Dataset Information

The use of single armed observational data to closing the gap in otherwise disconnected evidence networks: a network meta-analysis in multiple myeloma.

ABSTRACT: BACKGROUND:Network meta-analysis (NMA) allows for the estimation of comparative effectiveness of treatments that have not been studied in head-to-head trials; however, relative treatment effects for all interventions can only be derived where available evidence forms a connected network. Head-to-head evidence is limited in many disease areas, regularly resulting in disconnected evidence structures where a large number of treatments are available. This is also the case in the evidence of treatments for relapsed or refractory multiple myeloma. METHODS:Randomised controlled trials (RCTs) identified in a systematic literature review form two disconnected evidence networks. Standard Bayesian NMA models are fitted to obtain estimates of relative effects within each network. Observational evidence was identified to fill the evidence gap. Single armed trials are matched to act as each other's control group based on a distance metric derived from covariate information. Uncertainty resulting from including this evidence is incorporated by analysing the space of possible matches. RESULTS:Twenty five randomised controlled trials form two disconnected evidence networks; 12 single armed observational studies are considered for bridging between the networks. Five matches are selected to bridge between the networks. While significant variation in the ranking is observed, daratumumab in combination with dexamethasone and either lenalidomide or bortezomib, as well as triple therapy of carfilzomib, ixazomib and elozumatab, in combination with lenalidomide and dexamethasone, show the highest effects on progression free survival, on average. CONCLUSIONS:The analysis shows how observational data can be used to fill gaps in the existing networks of RCT evidence; allowing for the indirect comparison of a large number of treatments, which could not be compared otherwise. Additional uncertainty is accounted for by scenario analyses reducing the risk of over confidence in interpretation of results.

SUBMITTER: Schmitz S

PROVIDER: S-EPMC6022299 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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The use of single armed observational data to closing the gap in otherwise disconnected evidence networks: a network meta-analysis in multiple myeloma.

Schmitz Susanne S Maguire Áine Á Morris James J Ruggeri Kai K Haller Elisa E Kuhn Isla I Leahy Joy J Homer Natalia N Khan Ayesha A Bowden Jack J Buchanan Vanessa V O'Dwyer Michael M Cook Gordon G Walsh Cathal C

BMC medical research methodology 20180628 1

<h4>Background</h4>Network meta-analysis (NMA) allows for the estimation of comparative effectiveness of treatments that have not been studied in head-to-head trials; however, relative treatment effects for all interventions can only be derived where available evidence forms a connected network. Head-to-head evidence is limited in many disease areas, regularly resulting in disconnected evidence structures where a large number of treatments are available. This is also the case in the evidence of ...[more]

PMID: 29954322

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Project description:BackgroundNetwork meta-analysis (NMA) synthesizes direct and indirect evidence on multiple treatments to estimate their relative effectiveness. However, comparisons between disconnected treatments are not possible without making strong assumptions. When studies including multiple doses of the same drug are available, model-based NMA (MBNMA) presents a novel solution to this problem by modeling a parametric dose-response relationship within an NMA framework. In this article, we illustrate several scenarios in which dose-response MBNMA can connect and strengthen evidence networks.MethodsWe created illustrative data sets by removing studies or treatments from an NMA of triptans for migraine relief. We fitted MBNMA models with different dose-response relationships. For connected networks, we compared MBNMA estimates with NMA estimates. For disconnected networks, we compared MBNMA estimates with NMA estimates from an "augmented" network connected by adding studies or treatments back into the data set.ResultsIn connected networks, relative effect estimates from MBNMA were more precise than those from NMA models (ratio of posterior SDs NMA v. MBNMA: median = 1.13; range = 1.04-1.68). In disconnected networks, MBNMA provided estimates for all treatments where NMA could not and were consistent with NMA estimates from augmented networks for 15 of 18 data sets. In the remaining 3 of 18 data sets, a more complex dose-response relationship was required than could be fitted with the available evidence.ConclusionsWhere information on multiple doses is available, MBNMA can connect disconnected networks and increase precision while making less strong assumptions than alternative approaches. MBNMA relies on correct specification of the dose-response relationship, which requires sufficient data at different doses to allow reliable estimation. We recommend that systematic reviews for NMA search for and include evidence (including phase II trials) on multiple doses of agents where available.

Project description:Total-evidence dating (TED) allows evolutionary biologists to incorporate a wide range of dating information into a unified statistical analysis. One might expect this to improve the agreement between rocks and clocks but this is not necessarily the case. We explore the reasons for such discordance using a mammalian dataset with rich molecular, morphological and fossil information. There is strong conflict in this dataset between morphology and molecules under standard stochastic models. This causes TED to push divergence events back in time when using inadequate models or vague priors, a phenomenon we term 'deep root attraction' (DRA). We identify several causes of DRA. Failure to account for diversified sampling results in dramatic DRA, but this can be addressed using existing techniques. Inadequate morphological models also appear to be a major contributor to DRA. The major reason seems to be that current models do not account for dependencies among morphological characters, causing distorted topology and branch length estimates. This is particularly problematic for huge morphological datasets, which may contain large numbers of correlated characters. Finally, diversification and fossil sampling priors that do not incorporate all the available background information can contribute to DRA, but these priors can also be used to compensate for DRA. Specifically, we show that DRA in the mammalian dataset can be addressed by introducing a modest extra penalty for ghost lineages that are unobserved in the fossil record, for instance by assuming rapid diversification, rare extinction or high fossil sampling rate; any of these assumptions produces highly congruent divergence time estimates with a minimal gap between rocks and clocks. Under these conditions, fossils have a stabilizing influence on divergence time estimates and significantly increase the precision of those estimates, which are generally close to the dates suggested by palaeontologists.This article is part of the themed issue 'Dating species divergences using rocks and clocks'.

Dataset Information

The use of single armed observational data to closing the gap in otherwise disconnected evidence networks: a network meta-analysis in multiple myeloma.

Publications

The use of single armed observational data to closing the gap in otherwise disconnected evidence networks: a network meta-analysis in multiple myeloma.

Similar Datasets

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