Journal of clinical epidemiology
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The Grading of Recommendations Assessment, Development, and Evaluations (GRADE) working group has recognized some scenarios in which strong recommendations may be supported by low-quality evidence, the so-called paradigmatic situations. The adherence to these paradigmatic situations by the American Thyroid Association (ATA) guidelines, however, remains unknown. ⋯ ATA clinical guidelines are discordant with GRADE guidance. Future guidelines should carefully evaluate the quality of evidence and recognize its limitations when developing recommendations.
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Network meta-analysis (NMA) is increasingly being used to synthesize direct and indirect evidence and help decision makers simultaneously compare multiple treatments. We empirically evaluate the incremental gain in precision achieved by incorporating indirect evidence in NMAs. ⋯ Although NMAs have the potential to provide more precise results than those only based on direct evidence, the incremental gain may reliably occur only when at least two head-to-head studies are available and treatments are well connected. Researchers should routinely report and compare the results from both network and pairwise meta-analyses.
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Review Meta Analysis
Modified intention-to-treat analysis did not bias trial results.
To investigate whether analysis of the modified intention-to-treat (mITT) population with postrandomization exclusion of patients from analysis is associated with biased estimates of treatment effect compared to the conservative intention-to-treat (ITT) population. ⋯ We found no difference in the treatment effect between randomized trials using ITT and mITT analyses populations. This suggests that the mITT approach in rheumatoid arthritis trials investigating biological or targeted interventions does not introduce bias compared to ITT.
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To determine the predictive validity of the U.S. Evidence-based Practice Center (EPC) approach to GRADE (Grading of Recommendations Assessment, Development and Evaluation). ⋯ The limited predictive validity of the EPC approach to GRADE seems to reflect a mismatch between expected and observed changes in treatment effects as bodies of evidence advance from insufficient to high QOE.
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Review Meta Analysis Comparative Study
Meta-analyses of randomized controlled trials show suboptimal validity of surrogate outcomes for overall survival in advanced colorectal cancer.
To quantify and compare the treatment effects on three surrogate end points, progression-free survival (PFS), time to progression (TTP), and tumor response rate (TR) vs. overall survival (OS) based on a meta-analysis of randomized controlled trials (RCTs) of drug interventions in advanced colorectal cancer (aCRC). ⋯ None of the end points in this study were found to achieve the level of evidence (ie, mean R(2)trial > 0.60) that has been set to select high or excellent correlation levels by common surrogate evaluation tools. Previous surrogacy relationships observed between PFS and TTP vs. OS in selected settings may not apply across other classes or lines of therapy.