• Edward J Mills, John P A Ioannidis, Kristian Thorlund, Holger J Schünemann, Milo A Puhan, and Gordon H Guyatt.
• Faculty of Health Sciences, University of Ottawa, Room 031, Thompson Hall, 35 University Private, Ottawa, ON, K1N 7K4, Canada. edward.mills@uottawa.ca
• JAMA. 2012 Sep 26; 308 (12): 124612531246-53.

AbstractMultiple treatment comparison (MTC) meta-analysis uses both direct (head-to-head) randomized clinical trial (RCT) evidence as well as indirect evidence from RCTs to compare the relative effectiveness of all included interventions. The methodological quality of MTCs may be difficult for clinicians to interpret because the number of interventions evaluated may be large and the methodological approaches may be complex. Clinicians and others evaluating an MTC should be aware of the potential biases that can affect the interpretation of these analyses. Readers should consider whether the primary studies are sufficiently homogeneous to combine; whether the different interventions are sufficiently similar in their populations, study designs, and outcomes; and whether the direct evidence is sufficiently similar to the indirect evidence to consider combining. This article uses the existing Users' Guides format to address study validity, interpretation of results, and application to a patient scenario.

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