A discussion of the challenges in conducting a systematic review of adverse effects including randomized trials and non-randomized studies

Tags: Oral
Furlan A1, Irvin E1, Carnide N1, Munhall C1, Loke Y2, Marin T1
1Institute for Work and Health, Canada, 2University of East Anglia, UK

Objectives: To discuss the challenges faced by reviewers conducting a systematic review of adverse effects of a pharmacological intervention, and the solutions to each of these challenges that our team used in conducting a review for the Cochrane Back Review.

Results: We will use the example of a review of adverse effects of long-term use of opioids for patients with chronic non-cancer pain. We limited the adverse effects to: overdose, addiction, falls and fractures, function, quality of life and return to work. Many Cochrane Reviews have been published assessing the efficacy and effectiveness of opioids for various types of chronic pain, however these reviews are limited to RCTS which are short duration, whereas ours focuses on the long term effects.

Conclusions: The challenges we faced include: (1) searching for studies of adverse effects; (2) Selecting study designs of NRSs (with control group, without control group, case series, and case reports); (3) Assessing ROB in RCTs and NRSs; (4) Summarizing the findings using GRADE. By the end of the presentation, we hope that there will be a better understanding of some potential solutions to these challenges when conducting reviews of adverse events.