Presentation (CTI)

OBJECTIVES: Network meta-analysis (NMA) is a statistical approach used to compare results from clinical trials of different treatments that have not been studied in head-to-head trials. These estimates of comparative efficacy across multiple treatments can support clinical decision-making. To assure their clinical utility, NMAs require critical assessment, as not all analyses are equally valid. A robust NMA, for example, must compare clinical trials with reasonably similar study designs. It is important to evaluate the consistency of the studies compared and the NMA’s conclusions before using results to inform decision making. Many published NMAs differ according to included trials, outcomes assessed, and methods applied. The abundance and variable quality of published NMAs investigating treatments for psoriasis make it difficult for clinicians to parse all the available data and draw meaningful conclusions to inform their clinical practice.
METHODS: We have highlighted key methodologic considerations to outline best practices and aim to encourage clinicians to consider differences in eligibility criteria, baseline risk adjustment, overinterpretation of point estimates, short- and long-term comparisons, and limitations of analyses of safety outcomes when evaluating and interpreting NMAs in psoriasis, to ensure they can be confident in the most up-to-date and robust data to inform their clinical practice.
RESULTS: It is critical that clinicians have the knowledge necessary to assess NMAs accurately. Readers should check that the key assumptions of NMA are satisfied and whether cross trial heterogeneity is present and has been appropriately addressed. Conclusions regarding long-term efficacy should be interpreted with caution as these findings may be interpolated based on short-term results or derived from methods that cannot adequately manage cross-trial heterogeneity.
CONCLUSIONS: Even when NMAs use appropriate methods, conclusions drawn from their results may have a limited context, so it is important for clinicians to be informed by diverse sources of information.