Meta-analysis methods and models with applications in evaluation of cholesterol-lowering drugs

Stat Med. 2012 Dec 10;31(28):3597-616. doi: 10.1002/sim.5462. Epub 2012 Jul 25.

Abstract

In this paper, we propose a class of multivariate random effects models allowing for the inclusion of study-level covariates to carry out meta-analyses. As existing algorithms for computing maximum likelihood estimates often converge poorly or may not converge at all when the random effects are multi-dimensional, we develop an efficient expectation-maximization algorithm for fitting multi-dimensional random effects regression models. In addition, we also develop a new methodology for carrying out variable selection with study-level covariates. We examine the performance of the proposed methodology via a simulation study. We apply the proposed methodology to analyze metadata from 26 studies involving statins as a monotherapy and in combination with ezetimibe. In particular, we compare the low-density lipoprotein cholesterol-lowering efficacy of monotherapy and combination therapy on two patient populations (naïve and non-naïve patients to statin monotherapy at baseline), controlling for aggregate covariates. The proposed methodology is quite general and can be applied in any meta-analysis setting for a wide range of scientific applications and therefore offers new analytic methods of clinical importance.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Analysis of Variance
  • Anticholesteremic Agents / therapeutic use*
  • Azetidines / administration & dosage
  • Azetidines / therapeutic use
  • Cholesterol, LDL / administration & dosage
  • Cholesterol, LDL / adverse effects
  • Cholesterol, LDL / drug effects
  • Computer Simulation
  • Drug Therapy, Combination
  • Endpoint Determination
  • Evaluation Studies as Topic
  • Ezetimibe
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / administration & dosage
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Hypercholesterolemia / drug therapy*
  • Likelihood Functions
  • Lipoproteins, HDL / drug effects
  • Lipoproteins, HDL / physiology
  • Meta-Analysis as Topic*
  • Multivariate Analysis
  • Randomized Controlled Trials as Topic*
  • Research Design

Substances

  • Anticholesteremic Agents
  • Azetidines
  • Cholesterol, LDL
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Lipoproteins, HDL
  • Ezetimibe