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. 2015 Mar 6:350:h1088.
doi: 10.1136/bmj.h1088.

Uptake of systematic reviews and meta-analyses based on individual participant data in clinical practice guidelines: descriptive study

Claire L Vale  1 , Larysa H M Rydzewska  2 , Maroeska M Rovers  3 , Jonathan R Emberson  4 , François Gueyffier  5 , Lesley A Stewart  6 ; Cochrane IPD Meta-analysis Methods Group
Collaborators, Affiliations

Uptake of systematic reviews and meta-analyses based on individual participant data in clinical practice guidelines: descriptive study

Claire L Vale et al. BMJ. .

Abstract

Objective: To establish the extent to which systematic reviews and meta-analyses of individual participant data (IPD) are being used to inform the recommendations included in published clinical guidelines.

Design: Descriptive study.

Setting: Database maintained by the Cochrane IPD Meta-analysis Methods Group, supplemented by records of published IPD meta-analyses held in a separate database.

Population: A test sample of systematic reviews of randomised controlled trials that included a meta-analysis of IPD, and a separate sample of clinical guidelines, matched to the IPD meta-analyses according to medical condition, interventions, populations, and dates of publication.

Data extraction: Descriptive information on each guideline was extracted along with evidence showing use or critical appraisal, or both, of the IPD meta-analysis within the guideline; recommendations based directly on its findings and the use of other systematic reviews in the guideline.

Results: Based on 33 IPD meta-analyses and 177 eligible, matched clinical guidelines there was evidence that IPD meta-analyses were being under-utilised. Only 66 guidelines (37%) cited a matched IPD meta-analysis. Around a third of these (n=22, 34%) had critically appraised the IPD meta-analysis. Recommendations based directly on the matched IPD meta-analyses were identified for only 18 of the 66 guidelines (27%). For the guidelines that did not cite a matched IPD meta-analysis (n=111, 63%), search dates had preceded the publication of the IPD meta-analysis in 23 cases (21%); however, for the remainder, there was no obvious reasons why the IPD meta-analysis had not been cited.

Conclusions: Our results indicate that systematic reviews and meta-analyses based on IPD are being under-utilised. Guideline developers should routinely seek good quality and up to date IPD meta-analyses to inform guidelines. Increased use of IPD meta-analyses could lead to improved guidelines ensuring that routine patient care is based on the most reliable evidence available.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation with competing interests for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. Although there are no conflicts relating to this submission, FG has received grants from Teva and BMS, and personal fees from NovaDiscovery.

Figures

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Fig 1 Identification of eligible IPD meta-analyses
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Fig 2 Identification of eligible guidelines
See this image and copyright information in PMC

References

    1. Kirkham JJ, Dwan KM, Altman DG, Gamble C, Dodd S, Smyth R, et al. The impact of outcome reporting bias in randomised controlled trials on a cohort of systematic reviews. BMJ 2010;340:c365. - PubMed
    1. Stewart L, Tierney J, Burdett S. Do systematic reviews based on individual patient data offer a means of circumventing biases associated with trial publications? In: Rothstein H, Sutton A, Borenstein M, eds. Publication bias in meta-analysis: prevention, assessment and adjustments. Chichester: Wiley, 2005:261-86.
    1. Dwan K, Gamble C, Williamson PR, Kirkham JJ. Systematic review of the empirical evidence of study publication bias and outcome reporting bias—an updated review. PLoS One 2013;8:e66844. - PMC - PubMed
    1. Tierney JF, Stewart LA. Investigating patient exclusion bias in meta-analysis. Int J Epidemiol 2005;34:79-87. - PubMed
    1. Burdett S, Stewart LA, Tierney JF. Publication bias and meta-analysis (a practical example). Int J Technol Assess Health Care 2003;19:129-34. - PubMed

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