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Implementing hierarchical network meta-analysis incorporating exchangeable dose effects compared to standard hierarchical network meta-analysis

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To cite: Watt J, Hofmeister M, Del Giovane C, et al. BMJ EvidenceBased Medicine Epub ahead of print: [please include Day Month Year]. doi:10.1136/ bmjebm-2022-112136 © Author(s) (or their employer(s))… Click to show full abstract

To cite: Watt J, Hofmeister M, Del Giovane C, et al. BMJ EvidenceBased Medicine Epub ahead of print: [please include Day Month Year]. doi:10.1136/ bmjebm-2022-112136 © Author(s) (or their employer(s)) 2023. No commercial reuse. See rights and permissions. Published by BMJ. Introduction Network metaanalysis (NMA) compares the efficacy or safety of more than two treatments or treatment doses that are directly or indirectly compared through a common comparator. 2 Treatment doses are not routinely incorporated into NMAs, which potentially limits the applicability and validity of results. 4 In this paper, we will introduce readers to NMA incorporating dose effects, specifically, how they can implement a hierarchical random effects NMA incorporating exchangeable dose effects. In particular, we share a motivating clinical example describing the comparative risk of vomiting associated with different cholinesterase inhibitor doses (ie, donepezil, galantamine and rivastigmine) and use this example to illustrate (1) key similarities and differences between the standard NMA and NMA incorporating exchangeable dose effects; (2) why incorporating dose effects in NMA is important; (3) steps to follow when completing a systematic review with NMA incorporating dose effects; (4) results derived from a hierarchical random effects NMA incorporating exchangeable dose effects and how they will facilitate clinical decisionmaking and (5) how to consider potential dose effects when evaluating NMA relevance and credibility. Please refer to our companion publication for a more in depth theoretical discussion of hierarchical NMA models incorporating dose effects and alternative NMA models incorporating dose effects.

Keywords: network; network meta; exchangeable dose; dose effects; incorporating exchangeable; hierarchical network

Journal Title: BMJ Evidence-Based Medicine
Year Published: 2023

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