Multiple treatment comparison (MTC) meta-analysis uses both direct (head-to-head) randomized clinical trial (RCT) evidence as well as indirect evidence from RCTs to compare the relative effectiveness of all included interventions. The methodological quality of MTCs may be difficult for clinicians to interpret because the number of interventions evaluated may be large and the methodological approaches may be complex. Clinicians and others evaluating an MTC should be aware of the potential biases that can affect the interpretation of these analyses. Readers should consider whether the primary studies are sufficiently homogeneous to combine; whether the different interventions are sufficiently similar in their populations, study designs, and outcomes; and whether the direct evidence is sufficiently similar to the indirect evidence to consider combining. This article uses the existing Users' Guides format to address study validity, interpretation of results, and application to a patient scenario.
The figure shows 4 network graphs. In each graph, lines show where direct comparisons exist from one or more trials. The star shows a network for which all interventions have a single mutual comparator. A single closed loop involves 3 interventions and can provide data to calculate both direct comparisons and indirect comparisons. A well-connected network in which all interventions have been compared against each other in multiple randomized controlled trials (RCTs). The complex network has multiple loops and arms that may have sparse connections.
A, In an indirect comparison, there is direct evidence from paroxetine compared with placebo and direct evidence of lorazepam compared with placebo. Therefore, the indirect comparison can be applied to determine the effect of paroxetine compared with lorazepam, even if no direct head-to-head comparison exists for these 2 agents. B, In the closed loop, there is direct evidence that compares nicotine replacement therapy with both varenicline and also bupropion. There is also direct evidence comparing bupropion with varenicline. Therefore, enough information exists to evaluate whether the results are coherent between direct and indirect evidence.
The lines between treatment nodes indicate the comparisons made throughout randomized clinical trials (RCTs). The numbers on the lines indicate the number of RCTs informing a particular comparison. (The figure is based on Baldwin et al.1)
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 17
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Users' Guides to the Medical Literature
For example, the American College of Rheumatology developed the 7-item core set of disease...
The Rational Clinical Examination
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.