Abstract
This article presents official guidance from the Grading of Recommendations Assessments,
Development, and Evaluation (GRADE) working group on how to address incoherence when
assessing the certainty in the evidence from network meta-analysis. Incoherence represents
important differences between direct and indirect estimates that contribute to a network
estimate. Bias due to limitations in study design or publication bias, indirectness,
and intransitivity may be responsible for incoherence. Addressing incoherence requires
a judgment regarding the importance of the impact on the network estimate. Reviewers
need to be alert to the possibility of misguidedly arriving at excessively low ratings
of certainty by rating down for both incoherence and other closely related GRADE domains.
This article describes and illustrates each of these issues and provides explicit
guidance on how to deal with them.
Keywords
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Article info
Publication history
Published online: December 05, 2018
Accepted:
November 30,
2018
Footnotes
Conflict of interest: R.B-P. declares that none of the authors of this article has any conflict of interest to declare.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
