title: Continuously updated network meta-analysis and statistical monitoring for timely decision-making.
abstract: Pairwise and network meta-analysis (NMA) are traditionally used retrospectively to assess existing evidence. However, the current evidence often undergoes several updates as new studies become available. In each update recommendations about the conclusiveness of the evidence and the need of future studies need to be made. In the context of prospective meta-analysis future studies are planned as part of the accumulation of the evidence. In this setting, multiple testing issues need to be taken into account when the meta-analysis results are interpreted. We extend ideas of sequential monitoring of meta-analysis to provide a methodological framework for updating NMAs. Based on the z-score for each network estimate (the ratio of effect size to its standard error) and the respective information gained after each study enters NMA we construct efficacy and futility stopping boundaries. A NMA treatment effect is considered conclusive when it crosses an appended stopping boundary. The methods are illustrated using a recently published NMA where we show that evidence about a particular comparison can become conclusive via indirect evidence even if no further trials address this comparison.
authors: 1 Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.|2 Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.
authors: Adriani
authors: A
authors: Nikolakopoulou
authors: 2 Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.|3 Department of Primary Education, University of Ioannina, Ioannina, Greece.
authors: Dimitris
authors: D
authors: Mavridis
authors: 1 Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.
authors: Matthias
authors: M
authors: Egger
authors: 1 Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland.|2 Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.|4 Bern Institute of Primary Care (BIHAM), University of Bern, Bern, Switzerland.
authors: Georgia
authors: G
authors: Salanti
mesh_terms: D003627:Data Interpretation, Statistical; D003657:Decision Making; D048909:Diabetes Complications / Q000601:surgery; D006801:Humans; D000071076:Network Meta-Analysis as Topic; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D013223:Statistics as Topic; D000078202:Systematic Reviews as Topic
keywords: Sequential methods; efficacy and futility boundaries; multiple treatments; stopping rules; update of systematic reviews