Dose-effect meta-analysis for psychopharmacological interventions using randomised data.
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BORIS DOI
Official URL
Publisher DOI
PubMed ID
35042697
Description
OBJECTIVE
The current practice in meta-analysis of the effects of psychopharmacological interventions ignors the administered dose or restricts the analysis in a dose range. This may introduce unnecessary uncertainty and heterogeneity. Methods have been developed to integrate the dose-effect models in meta-analysis.
METHODS
We describe the two-stage and the one-stage models to conduct a dose-effect meta-analysis using common or random effects methods. We illustrate the methods on a dataset of selective serotonin reuptake inhibitor antidepressants. The dataset comprises 60 randomised controlled trials. The dose-effect is measured on an odds ratio scale and is modelled using restricted cubic splines to detect departure from linearity.
RESULTS
The estimated summary curve indicates that the probability of response increases up to 30 mg/day of fluoxetine-equivalent which results in reaching 50% probability to respond. Beyond 40 mg/day, no further increase in the response is observed. The one-stage model includes all studies, resulting in slightly less uncertainty than the two-stage model where only part of the data is analysed.
CONCLUSIONS
The dose-effect meta-analysis enables clinicians to understand how the effect of a drug changes as a function of its dose. Such analysis should be conducted in practice using the one-stage model that incorporates evidence from all available studies.
The current practice in meta-analysis of the effects of psychopharmacological interventions ignors the administered dose or restricts the analysis in a dose range. This may introduce unnecessary uncertainty and heterogeneity. Methods have been developed to integrate the dose-effect models in meta-analysis.
METHODS
We describe the two-stage and the one-stage models to conduct a dose-effect meta-analysis using common or random effects methods. We illustrate the methods on a dataset of selective serotonin reuptake inhibitor antidepressants. The dataset comprises 60 randomised controlled trials. The dose-effect is measured on an odds ratio scale and is modelled using restricted cubic splines to detect departure from linearity.
RESULTS
The estimated summary curve indicates that the probability of response increases up to 30 mg/day of fluoxetine-equivalent which results in reaching 50% probability to respond. Beyond 40 mg/day, no further increase in the response is observed. The one-stage model includes all studies, resulting in slightly less uncertainty than the two-stage model where only part of the data is analysed.
CONCLUSIONS
The dose-effect meta-analysis enables clinicians to understand how the effect of a drug changes as a function of its dose. Such analysis should be conducted in practice using the one-stage model that incorporates evidence from all available studies.
Date of Publication
2022-02
Publication Type
Article
Language(s)
en
Contributor(s)
Furukawa, Toshi A | |
Orsini, Nicola | |
Cipriani, Andrea |
Additional Credits
Series
Evidence-Based Mental Health
Publisher
BMJ Publishing Group
ISSN
1362-0347
Access(Rights)
open.access