Interventions for treating head lice: a network meta-analysis

Prediction models are essential in clinical decision-making for estimating the probability of current (diagnosis, screening) or future (prognosis) outcomes. Network meta-analysis (NMA) serves as a powerful tool to compare the performance of multiple prediction models simultaneously. However, there is hardly any guidance on methods and reporting for studies employing NMA to evaluate prediction models. To provide an overview of NMAs assessing prediction model (external validation) performance, regardless of whether they use aggregate data (AD) or individual participant data (IPD). In addition, we offer recommendations for improving the reporting and conduct of NMAs in prediction model research. We searched PubMed and Embase up to September 1, 2025, to identify studies that addressed the evaluation of diagnostic or prognostic prediction model performance using NMA. We included articles that employed NMA to compare and assess at least three prediction models. We summarized the identified studies based on, eg, their application (diagnostic vs prognostic), data use (AD vs IPD), medical contexts in which the models were assessed, and evaluation metrics applied (eg, discrimination, calibration, and (re)classification). In addition, we examined the statistical approaches employed, the NMA assumptions (such as consistency, transitivity, and exchangeability), and the ranking methods used for model comparison. After screening 2436 articles, 28 were included. Twenty-six studies (92.9%) used AD, while two (7.1%) used IPD. Hospital care was the most common setting (n = 22; 78.6%), with respirology (n = 7; 25.0%) and cardiology (n = 5; 17.9%) as the most frequently studied clinical domains. Key NMA assumptions were addressed differently across the 28 NMAs: 14.3% (n = 4) discussed transitivity, similarity, or exchangeability, and 53.6% (n = 15) tested for consistency. The statistical approach also varied, with 60.7% of studies (n = 17) reporting Bayesian methods and 17.9% (n = 5) reporting frequentist approaches. Surface under the cumulative ranking was the predominant ranking method (n = 18). Most NMAs included 5 to 10 models in the network, with 5 NMAs analyzing more than 20 models. Performance metrics varied, with 39.3% of studies (n = 11) reporting discrimination measures, such as C statistics, while none reported calibration metrics. Sensitivity or specificity was provided in 64.3% of studies (n = 18), and no articles reported advanced decision-analytic metrics like the decision curve analysis. This scoping review highlights the limited and diverse use of NMA methods in evaluating prediction models, with a predominant reliance on aggregate rather than IPD, and inconsistent consideration of key NMA assumptions and model performance metrics. We provide recommendations for the reporting and conduct of an NMA of prediction model validation performance. Prediction models are tools used in medicine to estimate a patient's risk of developing a disease or experiencing a health outcome. Many different prediction models exist for the same condition, and it can be difficult for doctors and researchers to know which model performs best. One way to compare multiple models is through a statistical method called network meta-analysis (NMA), which is commonly used to compare treatments but has rarely been applied to prediction models. In our study, we reviewed all published NMAs that evaluated prediction models to see how they were conducted and reported. We looked at whether the studies reported important performance measures, such as how well the models could distinguish between patients with and without the outcome (discrimination), and how well the predictions matched actual outcomes (calibration). We also checked if key NMA assumptions were considered and how analyses were conducted. We found that most studies used summary data instead of patient-level data. Many did not report crucial performance measures and rarely checked NMA assumptions. There was also limited transparency in how the models were analyzed, making it difficult for others to reproduce the results. Our findings show that while NMA has great potential to help compare prediction models and identify the most reliable ones, current practice often lacks the detailed reporting needed to make these comparisons fully trustworthy. We recommend better reporting, sharing of data and analysis code, and careful checking of assumptions to help researchers and doctors choose the most reliable models, ultimately improving patient care.

Meta-Review: Network Meta-Analyses in Child and Adolescent Psychiatry.

To evaluate the reporting quality of systematic reviews with network meta-analyses (NMAs) in Endodontics using the the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) for NMA checklist. The current investigation extends a recently published study in the International Endodontic Journal (Nagendrababu V, Faggion Jr CM, Pulikkotil SJ, Alatta A, Dummer PM Methodological assessment and overall confidence in the results of systematic reviews with network meta-analyses in Endodontics. International Endodontic Journal 2022;55:393-404) that assessed the methodological quality of systematic reviews with NMAs in Endodontics using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) tool. In the present study, the PRISMA for NMA checklist with 32 items was used to assess the reporting quality of the systematic reviews with NMAs (n = 12). Two independent assessors assigned '1' when an item was completely addressed, '0.5' when it was partially addressed, and '0' when it was not addressed. Disagreements were resolved through reviewer discussion until consensus was reached. If conflicts persisted, a third reviewer made the final decision. The PRISMA for NMA scores were shared with the relevant authors of the individual reviews to reduce the likelihood of misinterpretation and verify the scores assigned.The results for each individual item of the PRISMA-NMA items were calculated by summing the individual scores awarded; the maximum score for each item was 12. All the systematic reviews with NMAs adequately reported the following items: Title, Introduction section (Objectives), Methods section (Eligibility criteria and Information sources), Results section (Study selection, Study characteristics and Risk of bias within studies), and Discussion section (Summary of evidence). The items that were reported least often were the "geometry of the network" and "the summary of network geometry" with only 2 manuscripts (17%) including these items. A number of the items in the PRISMA-NMA checklist were adequately addressed in the NMAs; however, none adequately reported all the PRISMA-NMA items. The inadequacies of published NMAs that have been identified should be taken into consideration by authors of NMAs in Endodontics and by editors when managing the peer review process.In future, researchers who are writing systematic reviews with NMAs should comply with the PRISMA-NMA checklist. None of the included systematic reviews with NMA adequately reported all the PRISMA-NMA items. Inadequate reporting of a systematic review with NMA increases the possibility that it will provide invalid results. Therefore, authors should follow the PRISMA-NMA guidelines when reporting systematic reviews with NMA in Endodontics.

To support systematic reviewers new to network meta-analysis (NMA), we (1) identified and described published methods resources for conducting systematic reviews (SRs) with NMA of randomized controlled trials (RCTs); (2) mapped the resources to the typical steps for conducting NMAs; and (3) identified NMA guidance gaps. We performed a scoping review and comprehensively searched major databases, gray literature sources, and websites for methods resources that described or informed any steps in conducting SRs with NMA to guide review authors, particularly those new to the method. Title, abstract, and full-text screening were conducted independently in duplicate using Covidence. NMA resources were narratively described and tabulated by guidance type, review steps, and topic and mapped to the steps of conducting a systematic review with NMA. We considered documents in the 2011-2025 date range and included 90; the majority (39%) were published between 2021 and 2025. Most were classified as guides/guidance (29%), methods/methodology (22%), or reviews (27%). We found that the rate of published guidance around most steps of NMA increased or remained stable over time. Most resources for software were guidance for R and Stata. Guidance documents on assumptions and certainty of evidence were abundant (in excess of 13 documents per topic), whereas fewer guidance documents were available on elements of protocol development and presentation of results. We mapped methods resources across steps in conducting SRs with NMA, identifying areas with sparse guidance. This scoping review provides a comprehensive reference for conducting SRs using NMA, especially for those new to the methods. It highlights the significant increase in guidance since 2011, particularly on evidence certainty and NMA assumptions, and the availability of user-friendly web tools. Future work should focus on advanced NMA guidance and decision tools to aid reviewers in further navigating NMA complexities.

Antihypertensive drugs and risk of cancer: network meta-analyses and trial sequential analyses of 324,168 participants from randomised trials.

BackgroundElderly individuals who have memory problems without significant limitations in activities of daily living are often diagnosed as having mild cognitive impairment (MCI). Some of these individuals progress to dementia. Several cognitive enhancers (for example donepezil, galantamine, rivastigmine, memantine) have been approved for use in people with Alzheimer’s dementia but their use in patients with MCI is unclear. We aimed to determine the comparative effectiveness, safety, and cost of cognitive enhancers for MCI through a systematic review and network (that is, indirect comparisons) meta-analysis.Design/MethodsWe will include studies that examine the use of cognitive enhancers compared to placebo, supportive care, or other cognitive enhancers among patients diagnosed with MCI. Outcomes of interest include cognition and function (primary outcomes), as well as behavior, quality of life, safety, and cost (secondary outcomes). We will include all experimental studies (randomized controlled trials, quasi-randomized controlled trials, controlled clinical trials), quasi-experimental studies (controlled before-after, interrupted time series), and observational studies (cohort, case–control). Studies will be included regardless of publication status (that is, we will include unpublished studies), year, or language of dissemination.To identify potentially relevant material, we will search the following electronic databases from inception onwards: MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, and Ageline. The electronic database search will be supplemented by scanning the reference lists of included studies, searching Google and organization websites for unpublished or difficult to locate material literature, and contacting experts.Two reviewers will independently screen the studies for inclusion using the eligibility criteria established a priori and independently extract data. Risk of bias will be assessed using the Cochrane Risk of Bias tool for experimental and quasi-experimental studies and the Newcastle Ottawa Scale for observational epidemiology studies. Meta-analysis and network meta-analysis are planned, if the studies are deemed statistically, methodologically, and clinically homogenous.DiscussionOur systematic review will provide important information regarding the benefits, costs, and harms of cognitive enhancers for patients with MCI. This information can be used to assist healthcare providers, policy-makers, MCI patients and their family regarding the use of these agents.PROSPERO registry numberCRD42012002234

BackgroundAnkylosing spondylitis (AS) is a chronic inflammatory disease that impairs physical function, reduces quality of life, and is associated with psychological burdens such as anxiety and depression. While non-steroidal anti-inflammatory drugs (NSAIDs) and biologic therapies are standard treatments, exercise therapy is crucial for maintaining mobility and function. This study aimed to comprehensively compare the effects of 12 exercise interventions on AS patients’ disease activity and chest expansion (CE) via network meta-analysis (NMA) and dose-response meta-analysis, and explore dose-dependent effects to inform personalized exercise prescriptions.MethodologyFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, randomized controlled trials (RCTs) were searched from PubMed, Cochrane Library, Embase, and Web of Science until December 31, 2024. Eligible studies included adults with American College of Rheumatology/European League Against Rheumatism (ACR/EULAR)-diagnosed AS, comparing exercise with conventional treatment/placebo/no intervention, with outcomes of Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Metrology Index (BASMI), and CE. Two reviewers screened literature, extracted data, and assessed bias using the Cochrane Handbook. NMA and dose-response analysis (expressed as metabolic equivalents of task (MET) minutes/week) were performed (Prospero: CRD420251001511).ResultsThirty-two RCTs with 1757 participants were included. NMA showed hippotherapy simulation (HS) was most effective for reducing BASFI; aerobic exercise (AE) + Pilates was superior for BASDAI and BASMI; AE + Stretching Exercise (SE)+Supervise best improved CE. Dose-response analysis revealed non-linear relationships, with specific effective dose ranges identified for each outcome. Subgroup and sensitivity analyses confirmed result robustness.ConclusionExercise interventions, especially HS, AE + Pilates, and AE + SE + Supervise, effectively improve AS patients’ disease activity and CE. Non-linear dose-response relationships emphasize personalized prescriptions, providing evidence-based guidance for integrating exercise into AS management, with future large-scale RCTs needed to validate dose effects.

The increasing recognition of network meta-analyses (NMAs) in dentistry, particularly in periodontology and implantology, lacks assessed reporting quality. To address this, our study will undertake a systematic review of previously reported NMAs. Researchers conducted an electronic search in Web of Science and Scopus to identify NMAs across all dentistry journals. Two independent investigators selected studies, extracted data, and assessed reporting quality using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for NMA (PRISMA-NMA) checklist with 32 items. Each “yes” response earned 1 point, and “no” responses received 0 points, yielding an overall reporting quality score. In total, 39 NMAs were included in this study. The NMAs were published between 2010 and October 2024, with most of them published in 2022 (25%). Most of the NMAs employed the PRISMA-NMA guidelines (47%) and have been published in theJournal of Clinical Periodontology(53%). The overall reporting quality of the included NMAs ranged between 87.5 and 100% (i.e., high quality of reporting [≥ 75th %]), with 5 NMAs reporting all 27 items of the PRISMA-NMA statement. The limitations, presentation of network structure (results), funding, and objectives (methods) were reported in 97, 94, 81, and 78% of the NMAs, respectively. The least reported items were the protocol registration and the summary of network geometry, which were reported in 53% of the NMAs. All the remaining items were reported in all 39 NMAs. The reporting quality of the NMAs published related to periodontology and implantology was high. However, some deficiencies were revealed associated with the reporting quality of the PRISMA-NMA items, including protocol registration, formulation of the research question based on the PICO (Population, Intervention, Comparison, Outcome) format, and summarization of the network geometry.

Bibliographic study showed improving statistical methodology of network meta-analyses published between 1999 and 2015

Automatic screening using word embeddings achieved high sensitivity and workload reduction for updating living network meta-analyses

Because of the methodological complexity of network meta-analyses (NMAs), NMAs may be more vulnerable to methodological risks than conventional pair-wise meta-analysis. Our study aims to investigate epidemiology characteristics, conduction of literature search, methodological quality and reporting of statistical analysis process in the field of cancer based on PRISMA extension statement and modified AMSTAR checklist. We identified and included 102 NMAs in the field of cancer. 61 NMAs were conducted using a Bayesian framework. Of them, more than half of NMAs did not report assessment of convergence (60.66%). Inconsistency was assessed in 27.87% of NMAs. Assessment of heterogeneity in traditional meta-analyses was more common (42.62%) than in NMAs (6.56%). Most of NMAs did not report assessment of similarity (86.89%) and did not used GRADE tool to assess quality of evidence (95.08%). 43 NMAs were adjusted indirect comparisons, the methods used were described in 53.49% NMAs. Only 4.65% NMAs described the details of handling of multi group trials and 6.98% described the methods of similarity assessment. The median total AMSTAR-score was 8.00 (IQR: 6.00–8.25). Methodological quality and reporting of statistical analysis did not substantially differ by selected general characteristics. Overall, the quality of NMAs in the field of cancer was generally acceptable.

IntroductionA range of treatments are available for moderate-to-severe psoriasis; however, there remains a paucity of direct comparisons of these in head-to-head trials. Network meta-analyses (NMA) allow comparisons of these to support clinical decision making. This systematic literature review assesses the methodological quality of NMAs available for moderate-to-severe psoriasis and compares their methods and results. Their validity and applicability for current practice is also assessed.MethodsA systematic review of published NMAs of at least two biologics for moderate-to-severe psoriasis was undertaken. Embase, MEDLINE, MEDLINE In-Process, and the Cochrane Library were last searched on 19 February 2020. The quality of NMAs was assessed using the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) criteria. NMA methodology, funding, and results were compared and differences in results explored.ResultsTwenty-five analyses evaluating up to 19 different treatments at 8–24 weeks, and two analyses at 1 year, were included. Psoriasis Area Severity Index (PASI) response was assessed in 23, facilitating comparisons between NMAs. All NMAs met at least half of the ISPOR criteria. The major limitations were explaining the rationale for methodology, exploring effect modifiers, and consistency between direct and indirect estimates. The analyses differed in model type (Bayesian or frequentist), analysis of PASI response (binomial or multinomial), and analysis of different treatment doses (separate or pooled). PASI results were broadly similar, except for the Cochrane Collaboration NMA which provided lower estimates of treatment efficacy versus placebo. This analysis differed methodologically from others, including pooling data for different doses.ConclusionsBased on PASI 90 at induction, the majority of recent NMAs came to similar conclusions: interleukin (IL) 17 inhibitors (brodalumab, ixekizumab, secukinumab), IL-23 inhibitors (guselkumab and risankizumab) and infliximab were most efficacious, supporting the validity of NMAs in this clinical area. Decisions should be made using high-quality, up-to-date NMAs with assumptions relevant to clinical practice.Electronic supplementary materialThe online version of this article (10.1007/s13555-020-00463-y) contains supplementary material, which is available to authorized users.

Living network meta-analysis was feasible when considering the pace of evidence generation

PNS220 CHARACTERISTICS AND METHODS OF INCORPORATING RANDOMIZED AND NON-RANDOMIZED EVIDENCE IN NETWORK META-ANALYSES: A SCOPING REVIEW

Gaps in completeness of reporting and methodological quality: a metaresearch study of 139 network meta-analyses published in January 2023 using PRISMA-NMA and AMSTAR-2.