メタ分析と大規模な試験の比較に関する問題
J P Ioannidis1, J C Cappelleri, J Lau
1National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20852, USA. ji24m@nih.gov
JAMA
|April 18, 1998
まとめ
メタアナリシスと大規模な試験の間の不一致は,研究の選択とエンドポイントの定義に依存します. これらの臨床的エビデンスツールの慎重な評価は,医療実践の指導に不可欠です.
科学分野:
- 臨床流行病学 臨床流行病学とは
- 根拠に基づいた医学は,証拠に基づいた医療です.
背景:
- 様々なプロトコルを使用してメタ解析と大規模な試験の一致性を調査した.
- 矛盾する結論は,これらの臨床的証拠ツールの信頼性について疑問を投げかけています.
研究 の 目的:
- メタ解析と大規模な試験を比較したプロトコルを評価する.
- この2つの研究方法の一致性における意見の相違の理由を理解する.
主な方法:
- プロトコル設計の体系的な比較.
- 研究の選択,合意の定義,分析方法の分析.
- 大規模な試験とメタ解析の間の報告された不一致の検討.
主要な成果:
- 大規模な試験が有力なジャーナルからのものであった場合,または二次的エンドポイントが含まれていた場合,不一致は増加しました.
- 合意は定義によって著しく変化した (kappa 0.22-0.72);治療効果相関は -0.12から0.76.7までだった.
- 大規模な試験は,規模と不確実性が考慮された10-23%の時間においてメタアナリシスに異議を唱えました; 疾患リスク,プロトコル,品質,バイアスに起因します.
結論:
- 研究とエンドポイントの選択は,大規模な試験とメタ分析を比較する際に結論に影響を与えます.
- 2つの研究方法の批判的評価は,医学の実践を導く上でそれらの有用性を高めます.
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