This is a version of the LibGuide I started while employed at Temple University Health Sciences Library from July 2015-September 12, 2022. I plan to maintain it here going forward.
Other names for a Network Meta-Analysis
NMA, MTC Meta-Analysis, Multiple Treatment Meta-Analysis, Mixed Treatments Comparison, Multiple Treatments Comparison, Pair-Wise Meta-Analysis, Indirect Treatment Comparison, Multiple Treatment Comparison Meta-Analysis, Live Cumulative Network Analysis (New type)
What is a Network Meta-Analysis?
“Network meta-analysis compares multiple interventions simultaneously by analyzing studies making different comparisons in the same analysis.”
Source: M. Petticrew et al. (2013)
Network meta-analyses are best designed for:
- Conditions with multiple interventions
- Many combinations of direct or indirect interactions
- To answer more relevant clinical questions
- To make treatment estimates for an entire treatment network instead of scanning each individual pair-wise comparison
- To give the “full picture” to clinicians
- Gain precision by considering all available evidence, not just (A vs. B comparisons)
- Potential to more explicitly “rank” treatments using summary outputs
What is a Network Meta-Analysis? Outline of Stages
Timeframe: 12-18+ months. Same as a traditional systematic review. *Varies beyond the type of review. Depends on many factors such as but not limited to: resources available, the quantity and quality of the literature, and the expertise or experience of reviewers” (Grant et al. 2009)
Question: Addresses PICO for multiple interventions or treatments (3 or more). These may be broad or narrow. Combines indirect (triangular approach) or direct comparisons (pairwise approach).
Sources and searches: Requires a large search to locate all of the trials using transparent & reproducible methods.
Selection: Same as a systematic review–based upon clear inclusion/exclusion criteria. Requires a lot more screening of trials.
Appraisal: Formal quality assessment of all studies. Still includes Risk of Bias and quality of evidence assessments.
Synthesis: Statistical analysis when possible (heterogeneity a potential problem with indirect comparisons)–uses different statistical methods than a systematic review. Creates a web-like analysis called a Network Diagram or Network Comparison. May use bayesian frameworks or meta-regression analysis.
Limitations of a Network Meta-Analysis
- Requires specialist statistical expertise and software
- Assumes that all interventions included in the “network” are equally applicable to all populations and contexts of the studies included.
- May introduce study selection bias.
- Ease of software may lead researchers to undertake this type of review even though it may not be the most appropriate study design for their research question.
- Complex methodological approaches
- Still an evolving method
Source: M. Petticrew et al. (2013) and Li T. et al. (2011)
Example of a published Treatment Network for the Drugs Considered in the Example Multiple Treatment Comparison on Generalized Anxiety Disorder
Source:
Mills, Edward J., John P. A. Ioannidis, Kristian Thorlund, Holger J. Schünemann, Milo A. Puhan, and Gordon H. Guyatt. 2012. How to use an article reporting a multiple treatment comparison meta-analysis. Jama 308 (12): 1246-53. http://jamanetwork.com/journals/jama/fullarticle/1362030
Resources:
Assessing the Feasibility of a Network Meta-Analysis (VIDEO)
Petticrew M, Rehfuess E, Noyes J, et al. Synthesizing evidence on complex interventions:
how meta-analytical, qualitative, and mixed method approaches can contribute.
J Clin Epid. 2013;66:1230-1243.
Li T, Puhan MA, Swaroop SV, Dickersin K, et al. Network meta-analysis-highly attractive
but more methodological research is needed. BMC Medicine. 2011.
Reporting Standards-PRISMA NMA for Network Meta-Analyses
Cochrane Network Meta-analysis Toolkit
Link to Published Network Meta-Analyses
Graphical Tools for Network Meta-Analysis in STATA
ISPOR Task Force on Indirect Comparisons and Network Meta-Analysis
This link opens to a PDF document.
What is a Live Cumulative (NMA) Network Meta-Analysis:
An NMA that is updated at regular intervals via crowdsourcing of a research community.
Resources:
http://livenetworkmetaanalysis.com
Créquit P, Trinquart L, Ravaud P. Live cumulative network meta-analysis: protocol for second-line treatments in advanced non-small-cell lung cancer with wild-type or unknown status for epidermal growth factor receptor. BMJ Open 2016;6:e011841.
Oops, if you find any broken links, please contact me!
Systematic Review (Evidence Synthesis) Librarian 