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  1. Discrepancies between meta-analyses and subsequent large randomized, controlled trials.

    Article - En anglais

    Background Meta-analyses are now widely used to provide evidence to support clinical strategies.

    However, large randomized, controlled trials are considered the gold standard in evaluating the efficacy of clinical interventions.

    Methods We compared the results of large randomized, controlled trials (involving 1000 patients or more) that were published in four journals (the New England Journal of Medicine, the Lancet, the Annals of Internal Medicine, and the Journal of the American Medical Association) with the results of meta-analyses published earlier on the same topics.

    Regarding the principal and secondary outcomes, we judged whether the findings of the randomized trials agreed with those of the corresponding meta-analyses, and we determined whether the study results were positive (indicating that treatment improved the outcome) or negative (indicating that the outcome with treatment was the same or worse than without it) at the conventional level of statistical significance (P<0.05).

    Results We identified 12 large randomized, controlled trials and 19 meta-analyses addressing the same questions.

    For a total of 40 primary and secondary outcomes, agreement between the meta-analyses and the large clinical trials was only fair (kappa=0.35 ; 95 percent confidence interval, 0.06 to 0.64).

    The positive predictive value of the meta-analyses was 68 percent, and the negative predictive value 67 percent. (...)

    Mots-clés Pascal : Métaanalyse, Randomisation, Essai clinique, Enquête sur terrain, Divergence, Etude comparative, Evaluation, Homme, Médecine, Politique sanitaire

    Mots-clés Pascal anglais : Metaanalysis, Randomization, Clinical trial, Field inquiry, Divergence, Comparative study, Evaluation, Human, Medicine, Health policy

    Logo du centre Notice produite par :
    Inist-CNRS - Institut de l'Information Scientifique et Technique

    Cote : 97-0450496

    Code Inist : 002B30A09. Création : 03/02/1998.