メタ解析における分析戦略と治療結果の推定との関連性
Agnes Dechartres1, Douglas G Altman2, Ludovic Trinquart3
1Centre de Recherche Epidémiologie et Statistique, INSERM U1153, Paris, France2Centre d'Épidémiologie Clinique, Hôpital Hôtel Dieu, Assistance Publique des Hôpitaux de Paris, Paris, France3Faculté de Médecine, Université Paris Descartes, Sorbonne Paris Cit.
JAMA
|August 14, 2014
まとめ
すべての試験をメタ分析に含め,特に主観的な結果については,しばしばより大きな治療効果が得られます. これは,メタ解析における感受性分析が,確固たる結論を確実にするために重要であることを強調しています.
科学分野:
- バイオ統計学 バイオ統計学
- 臨床流行病学 臨床流行病学とは
- エビデンス・シンセシス
背景:
- メタアナリシスは,研究成果を統合する上で極めて重要です.
- 主な課題は,利用可能なすべての試験を含めるか,選択的な戦略を使用するかを決定することです.
研究 の 目的:
- すべての試験を含むメタアナリシスの治療結果と代替戦略を比較する.
- メタアナリシスの結果に対する異なる含有基準の影響を調査する.
主な方法:
- 高インパクトジャーナルとコクランデータベースから163件のメタ解析 (1240件のランダム化臨床試験) を分析した.
- すべての試験のメタ解析を,単一の最も正確な試験,最大の試験,制限メタ解析,およびバイアスのリスクが低い試験のような戦略と比較した.
- 確率比率の比率 (ROR) を差異を定量化するために使用し,ROR > 1 はすべての試験を含む場合より大きな結果を示します.
主要な成果:
- すべての試験のメタ解析は,単一の最も正確な試験と比較して,主観的な (ROR 1.13) および客観的な (ROR 1.03) 結果の両方でより大きな治療結果を示しました.
- 主観的なメタ解析の51%と客観的なメタ解析の39%で,実質的な差異が認められた.
- すべての試験のインクルージョンを他の戦略と比較すると,結果の不安定性を強調するさまざまな結果が見つかりました.
結論:
- メタアナリシスの治療結果の推定値は,採用された分析戦略によって大きく異なります.
- この変動は,結論に大きな変化をもたらし,系統的な感受性分析の必要性を強調する可能性があります.
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