Applying GRADE to a network meta-analysis of antidepressants led to more conservative conclusions

Ashley Bonner; Paul E Alexander; Romina Brignardello-Petersen; Toshi A Furukawa; Reed A Siemieniuk; Yuan Zhang; Wojtek Wiercioch; Ivan D Florez; Yutong Fei; Arnav Agarwal; Juan José Yepes-Nuñez; Joseph Beyene; Holger Schünemann; Gordon H Guyatt

doi:10.1016/j.jclinepi.2018.05.009

Applying GRADE to a network meta-analysis of antidepressants led to more conservative conclusions

J Clin Epidemiol. 2018 Oct:102:87-98. doi: 10.1016/j.jclinepi.2018.05.009. Epub 2018 May 22.

Authors

Affiliations

¹ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. Electronic address: [email protected].
² Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Standards and Practices, Guideline Development, The Infectious Diseases Society of America, Arlington, VA, USA.
³ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Evidence-Based Dentistry Unit, Faculty of Dentistry, University of Chile, Santiago, Chile.
⁴ Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan.
⁵ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Canada.
⁶ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
⁷ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Pediatrics, University of Antioquia, Medellin, Colombia.
⁸ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
⁹ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; School of Medicine, University of Toronto, Toronto, Ontario, Canada.
¹⁰ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; School of Medicine, University of Antioquia, Medellín, Colombia.

PMID: 29800689
DOI: 10.1016/j.jclinepi.2018.05.009

Abstract

Objective: To explore the impact of applying the Grading of Recommendations and Assessment, Development, and Evaluation (GRADE) approach to assess the certainty of the evidence in a published network meta-analysis (NMA) of antidepressant therapies.

Study design and settings: We applied the GRADE approach to rate the certainty of the evidence for two outcomes, efficacy and acceptability, in each of the 66 paired comparisons within a previously published NMA assessing the relative efficacy and acceptability of 12 new-generation antidepressants.

Results: For the outcome of efficacy, of the 25 comparisons in which the 95% CrI of OR excluded 1, 18 had certainty of evidence rated high or moderate. For the outcome of acceptability, of the 13 comparisons whose 95% CrI excluded 1, 10 had certainty of evidence rated high or moderate. Of the 11 comparisons involving sertraline, the antidepressants that the authors of the NMA suggested to be best, only 3 demonstrated it to be more effective and only 3 showed better tolerance, based on a 95% CrI excluding 1 and a high or moderate rating of certainty.

Conclusions: In this example, application of GRADE highlighted varying evidence certainty, led to more conservative conclusions, and potentially avoided unwarranted strong inferences based on low certainty evidence.

Keywords: Certainty of the evidence; GRADE approach; Network meta-analysis; Results interpretation.

MeSH terms

Antidepressive Agents / therapeutic use*
Depressive Disorder / drug therapy*
Evidence-Based Medicine
GRADE Approach / methods*
Humans
Network Meta-Analysis
Treatment Outcome

Substances

Antidepressive Agents