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Meta-analyses frequently pooled different study types together: a meta-epidemiological study.

René-Sosata Bun1, Jordan Scheer1, Sylvie Guillo2

  • 1Sorbonne Université, AP-HP. Sorbonne Université, Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie de l'AP-HP (Cephepi), Paris F75013, France.

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Therapeutic meta-analyses often combine observational studies and randomized controlled trials (RCTs). While treatment effects generally align, specific situations show differing estimates between study types.

Keywords:
Comparative effectiveness researchMeta-analysisMeta-epidemiologyObservational studiesRandomized controlled trialsSystematic reviewTherapeutic intervention

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Area of Science:

  • Medical research methodology
  • Evidence synthesis
  • Comparative effectiveness research

Background:

  • Therapeutic meta-analyses frequently incorporate diverse study designs.
  • Understanding how observational studies and randomized controlled trials (RCTs) are integrated is crucial for evidence interpretation.
  • Differences in treatment effects between study types can impact clinical decision-making.

Purpose of the Study:

  • To characterize therapeutic meta-analyses that include both observational studies and RCTs.
  • To examine the methods used for combining these different study types within meta-analyses.
  • To assess whether significant differences exist in treatment effect estimates derived from observational studies versus RCTs.

Main Methods:

  • A meta-epidemiological study was conducted on meta-analyses published between 2014 and 2018.
  • Searches were performed in leading medical journals and the Cochrane Database of Systematic Reviews.
  • Data were extracted on the combination methods for observational studies and RCTs, and their respective results.

Main Results:

  • Of 102 meta-analyses, 38% combined observational studies and RCTs without subgroup analysis, and 15% did so with subgroup analysis.
  • 11% pooled data separately for the same outcome, while 9% did not pool for the same outcome.
  • Treatment effect estimates did not significantly differ on average (estimate ratio = 0.98), but substantial heterogeneity (I² = 59%) was observed.

Conclusions:

  • Many meta-analyses combine results from both observational studies and RCTs.
  • While average treatment effects are similar, specific circumstances can lead to differing estimates.
  • Methodological choices in meta-analysis influence the interpretation of combined evidence.