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Users' Guides to the Medical Literature
September 26, 2012

How to Use an Article Reporting a Multiple Treatment Comparison Meta-analysis

Author Affiliations

Users' Guides to the Medical Literature Section Editor: Drummond Rennie, MD, Deputy Editor, JAMA.

Author Affiliations: Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada (Dr Mills); Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada (Drs Mills, Thorlund, Schünemann, and Guyatt); Stanford Prevention Research Center, Departments of Medicine and Health Research and Policy, Stanford University School of Medicine, and Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, California (Dr Ioannidis); Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Puhan).

JAMA. 2012;308(12):1246-1253. doi:10.1001/2012.jama.11228

Multiple treatment comparison (MTC) meta-analysis uses both direct (head-to-head) randomized clinical trial (RCT) evidence as well as indirect evidence from RCTs to compare the relative effectiveness of all included interventions. The methodological quality of MTCs may be difficult for clinicians to interpret because the number of interventions evaluated may be large and the methodological approaches may be complex. Clinicians and others evaluating an MTC should be aware of the potential biases that can affect the interpretation of these analyses. Readers should consider whether the primary studies are sufficiently homogeneous to combine; whether the different interventions are sufficiently similar in their populations, study designs, and outcomes; and whether the direct evidence is sufficiently similar to the indirect evidence to consider combining. This article uses the existing Users' Guides format to address study validity, interpretation of results, and application to a patient scenario.

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