Assessing the feasibility of network meta-analyses comparing pharmacological and non-pharmacological interventions for psychiatric disorders

Del Giovane C1, Cortese S2, Cipriani A3
1Institute of Primary Health Care (BIHAM), University of Bern, 2Center for Innovation in Mental Health, Academic Unit of Psychology; Clinical and Experimental Sciences, University of Southampton, 3Department of Psychiatry, University of Oxford

Background: Several network meta-analyses (NMAs) have been conducted to estimate the benefits and/or safety of pharmacological or, separately, non-pharmacological interventions for psychiatric disorders. Recently, a number of NMAs have included pharmacological and non-pharmacological interventions in the same network. The feasibility of such NMAs is questionable because the transitivity assumption (defined as the balance of the distributions of potential effect modifiers across all pairwise comparisons) underlying the methodological validity of a NMA might not hold. This is an important issue since the role of pharmacological versus non-pharmacological interventions is controversial for many psychiatric conditions.

Objectives: To assess the feasibility of currently available NMAs including pharmacological and non-pharmacological interventions for psychiatry disorders in the same network.

Methods: We searched (to January 2018) for published systematic reviews (SRs) with NMA that compared pharmacological and non-pharmacological interventions for psychiatric conditions in a single network. The protocol of any SR included in our analysis was also retrieved. Two independent researchers appraised the feasibility of each NMA critically by applying the framework recommended by Cope and colleagues (ref.).

Results: We identified eight SRs. Five NMAs were conducted in adults, the rest in children and adolescents, or children only. They focused on the following disorders: major depressive, anxiety, social anxiety, post-stroke depression, psychosis, attention deficit hyperactivity and obsessive–compulsive. Protocols were registered in PROSPERO for six SRs. We will present the results of our assessment at the Colloquium. We will also suggest specific items for NMA to be added to Cope's proposed approach.

Conclusions: The results obtained from NMAs are increasingly used to inform decision-making. Methodological assumptions underpinning the validity of a NMA should be particularly scrutinized when planning a NMA that includes pharmacological and non-pharmacological interventions in the same network, or when appraising its quality.

Ref: Cope et al. A process for assessing the feasibility of a network meta-analysis: a case study of everolimus in combination with hormonal therapy versus chemotherapy for advanced breast cancer. BMC Med 2014;12:93