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Comparative Efficacy Randomized Controlled Trials in Rheumatology Guidelines.

Katie Henry1, Desh Nepal1, Erin Valley1

  • 1Medical College of Wisconsin, Milwaukee.

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|July 27, 2022
PubMed
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This summary is machine-generated.

Few rheumatology guidelines use head-to-head randomized controlled trials (RCTs). Recommendations based on these comparative efficacy RCTs show higher levels of evidence, suggesting a need for more head-to-head trials in rheumatology research.

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Area of Science:

  • Rheumatology
  • Clinical Trial Design
  • Evidence-Based Medicine

Background:

  • Comparative efficacy randomized controlled trials (RCTs) compare active treatments head-to-head.
  • These trials are valuable for clinical practice guidelines.
  • The extent of their use in rheumatology guidelines is not well understood.

Purpose of the Study:

  • To assess the utilization of head-to-head RCTs in rheumatology clinical practice guidelines.
  • To evaluate the impact of head-to-head RCTs on the level of evidence for guideline recommendations.

Main Methods:

  • Searched ACR and EULAR websites for guidelines published between January 1, 2017, and June 12, 2021.
  • Identified and extracted data on design and outcomes of referenced RCTs.
  • Analyzed clinical practice recommendations and their associated evidence levels.

Main Results:

  • Fifteen ACR and nine EULAR guidelines were analyzed, citing 609 RCTs and providing 481 recommendations.
  • Only 28% of referenced RCTs used a head-to-head design.
  • Recommendations based on head-to-head RCTs were more likely to have a high level of evidence (LOE) using GRADE or OCEBM.
  • Many recommendations had strong endorsement despite low LOE.

Conclusions:

  • Less than one in six rheumatology guideline recommendations are informed by head-to-head RCTs.
  • Head-to-head RCTs are associated with higher levels of evidence in guideline recommendations.
  • Increased implementation of comparative efficacy RCTs is recommended for rheumatology guidelines.