect treatment effect estimates.
- Potential causes include study design limitations, publication bias, indirectness, and intransitivity.
- Judicious assessment of incoherence's impact is necessary to avoid unwarranted downgrades in evidence certainty.
Conclusions:
- Addressing incoherence requires careful judgment regarding its impact on the overall network estimate.
- Reviewers must be vigilant against over-downgrading evidence certainty due to incoherence and related GRADE domains.
- The article provides a framework for consistent and accurate certainty assessments in NMA.
Keywords:
Certainty in the evidenceGRADEIncoherenceInconsistencyNetwork meta-analysisQuality of the evidenceSystematic reviewsMore Related Videos
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