Importance of assessing and adjusting for cross-study heterogeneity in network meta-analysis: a case study of psoriasis

The importance of adjusting for cross-study heterogeneity when conducting network meta-analyses (NMAs) was demonstrated using a case study of biologic therapies for moderate-to-severe plaque psoriasis. Bayesian NMAs were conducted for Psoriasis Area and Severity Index 90 response. Several covariates...

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Bibliographic Details
Published in:Journal of comparative effectiveness research 2018-11, Vol.7 (11), p.1037-1051
Main Authors: Cameron, Chris, Hutton, Brian, Druchok, Cheryl, McElligott, Sean, Nair, Sandhya, Schubert, Agata, Situ, Aaron, Varu, Abhishek, Villacorta, Reggie
Format: Article
Language:English
Subjects:
biologic
heterogeneity
indirect comparison
network meta-analysis
placebo response
psoriasis
Psoriasis Area and Severity Index
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Summary:The importance of adjusting for cross-study heterogeneity when conducting network meta-analyses (NMAs) was demonstrated using a case study of biologic therapies for moderate-to-severe plaque psoriasis. Bayesian NMAs were conducted for Psoriasis Area and Severity Index 90 response. Several covariates were considered to account for cross-trial differences: baseline risk (i.e., placebo response), prior biologic use, body weight, psoriasis duration, age, race and baseline Psoriasis Area and Severity Index score. Model fit was evaluated. The baseline risk-adjusted NMA, which adjusts for multiple observed and unobserved effect modifiers, was associated with the best model fit. Lack of adjustment for cross-trial differences led to different clinical interpretations of findings. Failure to adjust for cross-trial differences in NMA can have important implications for clinical interpretations when studying the comparative efficacy of healthcare interventions.
ISSN:2042-6305
2042-6313
DOI:10.2217/cer-2018-0065