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Indirect and mixed treatment comparisons in arthritis research

机译：关节炎研究中的间接和混合治疗比较

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Evidence for the efficacy of biologic therapies in inflammatory arthritis comes overwhelmingly from placebo-controlled trials. Increasingly, however, authorities responsible for purchasing and re-imbursement have tried to determine whether there are differences between these powerful new therapies, which would lead them to recommend some in preference to others, either on grounds of efficacy or cost-effectiveness. In the absence of head-to-head trial comparisons, indirect comparisons may be used. Furthermore, network meta-analysis, also known as mixed treatment comparisons can combine information from trials in a connected network. These methods allow inferences about head-to-head comparisons even when there is little or no head-to-head evidence, which has caused some concern. In this article we briefly review these methodologies and describe results from recent applications to inflammatory arthritis in the clinical literature. We then focus on how the methodologies are used in decision making, taking as an illustration some recent technology appraisals conducted by the National Institute for Health and Clinical Excellence in the UK. We conclude that, in practice, the key decisions have been based on results from placebo-controlled trials.
机译：生物疗法在炎性关节炎中疗效的证据绝大多数来自安慰剂对照试验。但是，负责购买和报销的当局越来越多地尝试确定这些强大的新疗法之间是否存在差异，这将导致它们基于功效或成本效益，优先推荐某些新疗法。如果没有直接的试验比较，可以使用间接比较。此外，网络荟萃分析（也称为混合治疗比较）可以结合来自连接网络中试验的信息。即使很少或根本没有头对头的证据，这些方法也可以推断出头对头的比较，这引起了一些关注。在本文中，我们简要回顾了这些方法，并在临床文献中描述了炎症性关节炎的最新应用结果。然后，我们将重点介绍如何在决策中使用这些方法，并以英国国家卫生与临床卓越研究所最近进行的一些技术评估为例进行说明。我们得出的结论是，实际上，关键的决定是基于安慰剂对照试验的结果。

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    《Rheumatology》 |2011年第4期|p.5-9|共5页
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    Nicky J. Welton;

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