Overlapping network meta-analyses on psoriasis systemic treatments, an overview: quantity does not make quality

Area of Science:

• Dermatology
• Evidence Synthesis
• Health Technology Assessment

Background:

• Network meta-analyses (NMAs) are valuable for comparing systemic treatments in moderate-to-severe psoriasis.
• However, an increasing number of NMAs raises concerns about redundancy and reproducibility.

Purpose of the Study:

• To assess redundancy and characterize network meta-analyses (NMAs) for systemic treatments in moderate-to-severe psoriasis.
• To identify potential issues affecting the reliability and clinical utility of existing NMAs.

Main Methods:

• Systematic review of NMAs of randomized controlled trials in adult moderate-to-severe psoriasis.
• Searched PubMed, Epistemonikos, PROSPERO, and other databases up to February 2021.
• Assessed redundancy, overlap, confidence in results, funding, spin, reporting, and methodological characteristics.

Main Results:

• Included 47 redundant NMAs; only 4% covered all treatments.
• Confidence in results was critically low for 83% of NMAs.
• Spin was present in all abstracts, and reporting was poor; 55% received pharmaceutical funding.

Conclusions:

• Significant redundancy and methodological heterogeneity exist among NMAs for psoriasis treatments.
• Poor confidence, reporting issues, and spin compromise the reliability of many NMAs.
• Clinicians must interpret NMAs cautiously to ensure evidence-based decision-making.