A scoping review of network meta-analyses assessing the efficacy and safety of complementary and alternative medicine interventions

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Abstract

Background

Network meta-analysis (NMA) has rapidly grown in use during the past decade for the comparison of healthcare interventions. While its general use in the comparison of conventional medicines has been studied previously, to our awareness, its use to assess complementary and alternative medicines (CAM) has not been studied. A scoping review of the literature was performed to identify systematic reviews incorporating NMAs involving one or more CAM interventions.

Methods

An information specialist executed a multi-database search (e.g., MEDLINE, Embase, Cochrane), and two reviewers performed study selection and data collection. Information on publication characteristics, diseases studied, interventions compared, reporting transparency, outcomes assessed, and other parameters were extracted from each review.

Results

A total of 89 SR/NMAs were included. The largest number of NMAs was conducted in China (39.3%), followed by the United Kingdom (12.4%) and the United States (9.0%). Reviews were published between 2010 and 2018, with the majority published between 2015 and 2018. More than 90 different CAM therapies appeared at least once, and the median number per NMA was 2 (IQR 1–4); 20.2% of reviews consisted of only CAM therapies. Dietary supplements (51.1%) and vitamins and minerals (42.2%) were the most commonly studied therapies, followed by electrical stimulation (31.1%), herbal medicines (24.4%), and acupuncture and related treatments (22.2%). A diverse set of conditions was identified, the most common being various forms of cancer (11.1%), osteoarthritis of the hip/knee (7.8%), and depression (5.9%). Most reviews adequately addressed a majority of the PRISMA NMA extension items; however, there were limitations in indication of an existing review protocol, exploration of network geometry, and exploration of risk of bias across studies, such as publication bias.

Conclusion

The use of NMA to assess the effectiveness of CAM interventions is growing rapidly. Efforts to identify priority topics for future CAM-related NMAs and to enhance methods for CAM comparisons with conventional medicine are needed.

Systematic review registration

https://ruor.uottawa.ca/handle/10393/35658

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Most cited references 94

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Waiting list may be a nocebo condition in psychotherapy trials: a contribution from network meta-analysis.

T A Furukawa, H Noma, D. Caldwell … (2014)

Various control conditions have been employed in psychotherapy trials, but there is growing suspicion that they may lead to different effect size estimates. The present study aims to examine the differences among control conditions including waiting list (WL), no treatment (NT) and psychological placebo (PP). We comprehensively searched for all randomized controlled trials (RCTs) comparing cognitive-behaviour therapies (CBT) against various control conditions in the acute phase treatment of depression, and applied network meta-analysis (NMA) to combine all direct and indirect comparisons among the treatment and control arms. We identified 49 RCTs (2730 participants) comparing WL, NT, PP and CBT. This network of evidence was consistent, and the effect size estimates for CBT were substantively different depending on the control condition. The odds ratio of response for NT over WL was statistically significant at 2.9 (95% CI: 1.3-5.7). However, the quality of evidence, including publication bias, was less than ideal and none of the preplanned sensitivity analyses limiting to high-quality studies could be conducted, while findings of significant differences did not persist in post hoc sensitivity analyses trying to adjust for publication bias. There may be important differences in control conditions currently used in psychotherapy trials. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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Indirect treatment comparison/network meta-analysis study questionnaire to assess relevance and credibility to inform health care decision making: an ISPOR-AMCP-NPC Good Practice Task Force report.

Jeroen P Jansen, Thomas A Trikalinos, Joseph C Cappelleri … (2014)

Despite the great realized or potential value of network meta-analysis of randomized controlled trial evidence to inform health care decision making, many decision makers might not be familiar with these techniques. The Task Force developed a consensus-based 26-item questionnaire to help decision makers assess the relevance and credibility of indirect treatment comparisons and network meta-analysis to help inform health care decision making. The relevance domain of the questionnaire (4 questions) calls for assessments about the applicability of network meta-analysis results to the setting of interest to the decision maker. The remaining 22 questions belong to an overall credibility domain and pertain to assessments about whether the network meta-analysis results provide a valid answer to the question they are designed to answer by examining 1) the used evidence base, 2) analysis methods, 3) reporting quality and transparency, 4) interpretation of findings, and 5) conflicts of interest. The questionnaire aims to help readers of network meta-analysis opine about their confidence in the credibility and applicability of the results of a network meta-analysis, and help make decision makers aware of the subtleties involved in the analysis of networks of randomized trial evidence. It is anticipated that user feedback will permit periodic evaluation and modification of the questionnaire. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

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Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis

Roger Hilfiker, André Meichtry, Manuela Eicher … (2017)

Aim To assess the relative effects of different types of exercise and other non-pharmaceutical interventions on cancer-related fatigue (CRF) in patients during and after cancer treatment. Design Systematic review and indirect-comparisons meta-analysis. Data sources Articles were searched in PubMed, Cochrane CENTRAL and published meta-analyses. Eligibility criteria for selecting studies Randomised studies published up to January 2017 evaluating different types of exercise or other non-pharmaceutical interventions to reduce CRF in any cancer type during or after treatment. Study appraisal and synthesis Risk of bias assessment with PEDro criteria and random effects Bayesian network meta-analysis. Results We included 245 studies. Comparing the treatments with usual care during cancer treatment, relaxation exercise was the highest ranked intervention with a standardisedmean difference (SMD) of −0.77 (95% Credible Interval (CrI) −1.22 to −0.31), while massage (−0.78; −1.55 to −0.01), cognitive–behavioural therapy combined with physical activity (combined CBT, −0.72; −1.34 to −0.09), combined aerobic and resistance training (−0.67; −1.01 to −0.34), resistance training (−0.53; −1.02 to −0.03), aerobic (−0.53; −0.80 to −0.26) and yoga (−0.51; −1.01 to 0.00) all had moderate-to-large SMDs. After cancer treatment, yoga showed the highest effect (−0.68; −0.93 to −0.43). Combined aerobic and resistance training (−0.50; −0.66 to −0.34), combined CBT (−0.45; −0.70 to −0.21), Tai-Chi (−0.45; −0.84 to −0.06), CBT (−0.42; −0.58 to −0.25), resistance training (−0.35; −0.62 to −0.08) and aerobic (−0.33; −0.51 to −0.16) showed all small-to-moderate SMDs. Conclusions Patients can choose among different effective types of exercise and non-pharmaceutical interventions to reduce CRF.

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Author and article information

Contributors

Misty Pratt: mipratt@ohri.ca

Susan Wieland: lswieland@gmail.com

Nadera Ahmadzai: nahmadzai@ohri.ca

Claire Butler: clbutler@ohri.ca

Dianna Wolfe: dwolfe@ohri.ca

Kusala Pussagoda: kpussegoda@ohri.ca

Becky Skidmore: bskidmore@rogers.com

Argie Veroniki: averonik@cc.uoi.gr

Patricia Rios: riosp@smh.ca

Andrea C. Tricco: andrea.tricco@unityhealth.to

Brian Hutton:

ORCID: https://orcid.org/0000-0001-5662-8647

bhutton@ohri.ca

Journal

Journal ID (nlm-ta): Syst Rev

Journal ID (iso-abbrev): Syst Rev

Title: Systematic Reviews

Publisher: BioMed Central (London )

ISSN (Electronic): 2046-4053

Publication date (Electronic): 30 April 2020

Publication date PMC-release: 30 April 2020

Publication date Collection: 2020

Volume: 9

Electronic Location Identifier: 97

Affiliations

[1 ]GRID grid.412687.e, ISNI 0000 0000 9606 5108, Clinical Epidemiology Program, , Ottawa Hospital Research Institute, ; 501 Smyth Road, Box 201, Ottawa, Ontario K1H 8 L6 Canada

[2 ]GRID grid.411024.2, ISNI 0000 0001 2175 4264, University of Maryland School of Medicine, ; Baltimore, MD USA

[3 ]GRID grid.9594.1, ISNI 0000 0001 2108 7481, Department of Primary Education, School of Education, , University of Ioannina, ; Ioannina, Greece

[4 ]GRID grid.415502.7, Li Ka Shing Knowledge Institute, , St Michael’s Hospital, Unity Health Toronto, ; Toronto, Canada

[5 ]GRID grid.7445.2, ISNI 0000 0001 2113 8111, Institute of Reproductive and Developmental Biology, Department of Surgery & Cancer, Faculty of Medicine, , Imperial College, ; London, United Kingdom

[6 ]GRID grid.17063.33, ISNI 0000 0001 2157 2938, Epidemiology Division, Dalla Lana School of Public Health and Institute for Health Policy, Management, and Evaluation, , University of Toronto, ; Toronto, Canada

[7 ]GRID grid.28046.38, ISNI 0000 0001 2182 2255, School of Epidemiology and Public Health, , University of Ottawa, ; Ottawa, Canada

Author information

Brian Hutton https://orcid.org/0000-0001-5662-8647

Article

Publisher ID: 1328

DOI: 10.1186/s13643-020-01328-3

PMC ID: 7191816

PubMed ID: 32354348

SO-VID: a6109eaa-a686-42d7-87cc-751c8a792028

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 23 January 2020

Date accepted : 10 March 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000064, National Center for Complementary and Alternative Medicine;

Award ID: R24AT001293

Award Recipient : Susan Wieland

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ScienceOpen disciplines: Public health

Keywords: complementary and alternative medicine,scoping review,network meta-analysis

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ScienceOpen disciplines: Public health

Keywords: complementary and alternative medicine, scoping review, network meta-analysis

A scoping review of network meta-analyses assessing the efficacy and safety of complementary and alternative medicine interventions

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Most cited references 94

Waiting list may be a nocebo condition in psychotherapy trials: a contribution from network meta-analysis.

Indirect treatment comparison/network meta-analysis study questionnaire to assess relevance and credibility to inform health care decision making: an ISPOR-AMCP-NPC Good Practice Task Force report.

Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis

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