BACKGROUND: The systematic review of economic evaluations plays a critical role in making well-informed decisions about competing healthcare interventions. The quality of these systematic reviews varies due to the lack of internationally recognized methodological evaluation standards.
METHODS: Nine English and Chinese databases including the Cochrane Library, PubMed, EMbase (Ovid), NHS economic evaluation database (NHSEED) (Ovid), Health Technology Assessment (HTA) database, Chinese National Knowledge Infrastructure (CNKI), WangFang, VIP Chinese Science & Technology Periodicals (VIP) and Chinese Biomedical Literature Database (CBM) were searched. Two reviewers independently screened studies and extracted data. The methodological quality of the literature was measured with modified AMSTAR. Data were narrative synthesized.
RESULTS: 165 systematic reviews were included. The overall methodological quality of the literature was moderate according to the AMSTAR scale. In these articles, thirteen quality assessment tools and 32 author self-defined criteria were used. The three most widely used tools were the Drummond checklist (19.4%), the BMJ checklist (15.8%), the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement (12.7%). Others included the Quality of Health Economic Studies (QHES), the Consensus on Health Economic Criteria (CHEC), the checklist of Center for Reviews and Dissemination (CRD), the Philips checklist, the World Health Organization (WHO) checklist, the checklist of Critical Appraisal Skills Program (CASP), the Pediatric Quality Appraisal Questionnaire (PQAQ), the Joanna Briggs Institute (JBI) checklist, Spanish and Chinese guidelines. The quantitative scales used in these literature were the QHES and PQAQ.
CONCLUSIONS: Evidence showed that pharmacoeconomic systematic reviews' methodology remained to be improved, and the quality assessment criteria were gradually unified. Multiple scales can be used in combination to evaluate the quality of economic research in different settings and types.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
Varios medicamentos de uso común se han asociado con un mayor riesgo de cáncer en la literatura. Aquí, se evaluó la fuerza y la consistencia de estas reclamaciones en metaanálisis publicados. Hemos llevado a cabo una revisión paraguas de 74 artículos meta-análisis que abordan la asociación de medicamentos de uso común (antidiabéticos, antihipertensivos, antihiperlipidémicos, antirreumáticos, fármacos para la osteoporosis, entre otros) con el riesgo de cáncer en los que al menos un meta-análisis en la clase de medicamentos incluye algunos datos de los ensayos aleatorios. En total, 51 artículos encontraron diferencias estadísticamente significativas, 13 encontraron un riesgo menor de cáncer, y 11 encontraron cierto aumento del riesgo (uno informó el aumento o disminución de los riesgos). Los 11 meta-análisis que encontraron algunos riesgos crecientes reportaron 16 aumento de las estimaciones de riesgo, de los cuales 5 pertenecían al cáncer en general y 11 para el cáncer de sitio específico. Seis de las 16 estimaciones se obtuvieron a partir de los ensayos aleatorios y 10 a partir de datos observacionales. Las estimaciones de mayor riesgo fueron fuertemente correlacionados inversamente con la cantidad de pruebas (número de casos de cáncer) (coeficiente de correlación de Spearman = -0,77; p <0,001). En 4 de los 16 temas, otro meta-análisis que existía era más grande (n = 2) o incluido datos mejor controlados (n = 2) y en los 4 casos no hubo un aumento estadísticamente significativo del riesgo de malignidad. Ningún medicamento o clase tenían evidencia sustancial y consistente de un mayor riesgo de malignidad. Sin embargo, para la mayoría de los medicamentos que no podemos excluir los riesgos pequeños o riesgos en subgrupos de población. Dichos riesgos son poco probable que sea posible documentar robustamente a menos que se lleven a cabo estudios muy grandes, de colaboración con los análisis estandarizados y sin notificación selectiva.
OBJECTIVES: Compare the benefits and harms of corticosteroids, oral and biologic disease-modifying antirheumatic drugs (DMARDs) for adults with rheumatoid arthritis.
DATA SOURCES: English-language articles from 1980 to February 2011 identified through PubMed, Embase, Cochrane Library, and International Pharmaceutical Abstracts; unpublished literature including dossiers from pharmaceutical companies.
METHODS: Two people independently selected relevant head-to-head trials of any sample size, prospective cohort studies with at least 100 participants, and relevant good- or fair-quality meta-analyses that compared benefits or harms of 14 drug therapies. Retrospective cohort studies were also included for harms. For biologic DMARDs, placebo-controlled, double-blind RCTs were also included. We required trials and cohort studies to have a study duration of at least 12 weeks. Literature was synthesized qualitatively within and between the two main drug classes (oral and biologic DMARDs). Network meta-analysis also was performed to examine the relative efficacy of biologic DMARDs and comparing withdrawal rates from placebo controlled trials.
RESULTS: Head-to-head trials showed no clinically important differences in efficacy among oral DMARD comparisons (methotrexate, sulfasalazine, leflunomide). The only head-to-head trial comparing biologic DMARDs (abatacept vs. infliximab) found no clinically important differences. Combination therapy of biologic DMARDs plus methotrexate improved clinical response rates and functional capacity more than monotherapy with methotrexate. Network meta-analyses found higher odds of reaching ACR 50 response for etanercept compared with most other biologic DMARDs (abatacept, adalimumab, anakinra, infliximab, rituximab, tocilizumab) for methotrexate-resistant patients with active rheumatoid arthritis. Similar overall tolerability profiles were found among oral and biologic DMARDs, but short-term adverse events were more common with biologic DMARDs. Adjusted indirect comparisons of biologic DMARDs found that certolizumab had the most favorable overall withdrawal profile, followed by etanercept and rituximab. Certolizumab had lower relative withdrawal rates due to lack of efficacy than adalimumab, anakinra, and infliximab. Certolizumab and infliximab had more, while etanercept had fewer withdrawals due to adverse events than most other drugs. Evidence was insufficient to assess comparative risk of serious adverse events among biologic DMARDs. Combinations of biologic DMARDs have higher rates of serious adverse events than biologic DMARD monotherapy. Limited data existed for subgroups.
CONCLUSIONS: Limited head-to-head comparative evidence does not support one therapy over another for adults with rheumatoid arthritis. Network meta-analyses from placebo-controlled trials of biologics suggest some differences, including higher odds of reaching ACR 50 response, but strength of evidence was low.
Los moduladores inmunes dirigidos, conocidos comúnmente como modificadores de la respuesta biológica o simplemente biológicos, son una categoría relativamente nueva de medicamentos utilizados en el tratamiento de ciertos tipos de enfermedades inmunológicas e inflamatorias, incluyendo artritis reumatoide, artritis idiopática juvenil, espondilitis anquilosante, artritis psoriásica, placa Psoriasis, enfermedad de Crohn y colitis ulcerosa. La Administración de Drogas y Alimentos de los Estados Unidos aprobó el primero de los productos biológicos (infliximab) en 1998 y aprobó 9 agentes adicionales desde ese momento para tratar varias condiciones reumáticas y psoriasis en placas: etanercept (1998), anakinra (2001), adalimumab (2002), alefacept (2003), efalizumab (2003), abatacept (2005), rituximab (2006), natalizumab (2008) y certolizumab pegol (2008). En este informe, revisamos la efectividad comparativa, la seguridad y la tolerabilidad de los moduladores inmunes dirigidos.
The systematic review of economic evaluations plays a critical role in making well-informed decisions about competing healthcare interventions. The quality of these systematic reviews varies due to the lack of internationally recognized methodological evaluation standards.
METHODS:
Nine English and Chinese databases including the Cochrane Library, PubMed, EMbase (Ovid), NHS economic evaluation database (NHSEED) (Ovid), Health Technology Assessment (HTA) database, Chinese National Knowledge Infrastructure (CNKI), WangFang, VIP Chinese Science & Technology Periodicals (VIP) and Chinese Biomedical Literature Database (CBM) were searched. Two reviewers independently screened studies and extracted data. The methodological quality of the literature was measured with modified AMSTAR. Data were narrative synthesized.
RESULTS:
165 systematic reviews were included. The overall methodological quality of the literature was moderate according to the AMSTAR scale. In these articles, thirteen quality assessment tools and 32 author self-defined criteria were used. The three most widely used tools were the Drummond checklist (19.4%), the BMJ checklist (15.8%), the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement (12.7%). Others included the Quality of Health Economic Studies (QHES), the Consensus on Health Economic Criteria (CHEC), the checklist of Center for Reviews and Dissemination (CRD), the Philips checklist, the World Health Organization (WHO) checklist, the checklist of Critical Appraisal Skills Program (CASP), the Pediatric Quality Appraisal Questionnaire (PQAQ), the Joanna Briggs Institute (JBI) checklist, Spanish and Chinese guidelines. The quantitative scales used in these literature were the QHES and PQAQ.
CONCLUSIONS:
Evidence showed that pharmacoeconomic systematic reviews' methodology remained to be improved, and the quality assessment criteria were gradually unified. Multiple scales can be used in combination to evaluate the quality of economic research in different settings and types.
Síntesis amplia»Revisión panorámica de revisiones sistemáticas
