University of Leicester
Browse

Methodologies for network meta-analysis of randomised controlled trials in pain, anaesthesia, and perioperative medicine: a narrative review

Download (937.18 kB)
journal contribution
posted on 2025-04-03, 09:26 authored by Brett Doleman, Janus Christian Jakobsen, Ole Mathiesen, Nicola CooperNicola Cooper, Alexander SuttonAlexander Sutton, Jonathan Hardman
Network meta-analysis has emerged as a method for analysing clinical trials, with a large increase in the number of publications over the past decade. Network meta-analysis offers advantages over traditional pairwise meta-analysis, including increased power, the ability to compare treatments not compared in the original trials, and the ability to rank treatments. However, network meta-analyses are inherently more complex than pairwise meta-analyses, requiring additional statistical expertise and assumptions. Many factors can affect the certainty of evidence from pairwise meta-analysis and can often lead to unreliable results. Network meta-analysis is prone to all these issues, although it has the additional assumption of transitivity. Here we review network meta-analyses, problems with their conduct and reporting, and methodological strategies that can be used by those conducting reviews to help improve the reliability of their findings. We provide evidence that violation of the assumption of transitivity is relatively common and inadequately considered in published network meta-analyses. We explain key concepts with clinically relevant examples for those unfamiliar with network meta-analysis to facilitate their appraisal and application of their results to clinical practice.

Funding

UK National Institute for Health and Care Research (NIHR), Applied Research Collaboration East Midlands (ARC EM), and Leicester NIHR Biomedical Research Centre (BRC)

History

Author affiliation

College of Life Sciences Population Health Sciences

Version

  • VoR (Version of Record)

Published in

British Journal of Anaesthesia

Volume

134

Issue

4

Pagination

1029-1040

Publisher

Elsevier BV

issn

0007-0912

eissn

1471-6771

Copyright date

2025

Available date

2025-04-03

Language

en

Deposited by

Professor Nicola Cooper

Deposit date

2025-03-17

Usage metrics

    University of Leicester Publications

    Licence

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC