title: On the need for increased rigour and care in the conduct and interpretation of network meta-analyses in drug development.
abstract: The rise over recent years in the use of network meta-analyses (NMAs) in clinical research and health economic analysis is little short of meteoric driven, in part, by a desire from decision makers to extend inferences beyond direct comparisons in controlled clinical trials. But is the increased use and reliance of NMAs justified? Do such analyses provide a reliable basis for the relative effectiveness assessment of medicines and, in turn, for critical decisions relating to healthcare access and provisioning? And can such analyses also be used earlier, as part of the evidence base for licensure? Despite several important publications highlighting inherently unverifiable assumptions underpinning NMAs, these assumptions and associated potential for serious bias are often overlooked in the reporting and interpretation of NMAs. A more cautious, and better informed, approach to the use and interpretation of NMAs in clinical research is warranted given the assumptions that sit behind such analyses.
authors.affiliation: KJC Statistics Ltd, Sovereign House, Bramhall, Cheshire UK and University of Sheffield, UK.
authors.forename: Kevin
authors.initials: K
authors.lastname: Carroll
authors.affiliation: MHRA, London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Hemmings
mesh_terms: D003627:Data Interpretation, Statistical; D055808:Drug Discovery / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000592:standards* / Q000706:statistics & numerical data; D000071076:Network Meta-Analysis as Topic
keywords: bias; network meta-analyses; rigour