Robustness assessment of meta-analysis results based on enhanced funnel plots and trial sequential analysis_Chinese Journal of Evidence-Based Medicine

Authors：

XIE Weihua , DAI Pinyuan , SUN Jinfang , WANG Lina ,  YU Xiaojin

Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, Nanjing 210009, P.R.China;

Corresponding author：

YU Xiaojin, Email: xiaojinyu@seu.edu.cn

Keywords：

Enhanced funnel plot; Trial sequential analysis; Meta-analysis; Robustness; Green tea; Lipid metabolism

DOI：

10.7507/1672-2531.201910150

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To explore the application of enhanced funnel plots (EFP) and trial sequential analysis (TSA) in robustness assessment of meta-analysis results.Methods Data were extracted from published meta-analysis. The EFP was used to evaluate the robustness of the significance and heterogeneity of the current meta-analysis. The TSA was used to judge the sufficiency of the cumulative sample size of the current meta-analysis and to assess the robustness of conclusions based on current evidence.Results The EFP showed that the meta-analysis results of low-density lipoprotein (LDL) was robust, and the meta-analysis results of triglyceride (TG), total cholesterol (TC) and high-density lipoprotein (HDL) were not stable. The TSA showed that the cumulative sample size of LDL had reached the required information size (RIS), and the current conclusion was stable. The cumulative Z value of TG, TC and HDL neither reached the RIS nor passed through the TSA monitoring boundary or futility boundary, indicating that current conclusions were not robust.Conclusions The combination of EFP and TSA can make a comprehensive judgment on the robustness of current meta-analysis results, and provide methodological support in the robustness assessment of results for future systematic reviews and meta-analyses.

Citation： XIE Weihua, DAI Pinyuan, SUN Jinfang, WANG Lina, YU Xiaojin. Robustness assessment of meta-analysis results based on enhanced funnel plots and trial sequential analysis. Chinese Journal of Evidence-Based Medicine, 2020, 20(6): 713-718. doi: 10.7507/1672-2531.201910150 Copy

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14.	翁鸿, 龚侃, 刘小平, 等. 试验序贯分析在时间-事件数据中的应用. 中国循证医学杂志, 2017, 17(2): 239-242.
15.	翁鸿, 李胜, 何发智, 等. 试验序贯分析在 Stata 软件中的实现. 中国循证医学杂志, 2016, 16(12): 1472-1476.

1. Pereira TV, Ioannidis JP. Statistically significant meta-analyses of clinical trials have modest credibility and inflated effects. J Clin Epidemiol, 2011, 64(10): 1060-1069.
2. Pogue JM, Yusuf S. Cumulating evidence from randomized trials: utilizing sequential monitoring boundaries for cumulative meta-analysis. Control Clin Trials, 1997, 18(6): 580-593.
3. Thorlund K, Engstrøm J, Wetterslev J, et al. User manual for trial sequential analysis (TSA). Copenhagen: Copenhagen Trial Unit, 2011.
4. Kumar A, Shariff M, Adalja D, et al. Intravascular ultrasound versus angiogram guided drug eluting stent implantation. A systematic review and updated meta-analysis with trial sequential analysis. Int J Cardiol Heart Vasc, 2019, 25: 100419.
5. 李瑞, 孙金芳, 余小金, 等. SIX6 基因 rs10483727 多态性与原发性开角型青光眼发病关联性的 Meta 分析和试验序贯分析. 中国循证医学杂志, 2019, 19(3): 64-71.
6. Sterne JAC, Becker BJ, Egger M. The Funnel Plot. Chichester: Wiley, 2006.
7. Drewry AM, Ablordeppey EA, Murray ET, et al. Antipyretic therapy in critically ill septic patients: a systematic review and meta-analysis. Crit Care Med, 2017, 45(5): 806-813.
8. Verhagen AP, Ferreira M, Reijneveld-van de Vendel EAE, et al. Do we need another trial on exercise in patients with knee osteoarthritis?: No new trials on exercise in knee OA. Osteoarthritis Cartilage, 2019, 27(9): 1266-1269.
9. Palmer TM, Peters JL, Sutton AJ, et al. Contour-enhanced funnel plots for meta-analysis. Stata J, 2008, 8(2): 242-254.
10. Langan D, Higgins JP, Gregory W, et al. Graphical augmentations to the funnel plot assess the impact of additional evidence on a meta-analysis. J Clin Epidemiol, 2012, 65(5): 511-519.
11. Yuan F, Dong H, Fang K, et al. Effects of green tea on lipid metabolism in overweight or obese people: a meta-analysis of randomized controlled trials. Mol Nutr Food Res, 2018, 62(1): 1601122.
12. Duval S. Publication bias in meta-analysis-prevention, assessment and adjustments. Chichester: John Wiley&Sons Ltd, 2005.
13. Chevance A, Schuster T, Steele R, et al. Contour plot assessment of existing meta-analyses confirms robust association of statin use and acute kidney injury risk. J Clin Epidemiol, 2015, 68(10): 1138-1143.
14. 翁鸿, 龚侃, 刘小平, 等. 试验序贯分析在时间-事件数据中的应用. 中国循证医学杂志, 2017, 17(2): 239-242.
15. 翁鸿, 李胜, 何发智, 等. 试验序贯分析在 Stata 软件中的实现. 中国循证医学杂志, 2016, 16(12): 1472-1476.

Chinese Journal of Evidence-Based Medicine

Robustness assessment of meta-analysis results based on enhanced funnel plots and trial sequential analysis

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