Mixed Treatment Comparisons Sensitivity Analysis Methods

Katrina E Donahue; Dan E Jonas; Richard A Hansen; Robert Roubey; Beth Jonas; Linda J Lux; Gerald Gartlehner; Elizabeth Harden; Tania Wilkins; Visali Peravali; Shrikant I Bangdiwala; Andrea Yuen; Patricia Thieda; Laura C Morgan; Karen Crotty; Rishi Desai; Megan Van Noord

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Donahue KE, Jonas DE, Hansen RA, et al. Drug Therapy for Rheumatoid Arthritis in Adults: An Update [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Apr. (Comparative Effectiveness Reviews, No. 55.)

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This publication is provided for historical reference only and the information may be out of date.

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Drug Therapy for Rheumatoid Arthritis in Adults: An Update [Internet].

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Appendix KMixed Treatment Comparisons Sensitivity Analysis Methods

A total of 34 studies were identified for potential inclusion in the MTC meta-analysis comparing the efficacy of biologic DMARDs. The potential studies were:

Three studies evaluating abatacept: AIM 2006,¹ Kremer 2003,² and ATTEST 2008,³
Eight studies evaluating adalimumab: ARMADA 2003,⁴ STAR 2003,⁵ Keystone 2004,⁶ van de Putte 2003,⁷ van de Putte 2004,⁸ Kim 2007,⁹ CHANGE 2008,¹⁰ and Chen 2008,¹¹
Three studies evaluating anakinra: Cohen 2002,¹² Cohen 2004,¹³ and Bresnihan 1998,¹⁴
Three studies evaluating certolizumab pegol: RAPID-1 2008,¹⁵ RAPID-2 2009,¹⁶ and FAST4WARD 2009,¹⁷
Four studies evaluating etanercept: Moreland 1999,¹⁸ Weinblatt 1999,¹⁹ Lan 2004,²⁰ Moreland 1997,²¹
Two studies evaluating golimumab: GO-FORWARD 2009,²² and Kay 2008,²³
Six studies evaluating infliximab: ATTRACT 1999,²⁴ Abe 2006,²⁵ Kavanaugh 2000,²⁶ START 2006,²⁷ Zhang 2006,²⁸ ATTEST 2008,³ (listed twice as it included comparisons with both abatacept and infliximab)
Two studies evaluating rituximab: Edwards 2004,²⁹ and SERENE 2010,³⁰
Four studies evaluating tocilizumab: LITHE 2010,³¹ OPTION 2008,³² TOWARD 2008,³³ and CHARISMA 2006,³⁴

We reviewed all 34 studies for sources of heterogeneity and to consider whether to remove any studies that we did not feel were appropriate to include in the analyses. We considered factors such as handling of missing data, early escape design, unexpected high or low treatment response, study duration, and use of monotherapy treatment. Table 1 summarizes our approach for addressing the potential sources of heterogeneity. Based on our findings, we decided to exclude four studies, CHANGE 2008,¹⁰ RAPID-1 2008,¹⁵ RAPID-2 2009,¹⁶ and FAST4WARD 2009,¹⁷ because of heterogeneity due to early escape study design. Other sources of heterogeneity were explored through four sensitivity analyses. The results of these analyses are presented and discussed in Chapter 3.

Table 1

Approach for Addressing Potential Sources of Heterogeneity.

References

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Donahue KE, Jonas DE, Hansen RA, et al. Drug Therapy for Rheumatoid Arthritis in Adults: An Update [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Apr. (Comparative Effectiveness Reviews, No. 55.) Appendix K, Mixed Treatment Comparisons Sensitivity Analysis Methods.
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