Quality of Systematic Reviews With Network Meta-Analyses on JAK Inhibitors in the Treatment of Rheumatoid Arthritis: Application of the AMSTAR 2 Scale
Author(s)
Bruna Ramalho, PharmD1, Ana Penedones, PhD2, Diogo Mendes, PhD2, Carlos Alves, PhD1.
1Laboratory of Social Pharmacy and Public Health, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal, 2Clevidence, Oeiras, Portugal.
1Laboratory of Social Pharmacy and Public Health, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal, 2Clevidence, Oeiras, Portugal.
OBJECTIVES: Systematic reviews (SRs), particularly those using network meta-analysis (NMA), play a fundamental role in synthesising scientific evidence, enabling both direct and indirect comparisons of therapeutic interventions. Janus kinase (JAK) inhibitors have been the subject of numerous SRs with NMA due to their emerging role in RA management. However, the reliability of these reviews depends on their methodological quality, which can be critically assessed using the AMSTAR 2 tool. Methodological flaws in SRs may lead to biased conclusions, potentially compromising evidence-based practice. This study aimed to evaluate the methodological quality of SRs with NMA assessing the efficacy and/or safety of JAK inhibitors in RA, using AMSTAR 2.
METHODS: A structured search was conducted in PubMed to identify SRs with NMA evaluating JAK inhibitors as a therapeutic class in RA. Eligible publications were full-text articles in English addressing efficacy and/or safety. Narrative reviews, letters, duplicates, reviews on individual drugs or without quantitative synthesis were excluded. Three independent reviewers assessed methodological quality using the 16 AMSTAR 2 criteria.
RESULTS: 69 articles initially identified, 15 met the eligibility criteria: 10 focused on efficacy (exclusively or combined with secondary safety outcomes) and 5 on safety. The most consistently met criteria were “definition of the PICO question” (100%), “duplicate selection” (100%) and “sources of conflict of interest” (100%). The most frequent methodological weaknesses were lack of protocol registration (33%) and inadequate assessment of publication bias (60%). A notable difference emerged in how risk of bias was addressed: all safety-focused SRs complied (100%), while only 3 of the 10 reviews addressing efficacy met this criterion (30%).
CONCLUSIONS: Most SRs with NMA on JAK inhibitors in RA demonstrated important methodological limitations, especially regarding publication bias. Quality was higher in safety-focused reviews, while efficacy focused SRs with NMAs revealed weaker standards, highlighting the need for mor consistent and rigorous methodologies.
METHODS: A structured search was conducted in PubMed to identify SRs with NMA evaluating JAK inhibitors as a therapeutic class in RA. Eligible publications were full-text articles in English addressing efficacy and/or safety. Narrative reviews, letters, duplicates, reviews on individual drugs or without quantitative synthesis were excluded. Three independent reviewers assessed methodological quality using the 16 AMSTAR 2 criteria.
RESULTS: 69 articles initially identified, 15 met the eligibility criteria: 10 focused on efficacy (exclusively or combined with secondary safety outcomes) and 5 on safety. The most consistently met criteria were “definition of the PICO question” (100%), “duplicate selection” (100%) and “sources of conflict of interest” (100%). The most frequent methodological weaknesses were lack of protocol registration (33%) and inadequate assessment of publication bias (60%). A notable difference emerged in how risk of bias was addressed: all safety-focused SRs complied (100%), while only 3 of the 10 reviews addressing efficacy met this criterion (30%).
CONCLUSIONS: Most SRs with NMA on JAK inhibitors in RA demonstrated important methodological limitations, especially regarding publication bias. Quality was higher in safety-focused reviews, while efficacy focused SRs with NMAs revealed weaker standards, highlighting the need for mor consistent and rigorous methodologies.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
SA78
Topic
Health Technology Assessment, Methodological & Statistical Research, Study Approaches
Topic Subcategory
Literature Review & Synthesis, Meta-Analysis & Indirect Comparisons
Disease
Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)