Confidence intervals for random effects meta-analysis and robustness to publication bias

2010 ◽  
Vol 29 (29) ◽  
pp. 2969-2983 ◽  
Author(s):  
Masayuki Henmi ◽  
John B. Copas
Keyword(s):  
Confidence Intervals ◽  
Publication Bias ◽  
Random Effects ◽  
Meta Analysis

scholarly journals Association of bisphenol A with puberty timing: a meta-analysis

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Hui Meng ◽  
Yunping Zhou ◽  
Yunxia Jiang
Keyword(s):  
Bisphenol A ◽  
Confidence Intervals ◽  
Random Effects ◽  
Strong Correlation ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Random Effects Models ◽  
Study Heterogeneity ◽  
The Relationship ◽  
Prevalence Ratios

AbstractObjectivesThe results of existing studies on bisphenol A (BPA) and puberty timing did not reach a consensus. Thereby we performed this meta-analytic study to explore the association between BPA exposure in urine and puberty timing.MethodsMeta-analysis of the pooled odds ratios (OR), prevalence ratios (PR) or hazards ratios (HR) with 95% confidence intervals (CI) were calculated and estimated using fixed-effects or random-effects models based on between-study heterogeneity.ResultsA total of 10 studies involving 5621 subjects were finally included. The meta-analysis showed that BPA exposure was weakly associated with thelarche (PR: 0.96, 95% CI: 0.93–0.99), while no association was found between BPA exposure and menarche (HR: 0.99, 95% CI: 0.89–1.12; OR: 1.02, 95% CI: 0.73–1.43), and pubarche (OR: 1.00, 95% CI: 0.79–1.26; PR: 1.00, 95% CI: 0.95–1.05).ConclusionsThere was no strong correlation between BPA exposure and puberty timing. Further studies with large sample sizes are needed to verify the relationship between BPA and puberty timing.

EXPRESS: A meta-analysis of aspirin and subarachnoid haemorrhage in patients with intracranial aneurysms yields different results to the general population

2021 ◽  
pp. 174749302110048
Author(s):  
Frederick Ewbank ◽  
Jacqueline Birks ◽  
Diederik Bulters
Keyword(s):  
General Population ◽  
Subarachnoid Haemorrhage ◽  
Confidence Intervals ◽  
Random Effects ◽  
Intracranial Aneurysms ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Random Effects Models ◽  
Hazard Ratios ◽  
Unruptured Intracranial Aneurysms

Abstract Background Some studies have shown a protective association between aspirin use and subarachnoid haemorrhage (SAH). Other studies have found no relationship or the reverse. These studies differ in their study populations and definitions of SAH. Aims Our aim was to establish 1) if there is an association between aspirin and SAH, 2) how this differs between the general population and those with intracranial aneurysms. Summary of review Studies reporting aspirin use and the occurrence of SAH were included and grouped based on population (general population vs aneurysm population). Odds ratios, hazard ratios and confidence intervals were combined in random-effects models. 11 studies were included. Overall, there was an association between aspirin and SAH (OR 0.68 [0.48, 0.96]). However, populations were diverse and heterogeneity between studies high (p<0.00001), questioning the validity of combining these studies and justifying analysis by population. In the general population there was no difference in aspirin use between individuals with and without SAH (OR 1.15 [0.96, 1.38]). In patients with intracranial aneurysms, aspirin use was greater in patients without SAH (OR 0.37 [0.24, 0.58]), although these studies were at higher risk of bias. Conclusions There is an association between aspirin use and SAH in patients with intracranial aneurysms. This apparent protective relationship is not seen in the general population. Prospective randomised studies are required to further investigate the effect of aspirin on unruptured intracranial aneurysms.

Comparative Effectiveness of Lenalidomide Plus Dexamethasone for the Treatment of Refractory/Relapsed Multiple Myeloma: A Systematic Review and Mixed Treatment Comparison

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4076-4076
Author(s):  
Sallie Stradwick ◽  
Nick Freemantle ◽  
John Snowden ◽  
Felipe Rodrigues ◽  
Nic Brereton
Keyword(s):  
Multiple Myeloma ◽  
Combination Therapy ◽  
Confidence Intervals ◽  
Random Effects ◽  
Comparative Effectiveness ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Treatment Comparison ◽  
Mixed Treatment ◽  
Secondary Outcomes

Abstract Abstract 4076 OBJECTIVES: To evaluate the comparative effectiveness of lenalidomide (25 mg) plus dexamethasone (40 mg) (LEN/dex) for the treatment of relapsed/refractory multiple myeloma (RRMM) compared to thalidomide and bendamustine. Primary outcome of interest was time to progression (TTP). Secondary outcomes of interest were overall response rates (ORR) and overall survival (OS). METHODS: A comprehensive systematic literature review was conducted to identify any randomised controlled trials (RCTs) investigating the clinical efficacy of specified therapies for the treatment of RRMM. Specified therapies included lenalidomide, thalidomide and bendamustine. Of these therapies, only LEN/dex combination therapy is approved in RRMM but bendamustine and thalidomide (monotherapy or in combination with dexamethasone) have also shown activity in the treatment of myeloma. Electronic databases were searched from March 2002 to 2012 (language unrestricted. Randomized clinical trials were independently evaluated against predetermined criteria for inclusion and determined to be eligible for the meta-analysis prior to any outcome assessment. Fixed effects and random effects mixed-treatment comparisons (MTC) were carried out, adopting the methods described by Lu and Ades1. MTCs estimate the comparative effectiveness of multiple treatments using an evidence base of trials that individually do not compare all treatment options. Results for TTP were reported as hazard ratios (HR) and 95% confidence intervals and an associated probability of best treatment. Results for binary variables (ORR, OS) were reported as odds ratios (OR) and 95% confidence intervals. RESULTS: Sixteen original RCTs met the initial inclusion criteria; twelve (N = 3,590), nine (N = 3,350) and six (N = 2,295) of which were able to be connected to form a network of evidence which provided the heterogeneous trial base for MTC analysis of ORR, OS, and TTP comparison, respectively. Two trials directly investigated the efficacy of LEN/dex (N = 353) and three trials assessed the efficacy of thalidomide monotherapy (N = 785). No RCTs were identified that investigated the efficacy of bendamustine or thalidomide/dexamethasone combination therapy in RRMM. There were too few studies (investigating treatment arms of interest) relative to the number of trials in the network to formally estimate or test for heterogeneity. Therefore a fixed effects network meta-analysis was used instead of a random effects network meta-analysis. Comparability of trial populations was assessed and discussed in detail since these could not be adjusted for in the statistical model. Age, sex, baseline disease characteristics, time since diagnosis and medical history were similar between study populations. TTP analysis was statistically significant and favoured LEN/dex over thalidomide monotherapy: HR = 2.34 [1.31, 4.17]. The associated probability of LEN/dex being the best treatment within the evidence network is 97.9%. Secondary outcomes analysis were also statistically significant in favour of LEN/dex over thalidomide monotherapy (ORR: OR = 10.48 [4.75, 22.81]; OS: OR = 1.43 [1.12, 1.84]). CONCLUSIONS: Results demonstrated statistically significant superiority of lenalidomide plus dexamethasone therapy versus thalidomide monotherapy for the treatment of RRMM. No analyses were possible versus bendamustine or thalidomide/dexamethasone combination therapy due to the lack of RCTs investigating the efficacy of these therapeutic regimens in RRMM. Disclosures: Stradwick: Celgene International: Consultancy. Freemantle:BresMed: Consultancy. Off Label Use: Thalidomide monotherapy activity in the treatment of myeloma. Brereton:Celgene International: Consultancy.

scholarly journals Confidence intervals for the overall effect size in random-effects meta-analysis.

2008 ◽  
Vol 13 (1) ◽  
pp. 31-48 ◽  
Author(s):  
Julio Sánchez-Meca ◽  
Fulgencio Marín-Martínez
Keyword(s):  
Confidence Intervals ◽  
Random Effects ◽  
Effect Size ◽  
Meta Analysis

scholarly journals Predictive physiological anticipatory activity preceding seemingly unpredictable stimuli: An update of Mossbridge et al’s meta-analysis

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 407 ◽  
Author(s):  
Michael Duggan ◽  
Patrizio Tressoldi
Keyword(s):  
Confidence Intervals ◽  
Publication Bias ◽  
Effect Size ◽  
Statistical Estimation ◽  
Meta Analysis ◽  
Weighted Mean ◽  
Weighted Effect Size ◽  
Credible Intervals ◽  
Weighted Effect ◽  
Anticipatory Activity

Background: This is an update of the Mossbridge et al’s meta-analysis related to the physiological anticipation preceding seemingly unpredictable stimuli which overall effect size was 0.21; 95% Confidence Intervals: 0.13 - 0.29 Methods: Nineteen new peer and non-peer reviewed studies completed from January 2008 to June 2018 were retrieved describing a total of 27 experiments and 36 associated effect sizes. Results: The overall weighted effect size, estimated with a frequentist multilevel random model, was: 0.28; 95% Confidence Intervals: 0.18-0.38; the overall weighted effect size, estimated with a multilevel Bayesian model, was: 0.28; 95% Credible Intervals: 0.18-0.38. The weighted mean estimate of the effect size of peer reviewed studies was higher than that of non-peer reviewed studies, but with overlapped confidence intervals: Peer reviewed: 0.36; 95% Confidence Intervals: 0.26-0.47; Non-Peer reviewed: 0.22; 95% Confidence Intervals: 0.05-0.39. Similarly, the weighted mean estimate of the effect size of Preregistered studies was higher than that of Non-Preregistered studies: Preregistered: 0.31; 95% Confidence Intervals: 0.18-0.45; No-Preregistered: 0.24; 95% Confidence Intervals: 0.08-0.41. The statistical estimation of the publication bias by using the Copas selection model suggest that the main findings are not contaminated by publication bias. Conclusions: In summary, with this update, the main findings reported in Mossbridge et al’s meta-analysis, are confirmed.

scholarly journals Prevalence of Headache in Patients With Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis of 14,275 Patients

2020 ◽  
Vol 11 ◽  
Author(s):  
Md Asiful Islam ◽  
Sayeda Sadia Alam ◽  
Shoumik Kundu ◽  
Tareq Hossan ◽  
Mohammad Amjad Kamal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Quality Assessment ◽  
Confidence Intervals ◽  
Random Effects ◽  
Critical Appraisal ◽  
Meta Analysis ◽  
Clinical Manifestations ◽  
Random Effects Model ◽  
Pooled Prevalence ◽  
Significant Difference

Background: Coronavirus disease 2019 (COVID-19) started to spread globally since December 2019 from Wuhan, China. Headache has been observed as one of the clinical manifestations in COVID-19 patients. We aimed to conduct a comprehensive systematic review and meta-analysis to estimate the overall pooled prevalence of headache in COVID-19 patients.Methods: PubMed, Scopus, ScienceDirect, and Google Scholar databases were searched to identify studies published between December 2019 and March 2020. Adult (≥18 years) COVID-19 patients were considered eligible. We used random-effects model to estimate the pooled prevalence with 95% confidence intervals (CIs). Quality assessment was done using the Joanna Briggs Institute critical appraisal tools. This study is registered with PROSPERO (CRD42020182529).Results: We identified 2,055 studies, of which 86 studies (n = 14,275, 49.4% female) were included in the meta-analysis. Overall, the pooled prevalence of headache in COVID-19 patients was 10.1% [95% CI: 8.76–11.49]. There was no significant difference of headache prevalence in severe or critical vs. non-severe (RR: 1.05, p = 0.78), survived (recovered or discharged) vs. non-survived (RR: 1.36, p = 0.23), and ICU vs. non-ICU (RR: 1.06, p = 0.87) COVID-19 patients. We detected 64.0, 34.9, and 1.1% of the included studies as high, moderate, and low quality, respectively.Conclusions: From the first 4-month data of the outbreak, headache was detected in 10.1% of the adult COVID-19 patients.

Detecting and correcting for publication bias in meta-analysis – A truncated normal distribution approach

2016 ◽  
Vol 27 (9) ◽  
pp. 2722-2741 ◽  
Author(s):  
Qiaohao Zhu ◽  
KC Carriere
Keyword(s):  
Normal Distribution ◽  
Publication Bias ◽  
Random Effects ◽  
Effect Size ◽  
Meta Analysis ◽  
Truncated Normal Distribution ◽  
Random Effects Models ◽  
Funnel Plot ◽  
Fixed And Random Effects ◽  
Truncated Normal

Publication bias can significantly limit the validity of meta-analysis when trying to draw conclusion about a research question from independent studies. Most research on detection and correction for publication bias in meta-analysis focus mainly on funnel plot-based methodologies or selection models. In this paper, we formulate publication bias as a truncated distribution problem, and propose new parametric solutions. We develop methodologies of estimating the underlying overall effect size and the severity of publication bias. We distinguish the two major situations, in which publication bias may be induced by: (1) small effect size or (2) large p-value. We consider both fixed and random effects models, and derive estimators for the overall mean and the truncation proportion. These estimators will be obtained using maximum likelihood estimation and method of moments under fixed- and random-effects models, respectively. We carried out extensive simulation studies to evaluate the performance of our methodology, and to compare with the non-parametric Trim and Fill method based on funnel plot. We find that our methods based on truncated normal distribution perform consistently well, both in detecting and correcting publication bias under various situations.

Hepatic and hematological toxicity associated with selective internal radiation therapy (SIRT): A meta-analysis of randomized clinical trials.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 546-546
Author(s):  
Ashish Manne ◽  
Michael Behring ◽  
Upender Manne ◽  
Rojymon Jacob ◽  
Ravi Kumar Paluri
Keyword(s):  
Clinical Trials ◽  
Radiation Therapy ◽  
Publication Bias ◽  
Random Effects ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Random Effects Model ◽  
High Grade ◽  
Selective Internal Radiation Therapy ◽  
Internal Radiation

546 Background: For advanced hepatocellular cancers (HCCs) and colorectal cancers (CRCs) with liver metastasis, the impact of selective internal radiation therapy(SIRT) with yttrium-90 on survival outcomes is not established. A meta-analysis of randomized clinical trials (RCT) was performed to determine the relative risk (RR) of hepatic and hematological toxicities with the use of SIRT, compared to therapies not including SIRT. For patients with advanced HCC or CRC, we assessed the RR of high grade (grades 3 and 4) hyperbilirubinemia, fatigue, leucopenia, thrombocytopenia and elevated liver enzymes (AST and ALT) with use of SIRT. Methods: Citations from PubMed/Medline, clinical trials.gov, package inserts, and abstracts from major conferences were reviewed to include RCTs comparing arms with or without SIRT. Potential publication bias was assessed using the Egger test for funnel plot asymmetry. There was no publication bias and the trials were of high quality per Jadad scoring. Patients in control arms received trans-arterial chemo-embolization (TACE) or sorafenib for HCC or FOLFOX for CRC. The proportion and 95% confidence intervals (CIs) for patients with adverse events were derived for each arm of each study and used to calculate the RR. For the meta-analysis, both the fixed-effects model and the random-effects model were considered; the method proposed by DerSimonian and Laird was used to estimate the random-effects model. Results: The RR of grade 3/4 leucopenia was consistently high across high with the use of SIRT across all the studies (RR 2.05, 95% CI (1.22-3.42), p-value 0.027). The risk of hepatic dysfunction and fatigue was higher with SIRT but not statistically significant. Conclusions: Since SIRT is associated with increased risk of high-grade leukopenia, caution is advised in selecting patients with HCC’s with underlying decompensated cirrhosis or with CRCs and on cytotoxic therapy. Proper selection of patients would reduce toxicities from SIRT alone or SIRT in combination with systemic chemotherapy.

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