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Direct versus indirect comparisons: A summary of the evidence

Published online by Cambridge University Press:  09 April 2008

Gerald Gartlehner  and
Charity G. Moore
Gerald Gartlehner
Affiliation:
Danube University Krems
Charity G. Moore
Affiliation:
University of Pittsburgh
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Abstract

Objectives: The aim of this study was to provide a comprehensive summary and interpretation of the current evidence on the use and validity of statistical methods to conduct indirect comparisons of treatment effects.

Methods: A narrative review was conducted.

Results: Well-conducted methodological studies provide good evidence that adjusted indirect comparisons can lead to results similar to those from direct comparisons. The internal validity of several statistical methods to conduct indirect comparisons, therefore, has been established. Meta-regression, logistic regression, or adjusted indirect comparisons should be the methods of first choice. Unadjusted indirect comparisons are always unacceptable. Deciding whether to combine direct and indirect evidence will be a matter of informed judgment based on the similarities and dissimilarities of populations and interventions. Unverifiable assumptions with respect to the similarity of compared studies and low power are serious limitations of indirect comparisons.

Conclusions: In the absence of sufficient head-to-head evidence, adjusted indirect comparisons can be viewed as additional analytical tools to determine the comparative efficacy and effectiveness of competing interventions. Researchers who use indirect comparisons need to keep the limitations in mind.

Keywords

Indirect comparisonsAdjusted indirect comparisonsSummary of the evidence
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 24 , Issue 2 , April 2008 , pp. 170 - 177
Copyright
Copyright © Cambridge University Press 2008

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References

REFERENCES

1. Alves, C, Cachola, I, Brandao, J. Efficacy and tolerability of venlafaxine and fluoxetine in outpatients with major depression. Primary Care Psychiatry. 1999;5:57–63.Google Scholar
2. Baker, SG, Kramer, BS. The transitive fallacy for randomized trials: If A bests B and B bests C in separate trials, is A better than C? BMC Med Res Methodol. 2002;2:13.Google Scholar
3. Bennie, EH, Mullin, JM, Martindale, JJ. A double-blind multicenter trial comparing sertraline and fluoxetine in outpatients with major depression. J Clin Psychiatry. 1995;56:229–237.Google Scholar
4. Boyer, P, Danion, JM, Bisserbe, JC, et al. Clinical and economic comparison of sertraline and fluoxetine in the treatment of depression. A 6-month double-blind study in a primary-care setting in France. Pharmacoeconomics. 1998;13 (pt 2):157–169.Google Scholar
5. Bucher, HC, Guyatt, GH, Griffith, LE, et al. The results of direct and indirect treatment comparisons in meta-analysis of randomized controlled trials. J Clin Epidemiol. 1997;50:683–691.Google Scholar
6. Caldwell, DM, Ades, AE, Higgins, JP. Simultaneous comparison of multiple treatments: Combining direct and indirect evidence. BMJ. 2005;331:897–900.Google Scholar
7. Costa e Silva, J. Randomized, double-blind comparison of venlafaxine and fluoxetine in outpatients with major depression. J Clin Psychiatry. 1998;59:352–357.Google Scholar
8. Cunningham, LA. Once-daily venlafaxine extended release (XR) and venlafaxine immediate release (IR) in outpatients with major depression. Venlafaxine XR 208 Study Group. Ann Clin Psychiatry. 1997;9:157–164.Google Scholar
9. De Nayer, A, Geerts, S, Ruelens, L, et al. Venlafaxine compared with fluoxetine in outpatients with depression and concomitant anxiety. Int J Neuropsychopharmacol. 2002;5:115–120.Google Scholar
10. Dierick, M, Ravizza, L, Realini, R, et al. A double-blind comparison of venlafaxine and fluoxetine for treatment of major depression in outpatients. Prog Neuropsychopharmacol Biol Psychiatry. 1996;20:57–71.Google Scholar
11. Fava, M, Hoog, SL, Judge, RA, et al. Acute efficacy of fluoxetine versus sertraline and paroxetine in major depressive disorder including effects of baseline insomnia. J Clin Psychopharmacol. 2002;22:137–147.Google Scholar
12. Fava, M, Judge, R, Hoog, SL, et al. Fluoxetine versus sertraline and paroxetine in major depressive disorder: Changes in weight with long-term treatment. J Clin Psychiatry. 2000;61:863–867.Google Scholar
13. Glenny, AM, Altman, DG, Song, F, et al. Indirect comparisons of competing interventions. Health Technol Assess. 2005;9:1–148.Google Scholar
14. Gotzsche, PC. Lessons from and cautions about noninferiority and equivalence randomized trials. JAMA. 2006;295:1172–1174.Google Scholar
15. Greene, WL, Concato, J, Feinstein, AR. Claims of equivalence in medical research: Are they supported by the evidence? Ann Intern Med. 2000;132:715–722.Google Scholar
16. Higgins, JPT, Green, S, eds. Cochrane handbook for systematic reviews of interventions. 4.2.5 [updated May 2005]. In: The Cochrane Library, Issue 3, 2005. Chichester, UK: John Wiley & Sons, Ltd.Google Scholar
17. Hypericum Depression Trial Study Group. Effect of Hypericum perforatum (St John's wort) in major depressive disorder: A randomized controlled trial. JAMA. 2002;287:1807–1814.Google Scholar
18. Ioannidis, JP. Indirect comparisons: The mesh and mess of clinical trials. Lancet. 2006;368:1470–1472.Google Scholar
19. Khan, A, Fabre, LF, Rudolph, R. Venlafaxine in depressed outpatients. Psychopharmacol Bull. 1991;27:141–144.Google Scholar
20. Kocsis, JH, Zisook, S, Davidson, J, et al. Double-blind comparison of sertraline, imipramine, and placebo in the treatment of dysthymia: Psychosocial outcomes. Am J Psychiatry. 1997;154:390–395.Google Scholar
21. Kroenke, K, West, SL, Swindle, R, et al. Similar effectiveness of paroxetine, fluoxetine, and sertraline in primary care: A randomized trial. JAMA. 2001;286:2947–2955.Google Scholar
22. Lu, G, Ades, AE. Combination of direct and indirect evidence in mixed treatment comparisons. Stat Med. 2004;23:3105–3124.Google Scholar
23. Lumley, T. Network meta-analysis for indirect treatment comparisons. Stat Med. 2002;21:2313–2324.Google Scholar
24. Lydiard, RB, Stahl, SM, Hertzman, M, et al. A double-blind, placebo-controlled study comparing the effects of sertraline versus amitriptyline in the treatment of major depression. J Clin Psychiatry. 1997;58:484–491.Google Scholar
25. McDonagh, MS CS. Drug class review on proton pump inhibitors. Drug effectiveness review project 2006. Available at: http://www.ohsu.edu/drugeffectiveness/reports/documents/PPIs %20Final%Report%u4%Unshaded.pdf. Accessed 11/2/2007.Google Scholar
26. Mehtonen, OP, Sogaard, J, Roponen, P, et al. Randomized, double-blind comparison of venlafaxine and sertraline in outpatients with major depressive disorder. Venlafaxine 631 Study Group. J Clin Psychiatry. 2000;61:95–100.Google Scholar
27. Mendels, J, Johnston, R, Mattes, J, et al. Efficacy and safety of b.i.d. doses of venlafaxine in a dose-response study. Psychopharmacol Bull. 1993;29:169–174.Google Scholar
28. Nemeroff, CB, Thase, ME. A double-blind, placebo-controlled comparison of venlafaxine and fluoxetine treatment in depressed outpatients. J Psychiatr Res. 2007;41:351–359.Google Scholar
29. Newhouse, PA, Krishnan, KR, Doraiswamy, PM, et al. A double-blind comparison of sertraline and fluoxetine in depressed elderly outpatients. J Clin Psychiatry. 2000;61:559–568.Google Scholar
30. Olie, JP, Gunn, KP, Katz, E. A double-blind placebo-controlled multicentre study of sertraline in the acute and continuation treatment of major depression. Eur Psychiatry. 1997;12:34–41.Google Scholar
31. Reimherr, FW, Byerley, WF, Ward, MF, et al. Sertraline, a selective inhibitor of serotonin uptake, for the treatment of outpatients with major depressive disorder. Psychopharmacol Bull. 1988;24:200–205.Google Scholar
32. Reimherr, FW, Chouinard, G, Cohn, CK, et al. Antidepressant efficacy of sertraline: A double-blind, placebo-and amitriptyline-controlled, multicenter comparison study in outpatients with major depression. J Clin Psychiatry. 1990;51 (Suppl B):18–27.Google Scholar
33. Rudolph, RL, Feiger, AD. A double-blind, randomized, placebo-controlled trial of once-daily venlafaxine extended release (XR) and fluoxetine for the treatment of depression. J Affect Disord. 1999;56:171–181.Google Scholar
34. Schatzberg, A, Roose, S. A double-blind, placebo-controlled study of venlafaxine and fluoxetine in geriatric outpatients with major depression. Am J Geriatr Psychiatry. 2006;14:361–370.Google Scholar
35. Schneider, LS, Nelson, JC, Clary, CM, et al. An 8-week multicenter, parallel-group, double-blind, placebo-controlled study of sertraline in elderly outpatients with major depression. Am J Psychiatry. 2003;160:1277–1285.Google Scholar
36. Sechter, D, Troy, S, Paternetti, S, et al. A double-blind compari-son of sertraline and fluoxetine in the treatment of major depressive episode in outpatients. Eur Psychiatry. 1999;14:41–48.Google Scholar
37. Silverstone, PH, Ravindran, A. Once-daily venlafaxine extended release (XR) compared with fluoxetine in outpatients with depression and anxiety. Venlafaxine XR 360 Study Group. J Clin Psychiatry. 1999;60:22–28.Google Scholar
38. Sir, A, D'Souza, RF, Uguz, S, et al. Randomized trial of sertraline versus venlafaxine XR in major depression: Efficacy and discontinuation symptoms. J Clin Psychiatry. 2005;66:1312–1320.Google Scholar
39. Song, F, Altman, DG, Glenny, AM, et al. Validity of indirect comparison for estimating efficacy of competing interventions: Empirical evidence from published meta-analyses. BMJ. 2003;326:472.Google Scholar
40. Song, F, Glenny, AM, Altman, DG. Indirect comparison in evaluating relative efficacy illustrated by antimicrobial prophylaxis in colorectal surgery. Control Clin Trials. 2000;21:488–897.Google Scholar
41. Thase, ME. Efficacy and tolerability of once-daily venlafaxine extended release (XR) in outpatients with major depression. The Venlafaxine XR 209 Study Group. J Clin Psychiatry. 1997;58:393–398.Google Scholar
42. Tylee, A, Beaumont, G, Bowden, MW, et al. A double-blind, randomized, 12-week comparison study of the safety and efficacy of venlafaxine and fluoxetine in moderate to severe major depression in general practice. Primary Care Psychiatry. 1997;3:51–58.Google Scholar
43. Tzanakaki, M, Guazzelli, M, Nimatoudis, I, et al. Increased remission rates with venlafaxine compared with fluoxetine in hospitalized patients with major depression and melancholia. Int Clin Psychopharmacol. 2000;15:29–34.Google Scholar
44. Van Moffaert, M, Bartholome, F, Cosyns, P, et al. A controlled comparison of sertraline and fluoxetine in acute and continuation treatment of major depression. Hum Psychopharmacol. 1995;10:393–405.Google Scholar