Abstract
Objectives
We aimed to evaluate the underlying assumptions of a network meta-analysis investigating
which depression treatment works best in primary care and to highlight challenges
and pitfalls of interpretation under consideration of these assumptions.
Study Design and Setting
We reviewed 100 randomized trials investigating pharmacologic and psychological treatments
for primary care patients with depression. Network meta-analysis was carried out within
a frequentist framework using response to treatment as outcome measure. Transitivity
was assessed by epidemiologic judgment based on theoretical and empirical investigation
of the distribution of trial characteristics across comparisons. Homogeneity and consistency
were investigated by decomposing the Q statistic.
Results
There were important clinical and statistically significant differences between “pure”
drug trials comparing pharmacologic substances with each other or placebo (63 trials)
and trials including a psychological treatment arm (37 trials). Overall network meta-analysis
produced results well comparable with separate meta-analyses of drug trials and psychological
trials. Although the homogeneity and consistency assumptions were mostly met, we considered
the transitivity assumption unjustifiable.
Conclusion
An exchange of experience between reviewers and, if possible, some guidance on how
reviewers addressing important clinical questions can proceed in situations where
important assumptions for valid network meta-analysis are not met would be desirable.
Keywords
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Article info
Publication history
Published online: October 30, 2015
Accepted:
October 26,
2015
Footnotes
Funding: The study was funded by the German Ministry of Education and Research (grant 01KG1012). The sponsor was not involved in the design, data collection, analysis, interpretation, writing of the report, or decision to submit the report for publication.
Conflict of interest: The authors declare that they have no conflict of interests.
Systematic review registration: 01KG1012 at http://www.gesundheitsforschung-bmbf.de/de/2852.php.
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