Meta-analysis of NSAIDs: Contribution of Drugs, Doses, Trial Designs, and Meta-analytic Techniques

Publisher Website
Google Scholar
Abstract
Gøtzsche PC. Meta-analysis of NSAIDs: Contribution of Drugs, Doses, Trial Designs, and Meta-analytic Techniques. Scand J Rheumatol 1993; 22: 255–260. To elucidate potential bias sources in meta-analyses, I studied whether the effect of nonsteroidal, anti-inflammatory drugs on joint count in patients with rheumatoid arthritis was related to trial design (active or placebo control), sample size, duration of treatment, drop-out rate, the existence of a wash-in period, drug, dose, and meta-analytic technique. In short-term trials, none of the covariates was related to the effect size. No differences between drugs or doses were found in usual gold standard meta-analyses, comparing drugs within trials before pooling. In a meta-analysis of treatment arms, however, four drugs were either significantly more or less effective than average, but these deviations were spurious. In meta-analyses of NSAIDs, indirect comparisons may allow a preliminary comparison of drugs that have not been compared directly. Treatment arms should be compared within trials before pooling, however.