Can trial sequential monitoring boundaries reduce spurious inferences from meta-analyses?

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ID: 305128
2008
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Abstract
Results from apparently conclusive meta-analyses may be false. A limited number of events from a few small trials and the associated random error may be under-recognized sources of spurious findings. The information size (IS, i.e. number of participants) required for a reliable and conclusive meta-analysis should be no less rigorous than the sample size of a single, optimally powered randomized clinical trial. If a meta-analysis is conducted before a sufficient IS is reached, it should be evaluated in a manner that accounts for the increased risk that the result might represent a chance finding (i.e. applying trial sequential monitoring boundaries).We analysed 33 meta-analyses with a sufficient IS to detect a treatment effect of 15% relative risk reduction (RRR). We successively monitored the results of the meta-analyses by generating interim cumulative meta-analyses after each included trial and evaluated their results using a conventional statistical criterion (alpha = 0.05) and two-sided Lan-DeMets monitoring boundaries. We examined the proportion of false positive results and important inaccuracies in estimates of treatment effects that resulted from the two approaches.Using the random-effects model and final data, 12 of the meta-analyses yielded P > alpha = 0.05, and 21 yielded P alpha = 0.05. The monitoring boundaries eliminated all false positives. Important inaccuracies in estimates were observed in 6 out of 21 meta-analyses using the conventional P
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Authors Kristian Thorlund, P.J. Devereaux, Jørn Wetterslev, Gordon Guyatt, John P. A. Ioannidis, Lehana Thabane, Lise Lotte Gluud, Bodil Als‐Nielsen, Christian Gluud
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Journal International Journal of Epidemiology
Year 2008
DOI
10.1093/ije/dyn179
URL
https://doi.org/10.1093/ije/dyn179
Keywords Keywords not found

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