Method's corner: Allergist's guide to network meta-analysis

Abstract

Network meta-analyses (NMAs) simultaneously estimate the effects of multiple possible treatment options for a given clinical presentation. For allergists to benefit optimally from NMAs, they must understand the process and be able to interpret the results. Through a worked example published in Pediatric Allergy and Immunology, we summarize how to identify credible NMAs and interpret them with a focus on recent innovations in the GRADE approach (Grading of Recommendations Assessment, Development, and Evaluation). NMAs build on traditional systematic reviews and meta-analyses that consider only direct paired comparisons by including indirect evidence, thus allowing the simultaneous assessment of the relative effect of all pairs of competing alternatives. Our framework informs clinicians of how to identify credible NMAs and address the certainty of the evidence. Trustworthy NMAs fill a critical gap in providing key inferences using direct and indirect evidence to inform clinical decision making when faced with more than two competing courses of treatment options. This document will help allergists to identify trustworthy NMAs to enhance patient care.

Keywords: Allergy and Immunology; GRADE approach; McMaster; atopic dermatitis; clinical decision making; coronavirus disease 2019 (COVID-19); critical appraisal; eczema; evidence-based medicine (EBM); guidelines; indirect treatment comparison (ITC); multiple treatment comparison (MTC); network meta-analysis (NMA); probiotics; statistics; systematic review; therapy management options; user's guide.