Article type
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Abstract
Background: Particular challenges face the healthcare decision maker when presented with choice among innovative and expanding health technologies as there may be evidence from only a restricted range of study designs; limited follow up and absence of direct comparison between technologies. In order to make best use of limited data from studies of such technologies, a range of techniques in meta-analysis may be employed including adjusted indirect comparison (described by Song) and meta-analysis of longitudinal data (developed by Jones). The National Institute for Health and Clinical Excellence commissioned our group to assess the clinical effects of three new biological agents (adalimumab, etanercept and infliximab) which inhibit TNF-alpha activity and therefore show promise for alleviating and modifying disease in people with ankylosing spondylitis.
Objectives: Using our systematic review of RCTs, we intend to contextualise the application of established and emerging metaanalytical techniques. Referring to current practice within The Cochrane Collaboration we will describe potential improvements in managing longitudinal data in systematic reviews.
Results: Techniques of evidence synthesis employed included meta-analysis of aggregate data from placebo controlled trials of adalimumab, etanercept or infliximab at discrete time points; pooling of these studies to estimate the effects of TNF-alpha inhibitors as a whole; adjusted indirect statistical comparison of TNF-alpha inhibitors and meta-analysis of longitudinal continuous data. Analysis of compound outcomes indicative of response to treatment (Assessments in Ankylosing Spondylitis response criteria) and composite scores of disease activity (Bath Ankylosing Spondylitis Disease Activity Index) and function (Bath Ankylosing Spondylitis Functional Index) will be presented for each approach listed above. The potential implications for Cochrane systematic reviews will be discussed along with experience in presentation of these analyses to the healthcare decision maker.
Objectives: Using our systematic review of RCTs, we intend to contextualise the application of established and emerging metaanalytical techniques. Referring to current practice within The Cochrane Collaboration we will describe potential improvements in managing longitudinal data in systematic reviews.
Results: Techniques of evidence synthesis employed included meta-analysis of aggregate data from placebo controlled trials of adalimumab, etanercept or infliximab at discrete time points; pooling of these studies to estimate the effects of TNF-alpha inhibitors as a whole; adjusted indirect statistical comparison of TNF-alpha inhibitors and meta-analysis of longitudinal continuous data. Analysis of compound outcomes indicative of response to treatment (Assessments in Ankylosing Spondylitis response criteria) and composite scores of disease activity (Bath Ankylosing Spondylitis Disease Activity Index) and function (Bath Ankylosing Spondylitis Functional Index) will be presented for each approach listed above. The potential implications for Cochrane systematic reviews will be discussed along with experience in presentation of these analyses to the healthcare decision maker.