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Network meta-analysis (NMA)

Comparing efficacy of dual therapies among patients with COPD

New evidence, using the established, robust statistical methodology of a Network Meta-Analysis (NMA), has extended the evidence base for use of fixed dose LAMA/LABA dual therapies in patients with COPD.1

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Head-to-head randomised controlled trials comparing outcomes between LAMA/LABA dual therapies are limited, and recent evidence may help clarify relative benefits of different LAMA/LABA combinations.1 Previous meta-analyses of clinical trial data comparing dual and mono-bronchodilator therapies have shown a gradient of effectiveness between LAMA/LABA fixed-dose combinations in patients with COPD based on data available in 2015.2,3 This new NMA presents the relative benefits of different LAMA/LABA combinations.1

What is a network meta-analysis (NMA), and why use it?

An NMA allows simultaneous comparison of multiple treatment options in the absence of head-to-head studies. This is made possible by establishing a linked network of evidence. During an NMA, a systematic literature review (SLR) is conducted, and a network of evidence is linked. This allows both direct and indirect comparisons (through direct RCT evidence and indirect evidence via a common comparator).4,5

NMA: evidence from direct and indirect treatment comparisons4,5

NMA comparisons chart

Methodological considerations

NMAs are based on the assumption of:5,6

Similarity

Included trials are similar clinically and methodologically

Consistency

The indirect evidence must be consistent with the direct evidence

Transitivity

There is validity in making indirect comparisons between trials

There are differences in study design and patient populations of the included trials:1

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The similarity assumption holds for this NMA

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Heterogeneity was seen across multiple studies but was within acceptable limits to allow study comparisons

NMAs can use a fixed effect or random effect approach:5

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In the fixed effect approach, the assumption is that all studies assume one true effect size, and observed differences in estimates between studies are due to sampling error only

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In the random effect approach, the assumption is that sampling error exists but with the expectation that true effect size varies both across studies and across comparisons (direct and indirect)

Continue your journey

NMA class comparison data in COPD

UMEC/VI versus dual and mono-bronchodilator therapies

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Summary

Summary of NMA class comparison results for UMEC/VI versus dual and mono-broncodilator therapies

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Abbreviations

COPD, chronic obstructive pulmonary disease; LABA, long-acting β2-agonist; LAMA, long-acting muscarinic antagonist; NMA, network meta-analysis; RCT, randomised controlled trial; SLR, systematic literature review.

References

  1. Ismaila AS, et al. Adv Ther. 2022;39:4961-5010.
  2. Calzetta L, et al. Chest. 2016;149:1181-1196.
  3. Sion KYJ, et al. Pulm Ther. 2017;3:297-316.
  4. Rouse B, et al. Intern Emerg Med. 2017;12:103-111.
  5. Tonin FS, et al. Pharm Pract (Granada). 2017;15:943.
  6. Hoaglin DC, et al. Value Health. 2011;14:429-437.

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Trademarks are owned by or licensed to the GSK group of companies.

NX-GBL-UCV-WCNT-220015 | Date of preparation: February 2023