title: Comparison of effect sizes associated with biomarkers reported in highly cited individual articles and in subsequent meta-analyses.
abstract: BACKGROUND
  Many biomarkers are proposed in highly cited studies as determinants of disease risk, prognosis, or response to treatment, but few eventually transform clinical practice.
  
  
  OBJECTIVE
  To examine whether the magnitude of the effect sizes of biomarkers proposed in highly cited studies is accurate or overestimated.
  
  
  METHODS
  We searched ISI Web of Science and MEDLINE until December 2010.
  
  
  METHODS
  We included biomarker studies that had a relative risk presented in their abstract. Eligible articles were those that had received more than 400 citations in the ISI Web of Science and that had been published in any of 24 highly cited biomedical journals. We also searched MEDLINE for subsequent meta-analyses on the same associations (same biomarker and same outcome).
  
  
  METHODS
  In the highly cited studies, data extraction was focused on the disease/outcome, biomarker under study, and first reported relative risk in the abstract. From each meta-analysis, we extracted the overall relative risk and the relative risk in the largest study. Data extraction was performed independently by 2 investigators.
  
  
  RESULTS
  We evaluated 35 highly cited associations. For 30 of the 35 (86%), the highly cited studies had a stronger effect estimate than the largest study; for 3 the largest study was also the highly cited study; and only twice was the effect size estimate stronger in the largest than in the highly cited study. For 29 of the 35 (83%) highly cited studies, the corresponding meta-analysis found a smaller effect estimate. Only 15 of the associations were nominally statistically significant based on the largest studies, and of those only 7 had a relative risk point estimate greater than 1.37.
  
  
  CONCLUSIONS
  Highly cited biomarker studies often report larger effect estimates for postulated associations than are reported in subsequent meta-analyses evaluating the same associations.
authors.affiliation: Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California 94305, USA. jioannid@stanford.edu
authors.forename: John P A
authors.initials: JP
authors.lastname: Ioannidis
authors.forename: Orestis A
authors.initials: OA
authors.lastname: Panagiotou
mesh_terms: D015415:Biomarkers / Q000032:analysis*; D003627:Data Interpretation, Statistical; D015987:Effect Modifier, Epidemiologic; D006801:Humans; D015201:Meta-Analysis as Topic; D018570:Risk Assessment; D018401:Sample Size
chemical_list: D015415:Biomarkers