Abstract
Objectives
Robustness of an existing meta-analysis can justify decisions on whether to conduct
an additional study addressing the same research question. We illustrate the graphical
assessment of the potential impact of an additional study on an existing meta-analysis
using published data on statin use and the risk of acute kidney injury.
Study Design and Setting
A previously proposed graphical augmentation approach is used to assess the sensitivity
of the current test and heterogeneity statistics extracted from existing meta-analysis
data. In addition, we extended the graphical augmentation approach to assess potential
changes in the pooled effect estimate after updating a current meta-analysis and applied
the three graphical contour definitions to data from meta-analyses on statin use and
acute kidney injury risk.
Results
In the considered example data, the pooled effect estimates and heterogeneity indices
demonstrated to be considerably robust to the addition of a future study. Supportingly,
for some previously inconclusive meta-analyses, a study update might yield statistically
significant kidney injury risk increase associated with higher statin exposure.
Conclusions
The illustrated contour approach should become a standard tool for the assessment
of the robustness of meta-analyses. It can guide decisions on whether to conduct additional
studies addressing a relevant research question.
Keywords
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References
- A new network to promote evidence-based research.Lancet. 2014; 384: 1903-1904
Web-url. Available at: http://www.gradeworkinggroup.org. Accessed April 13, 2015.
- When is a further clinical trial justified?.BMJ. 2012; 345: e5913
- A multicomponent decision tool for prioritising the updating of systematic reviews.BMJ. 2013; 347: f7191
- Evidence synthesis as the key to more coherent and efficient research.BMC Med Res Methodol. 2009; 9: 29
- Graphical augmentations to the funnel plot to assess the impact of a new study on an existing meta-analysis.Stata J. 2012; 12: 605-622
- Planning future studies based on the conditional power of a meta-analysis.Stat Med. 2013; 32: 11-24
- Simulation-based sample-size calculation for designing new clinical trials and diagnostic test accuracy studies to update an existing meta-analysis.Stata J. 2013; 13: 451-473
- Graphical augmentations to the funnel plot assess the impact of additional evidence on a meta-analysis.J Clin Epidemiol. 2012; 65: 511-519
- Evidence-based sample size calculations based upon updated meta-analysis.Stat Med. 2007; 26: 2479-2500
- Sequential methods for random-effects meta-analysis.Stat Med. 2011; 30: 903-921
- Quantifying heterogeneity in a meta-analysis.Stat Med. 2002; 21: 1539-1558
- Use of high potency statins and rates of admission for acute kidney injury: multicenter, retrospective observational analysis of administrative databases.BMJ. 2013; 346: f880
- A re-evaluation of random-effects meta-analysis.J R Stat Soc Ser A Stat Soc. 2009; 172: 137-159
- Overcoming the limitations of current meta-analysis of randomised controlled trials.Lancet. 1998; 351: 47-52
- Trial sequential analysis may establish when firm evidence is reached in cumulative meta-analysis.J Clin Epidemiol. 2008; 61: 64-75
- Can trial sequential monitoring boundaries reduce spurious inferences from meta-analyses?.Int J Epidemiol. 2009; 38: 276-286
Article info
Publication history
Published online: June 16, 2015
Accepted:
May 30,
2015
Footnotes
Funding and disclosure of financial interests: This work was supported by the Canadian Network for Observational Drug Effect Studies (CNODES), a collaborating centre of the Drug Safety and Effectiveness Network (DSEN), funded by the Canadian Institutes of Health Research (Grant Number DSE-111845). T.S. is supported by a CNODES postdoctoral award. R.W.P. is supported in part by a National Scholar (Chercheur National) of the Fonds de Recherche du Québec—Santé (FQR-S) and is a member of the Research Institute of the McGill University Health Center, which is supported by core funds from FQR-S.
All authors declare to have no support from any other organization for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 5 years; and no other relationships or activities that could appear to have influenced the submitted work.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
