scholarly journals Treatment Comparison in Rheumatoid Arthritis: Head-to-Head Trials and Innovative Study Designs

2014 ◽  
Vol 2014 ◽  
pp. 1-17 ◽  
Author(s):  
Ennio Giulio Favalli ◽  
Serena Bugatti ◽  
Martina Biggioggero ◽  
Roberto Caporali
Keyword(s):  
Rheumatoid Arthritis ◽  
Treatment Options ◽  
Real Life ◽  
Treatment Comparison ◽  
Optimal Sequencing ◽  
Wide Range ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
Study Designs ◽  
Indirect Comparisons

Over the last decades, the increasing knowledge in the area of rheumatoid arthritis has progressively expanded the arsenal of available drugs, especially with the introduction of novel targeted therapies such as biological disease modifying antirheumatic drugs (DMARDs). In this situation, rheumatologists are offered a wide range of treatment options, but on the other side the need for comparisons between available drugs becomes more and more crucial in order to better define the strategies for the choice and the optimal sequencing. Indirect comparisons or meta-analyses of data coming from different randomised controlled trials (RCTs) are not immune to conceptual and technical challenges and often provide inconsistent results. In this review we examine some of the possible evolutions of traditional RCTs, such as the inclusion of active comparators, aimed at individualising treatments in real-life conditions. Although head-to-head RCTs may be considered the best tool to directly compare the efficacy and safety of two different DMARDs, surprisingly only 20 studies with such design have been published in the last 25 years. Given the recent advent of the first RCTs truly comparing biological DMARDs, we also review the state of the art of head-to-head trials in RA.

scholarly journals A Systematic Review and Qualitative Synthesis Resulting in a Typology of Elementary Classroom Movement Integration Interventions

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Spyridoula Vazou ◽  
Collin A. Webster ◽  
Gregory Stewart ◽  
Priscila Candal ◽  
Cate A. Egan ◽  
...  
Keyword(s):  
Physical Activity ◽  
Teacher Collaboration ◽  
A Priori ◽  
Real Life ◽  
Dose Intensity ◽  
Routine Practice ◽  
Qualitative Synthesis ◽  
Wide Range ◽  
Meta Analyses ◽  
Movement Integration

Abstract Background/Objective Movement integration (MI) involves infusing physical activity into normal classroom time. A wide range of MI interventions have succeeded in increasing children’s participation in physical activity. However, no previous research has attempted to unpack the various MI intervention approaches. Therefore, this study aimed to systematically review, qualitatively analyze, and develop a typology of MI interventions conducted in primary/elementary school settings. Subjects/Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to identify published MI interventions. Irrelevant records were removed first by title, then by abstract, and finally by full texts of articles, resulting in 72 studies being retained for qualitative analysis. A deductive approach, using previous MI research as an a priori analytic framework, alongside inductive techniques were used to analyze the data. Results Four types of MI interventions were identified and labeled based on their design: student-driven, teacher-driven, researcher-teacher collaboration, and researcher-driven. Each type was further refined based on the MI strategies (movement breaks, active lessons, other: opening activity, transitions, reward, awareness), the level of intrapersonal and institutional support (training, resources), and the delivery (dose, intensity, type, fidelity). Nearly half of the interventions were researcher-driven, which may undermine the sustainability of MI as a routine practice by teachers in schools. An imbalance is evident on the MI strategies, with transitions, opening and awareness activities, and rewards being limitedly studied. Delivery should be further examined with a strong focus on reporting fidelity. Conclusions There are distinct approaches that are most often employed to promote the use of MI and these approaches may often lack a minimum standard for reporting MI intervention details. This typology may be useful to effectively translate the evidence into practice in real-life settings to better understand and study MI interventions.

scholarly journals Defining refractory rheumatoid arthritis

2018 ◽  
Vol 77 (7) ◽  
pp. 966-969 ◽  
Author(s):  
Maya H Buch
Keyword(s):  
Rheumatoid Arthritis ◽  
Controlled Trial ◽  
Real Life ◽  
Outcome Data ◽  
Refractory Disease ◽  
Persistent Inflammation ◽  
Antidrug Antibody ◽  
Underlying Mechanisms ◽  
Randomised Controlled ◽  
Future Evaluation

While biologic disease-modifying antirheumatic drugs (bDMARDs) have transformed outcomes of people with rheumatoid arthritis (RA), a proportion of patients are refractory to multiple bDMARDs. Definitions of refractory RA thus far have been arbitrary, and outcome data and impact of such cohorts remain limited. Extrapolation from randomised controlled trial and some real-life data suggest approximately 20% progress onto a third bDMARD with a more modest proportion failing additional bDMARDs. This viewpoint discusses an opinion of refractory RA disease and proposes key principles to accurately identify refractory cohorts. These include demonstrating presence of persistent inflammation despite multiple therapies and acknowledging development of antidrug antibody. Potential basis of refractory disease is summarised, and suggestions for an initial approach in the future evaluation of refractory disease are offered. Specific investigation of refractory RA disease is necessary to inform the clinical need and provide a basis for robust investigation of underlying mechanisms.

scholarly journals Risk of serious infections during rituximab, abatacept and anakinra treatments for rheumatoid arthritis: meta-analyses of randomised placebo-controlled trials

2008 ◽  
Vol 68 (1) ◽  
pp. 25-32 ◽  
Author(s):  
C Salliot ◽  
M Dougados ◽  
L Gossec
Keyword(s):  
Rheumatoid Arthritis ◽  
Randomised Controlled Trials ◽  
Biological Agents ◽  
Cochrane Library ◽  
Controlled Trials ◽  
Serious Infection ◽  
Serious Infections ◽  
High Doses ◽  
Randomised Controlled ◽  
Meta Analyses

Background:Tumour necrosis factor α blockers in rheumatoid arthritis are known to increase the risk of serious infections defined as life-threatening, requiring hospitalisation or intravenous antibiotics. Recently, new biological agents have become available. Their safety is an important issue.Purpose:To assess if biological agents, ie rituximab, abatacept and anakinra increase the risk of serious infections in patients with rheumatoid arthritis in published randomised controlled trials.Data source:A systematic review of the literature using PUBMED, EMBASE, Cochrane library and abstracts databases (American College of Rheumatology and European League Against Rheumatism annual meetings) was performed up to October 2007. This search was completed with data from the Food and Drug Administration, the European Agency for the Evaluation of Medicinal Products and manufacturers.Data extraction:Three fixed-effect meta-analyses were performed to compare serious infection rates between each biological agent and placebo. Pooled odds ratios (ORs) were calculated, using the Mantel–Haenszel method with a continuity correction.Data synthesis:Twelve randomised controlled trials with data concerning serious infections were analysed (three for rituximab, five for abatacept and four for anakinra). They included 745 patients, 1960 patients, 2062 patients and 2112 patients treated by rituximab, abatacept, anakinra and placebo respectively. The overall pooled ORs did not reveal a statistically significant increased risk of serious infection for abatacept and rituximab; this risk was increased for high doses of anakinra (⩾100 mg daily) versus low dose and placebo (ORs = 9.63 (95% CI, 1.31 to 70.91) and 3.40 (95% CI, 1.11 to 10.46) respectively).Conclusions:These meta-analyses did not reveal a significant increase in the risk of serious infections during rituximab or abatacept treatments in patients with rheumatoid arthritis; however, high doses of anakinra may increase this risk, especially when patients have comorbidity factors. Large studies must be performed to confirm this safety profile in daily practice.

scholarly journals Real-world research and its importance in respiratory medicine

Breathe ◽  
2015 ◽  
Vol 11 (1) ◽  
pp. 26-38 ◽  
Author(s):  
David Price ◽  
Guy Brusselle ◽  
Nicolas Roche ◽  
Daryl Freeman ◽  
Alison Chisholm
Keyword(s):  
Clinical Practice ◽  
Treatment Outcomes ◽  
Real World ◽  
Randomised Controlled Trials ◽  
Real Life ◽  
Controlled Trials ◽  
List Type ◽  
Pragmatic Clinical Trials ◽  
Randomised Controlled ◽  
Meta Analyses

Educational AimsTo improve understanding of: The relative benefits and limitations of evidence derived from different study designs and the role that real-life asthma studies can play in addressing limitations in the classical randomised controlled trial (cRCT) evidence base.The importance of guideline recommendations being modified to fit the populations studied and the model of care provided in their reference studies.Key pointsClassical randomised controlled trials (cRCTs) show results from a narrow patient group with a constrained ecology of care.Patients with “real-life” co-morbidities and lifestyle factors receiving usual care often have different responses to medication which will not be captured by cRCTs if they are excluded by strict selection criteria.Meta-analyses, used to direct guidelines, contain an inherent meta-bias based on patient selection and artificial patient care.Guideline recommendations should clarify where they related to cRCT ideals (in terms of patient populations, medical resources and care received) and could be enhanced through inclusion of evidence from studies designed to better model the populations and care approaches present in routine care.SummaryClinical practice requires a complex interplay between experience and training, research, guidelines and judgement, and must not only draw on data from traditional or classical randomised controlled trials (cRCTs), but also from pragmatically designed studies that better reflect real-life clinical practice. To minimise extraneous variables and to optimise their internal validity, cRCTs exclude patients, clinical characteristics and variations in care that could potentially confound outcomes. The result is that respiratory cRCTs often enrol a small, non-representative subset of patients and overlook the important interplay and interactions between patients and the real world, which can effect treatment outcomes.Evidence from real-life studies (e.g. naturalistic or pragmatic clinical trials and observational studies encompassing healthcare database studies and cohort studies) can be combined with cRCT evidence to provide a fuller picture of intervention effectiveness and realistic treatment outcomes, and can provide useful insights into alternative management approaches in more challenging asthma patients. The Respiratory Effectiveness Group (REG), in collaboration with the European Academy of Allergy and Clinical Immunology (EAACI) and the European Respiratory Society (ERS), is developing quality appraisal tools and methods for integrating different sources of evidence. A REG/EAACI taskforce aims to help support future guideline developers to avoid a one-size-fits-all approach to recommendations and to tailor the conclusions of their meta-analyses to the populations under consideration.

scholarly journals LABA/LAMA combination in COPD: a meta-analysis on the duration of treatment

2017 ◽  
Vol 26 (143) ◽  
pp. 160043 ◽  
Author(s):  
Luigino Calzetta ◽  
Paola Rogliani ◽  
Josuel Ora ◽  
Ermanno Puxeddu ◽  
Mario Cazzola ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Treatment Options ◽  
Forced Expiratory Volume ◽  
Fixed Dose ◽  
Chronic Obstructive ◽  
Duration Of Treatment ◽  
Eligibility Criteria ◽  
Treatment Comparison ◽  
Long Acting ◽  
Meta Analyses

When there are no randomised clinical trials directly comparing all relevant treatment options, an indirect treatment comparison via meta-analysis of the available clinical evidence is an acceptable alternative. However, meta-analyses may be very misleading if not adequately performed. Here, we propose and validate a simple and effective approach to meta-analysis for exploring the effectiveness of long-acting β2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) fixed-dose combinations in chronic obstructive pulmonary disease.14 articles with 20 329 patients (combinations n=9292; monocomponents n=11 037) were included in this study. LABA/LAMA combinations were always more effective than the monocomponents in terms of the improvement in trough forced expiratory volume in 1 s, transition dyspnoea index and St George's Respiratory Questionnaire scores after 3, 6 and 12 months of treatment. No significant publication bias was identified. Significant discrepancies with previous network meta-analyses have been found, with overall differences ranging from 26.7% to 43.3%.Results from previous network meta-analyses were misleading because no adequate attention was given to formulating the review question, specifying eligibility criteria, correctly identifying studies, collecting appropriate information and deciding what it would be pharmacologically relevant to analyse. The real gradient of effectiveness of LABA/LAMA fixed-dose combinations remains an unmet medical need; however, it can be investigated indirectly using a high-quality meta-analytic approach.

scholarly journals Common elective orthopaedic procedures and their clinical effectiveness: umbrella review of level 1 evidence

BMJ ◽  
2021 ◽  
pp. n1511
Author(s):  
Ashley W Blom ◽  
Richard L Donovan ◽  
Andrew D Beswick ◽  
Michael R Whitehouse ◽  
Setor K Kunutsor
Keyword(s):  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Meniscal Repair ◽  
Clinical Effectiveness ◽  
Controlled Trials ◽  
Operative Care ◽  
Total Knee ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
Study Designs

AbstractObjectiveTo determine the clinical effectiveness of common elective orthopaedic procedures compared with no treatment, placebo, or non-operative care and assess the impact on clinical guidelines.DesignUmbrella review of meta-analyses of randomised controlled trials or other study designs in the absence of meta-analyses of randomised controlled trials.Data sourcesTen of the most common elective orthopaedic procedures—arthroscopic anterior cruciate ligament reconstruction, arthroscopic meniscal repair of the knee, arthroscopic partial meniscectomy of the knee, arthroscopic rotator cuff repair, arthroscopic subacromial decompression, carpal tunnel decompression, lumbar spine decompression, lumbar spine fusion, total hip replacement, and total knee replacement—were studied. Medline, Embase, Cochrane Library, and bibliographies were searched until September 2020.Eligibility criteria for selecting studiesMeta-analyses of randomised controlled trials (or in the absence of meta-analysis other study designs) that compared the clinical effectiveness of any of the 10 orthopaedic procedures with no treatment, placebo, or non-operative care.Data extraction and synthesisSummary data were extracted by two independent investigators, and a consensus was reached with the involvement of a third. The methodological quality of each meta-analysis was assessed using the Assessment of Multiple Systematic Reviews instrument. The Jadad decision algorithm was used to ascertain which meta-analysis represented the best evidence. The National Institute for Health and Care Excellence Evidence search was used to check whether recommendations for each procedure reflected the body of evidence.Main outcome measuresQuality and quantity of evidence behind common elective orthopaedic interventions and comparisons with the strength of recommendations in relevant national clinical guidelines.ResultsRandomised controlled trial evidence supports the superiority of carpal tunnel decompression and total knee replacement over non-operative care. No randomised controlled trials specifically compared total hip replacement or meniscal repair with non-operative care. Trial evidence for the other six procedures showed no benefit over non-operative care.ConclusionsAlthough they may be effective overall or in certain subgroups, no strong, high quality evidence base shows that many commonly performed elective orthopaedic procedures are more effective than non-operative alternatives. Despite the lack of strong evidence, some of these procedures are still recommended by national guidelines in certain situations.Systematic review registrationPROSPERO CRD42018115917.

scholarly journals Utilisation of semiconductor sequencing for detection of actionable fusions in solid tumors

2021 ◽  
Author(s):  
Marco Loddo ◽  
Keeda-Marie Hardisty ◽  
Tiffany Haddow ◽  
Robert Thatcher ◽  
Gareth Williams
Keyword(s):  
Treatment Options ◽  
Real Life ◽  
Solid Tumours ◽  
Tissue Samples ◽  
Sequencing Platform ◽  
Cancer Management ◽  
Fda Approval ◽  
Semiconductor Sequencing ◽  
Wide Range ◽  
Personalised Treatment

Oncogenic  fusions represent compelling druggable targets in solid tumours highlighted by the recent site agnostic FDA approval of larotrectinib for NTRK rearrangements. However screening for fusions in routinely processed tissue samples is constrained due to degradation of nucleic acid as a result of formalin fixation., To investigate the clinical utility of semiconductor sequencing optimised for detection of actionable fusion transcripts in formalin fixed samples, we have undertaken  an analysis of test trending data  generated by a clinically validated next generation sequencing  platform designed to capture 867 of the most clinically relevant druggable driver-partner oncogenic fusions.   Here we showacross a real-life cohort of 1112 patients with solid tumours  that actionable fusions occur at high frequency (7.4%) with linkage to a wide range of targeted therapy protocols including seven fusion-drug matches with FDA/EMA approval and/or NCCN/ESMO recommendations and 80 clinical trials. The majority of actionable fusions identified were independent of tumour type in keeping with signalling via evolutionary conserved Wnt/β-catenin, RAS/RAF/MEK/ERK, PI3K/AKT/MTOR, PLCy/PKC and JAK/STAT pathways. Taken together our data indicates that semiconductor sequencing for detection of actionable fusions can be integrated into routine diagnostic pathology workflows enabling the identification of personalised treatment options that have potential to improve clinical cancer management across many tumour types.Oncogenic  fusions represent compelling druggable targets in solid tumours highlighted by the recent site agnostic FDA approval of larotrectinib for NTRK rearrangements. However screening for fusions in routinely processed tissue samples is constrained due to degradation of nucleic acid as a result of formalin fixation., To investigate the clinical utility of semiconductor sequencing optimised for detection of actionable fusion transcripts in formalin fixed samples, we have undertaken  an analysis of test trending data  generated by a clinically validated next generation sequencing  platform designed to capture 867 of the most clinically relevant druggable driver-partner oncogenic fusions.   Here we showacross a real-life cohort of 1112 patients with solid tumours  that actionable fusions occur at high frequency (7.4%) with linkage to a wide range of targeted therapy protocols including seven fusion-drug matches with FDA/EMA approval and/or NCCN/ESMO recommendations and 80 clinical trials. The majority of actionable fusions identified were independent of tumour type in keeping with signalling via evolutionary conserved Wnt/β-catenin, RAS/RAF/MEK/ERK, PI3K/AKT/MTOR, PLCy/PKC and JAK/STAT pathways. Taken together our data indicates that semiconductor sequencing for detection of actionable fusions can be integrated into routine diagnostic pathology workflows enabling the identification of personalised treatment options that have potential to improve clinical cancer management across many tumour types.

scholarly journals The role of meta-analyses and umbrella reviews in assessing the harms of psychotropic medications: beyond qualitative synthesis

2018 ◽  
Vol 27 (6) ◽  
pp. 537-542 ◽  
Author(s):  
M. Solmi ◽  
C. U. Correll ◽  
A. F. Carvalho ◽  
J. P. A. Ioannidis
Keyword(s):  
Observational Studies ◽  
Safety Data ◽  
Real Life ◽  
Assessment Tools ◽  
Qualitative Synthesis ◽  
Level Of Evidence ◽  
Clinical Scenarios ◽  
Quantitative Synthesis ◽  
Randomised Controlled ◽  
Meta Analyses

Abstractὠφελέειν, ἢ μὴ βλάπτειν (Primum non nocere) – Hιppocrates’ principle should still guide daily medical prescribing. Therefore, assessing evidence of psychopharmacologic agents’ safety and harms is essential. Randomised controlled trials (RCTs) and observational studies may provide complementary information about harms of psychopharmacologic medications from both experimental and real-world settings. It is considered that RCTs provide a better control of confounding variables, while observational studies provide evidence from larger samples, longer follow-ups, in more representative samples, which may be more reflective of real-life clinical scenarios. However, this may not always hold true. Moreover, in observational studies, safety data are poorly or inconsistently reported, precluding reliable quantitative synthesis in meta-analyses. Beyond individual studies, meta-analyses, which represent the highest level of ‘evidence’, can be misleading, redundant and of low methodological quality. Overlapping meta-analyses sometimes even reach different conclusions on the same topic. Meta-analyses should be assessed systematically. Descriptive reviews of reviews can be poorly informative. Conversely, ‘umbrella reviews’ can use a quantitative approach to grade evidence. In this editorial, we present the main factors involved in the assessment of psychopharmacologic agents’ harms from individual studies, meta-analyses and umbrella reviews. Study design features, sample size, number of the events of interest, summary effect sizes, p-values, heterogeneity, 95% prediction intervals, confounding factor adjustment and tests of bias (e.g., small-study effects and excess significance) can be combined with other assessment tools, such as AMSTAR and GRADE to create a framework for assessing the credibility of evidence.

Novel chemotherapy combinations for metastatic gastric adenocarcinoma (mAGC): An updated meta-analysis.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 125-125 ◽  
Author(s):  
Anna Dorothea Wagner ◽  
Markus Moehler ◽  
Wilfried Grothe ◽  
Johannes Haerting ◽  
Susanne Unverzagt
Keyword(s):  
Overall Survival ◽  
Selection Criteria ◽  
Meta Analysis ◽  
Treatment Options ◽  
Single Agent ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Central Register ◽  
Randomised Controlled ◽  
Meta Analyses

125 Background: Despite the successful integration of targeted therapies, chemotherapy remains the mainstay of treatment for mAGC. Uncertainty remains regarding the choice of the regimen. Methods: We searched: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE until February 2014; proceedings from ECCO, ESMO, ASCO until June 2014 with Selection criteria: Randomised controlled trials on chemotherapy in mAGC. Objectives: To assess and compare the effects on overall survival of regimens containing: 1) irinotecan (I) vs non-I, 2) docetaxel (D) vs non-D, 3) capecitabine (C) vs 5-FU, 4) S-1 vs 5-FU, 5) oxaliplatin (O) vs the same regimen containing cisplatin. For 1) and 2), substitutive (other chemotherapy substituted by I or D) and additive comparisons (I or D added) were analyzed separately. Results: The meta-analyses of overall survival included: Comparison 1) a. Substitutive: 5 trials, 724 patients (pts), with a HR of 0.85 (95% CI 0.73-0.99), b. Additive: 3 trials, 500 pts, with a HR of 0.88 (95% CI 0.76-1.03), both in favor of the I-containing regimens. Comparison 2) In total, 6 trials, 1702 pts, with a HR of 0.89 (95% CI 0.80-0.99) in favor of patients treated with D. a. Substitutive: 3 trials, 479 pts, with a HR of 1.05 (95% CI 0.87-1.27) in favor of patients treated without D. b. Additive: 3 trials, 1223 pts, with a HR of 0.82 (95% CI 0.87-0.93), in favor of D-containing regimens. If only studies (2 trials, 588 pts) are considered, in which D is added to a platinum/5-FU doublet, the HR is 0.79 (95% CI 0.64-0.98) in favor of the D-containing regimen. Comparison 3) 2 trials, 401 pts, with a HR of 0.85 (95% CI 0.68-1.06) in favor of the C-containing-regimen. Comparison 4) 2 trials, 1497 pts, with a HR of 0.89 (95% CI 0.80-1.0) in favor of the S-1-containing regimen. Comparison 5) 1 trial, 220 pts, with a HR of 0.82 (0.47-1.45) in favor of the O-containing regimen. Conclusions: All different chemotherapy combinations including I, D, O or oral 5-FU prodrugs are valid treatment options for mAGC. Among the comparisons analyzed above, only D-containing combinations, in which D was added to a single-agent or two-drug (platinum/5-FU) combination show a significant advantage in overall survival as compared to regimens without D.

scholarly journals Simple study designs in ecology produce inaccurate estimates of biodiversity responses

2019 ◽  
Author(s):  
Alec P. Christie ◽  
Tatsuya Amano ◽  
Philip A. Martin ◽  
Gorm E. Shackelford ◽  
Benno I. Simmons ◽  
...  
Keyword(s):  
Environmental Impact ◽  
Sample Size ◽  
Study Design ◽  
Evidence Synthesis ◽  
List Type ◽  
Robust Designs ◽  
Wide Range ◽  
Randomised Controlled ◽  
Study Designs ◽  
The Impact

AbstractEcologists use a wide range of study designs to estimate the impact of interventions or threats but there are no quantitative comparisons of their accuracy. For example, while it is accepted that simpler designs, such as After (sampling sites post-impact without a control), Before-After (BA) and Control-Impact (CI), are less robust than Randomised Controlled Trials (RCT) and Before-After Control-Impact (BACI) designs, it is not known how much less accurate they are.We simulate a step-change response of a population to an environmental impact using empirically-derived estimates of the major parameters. We use five ecological study designs to estimate the effect of this impact and evaluate each one by determining the percentage of simulations in which they accurately estimate the direction and magnitude of the environmental impact. We also simulate different numbers of replicates and assess several accuracy thresholds.We demonstrate that BACI designs could be 1.1-1.5 times more accurate than RCTs, 2.9-4.1 times more accurate than BA, 3.8-5.6 times more accurate than CI, and 6.8-10.8 times more accurate than After designs, when estimating to within ±30% of the true effect (depending on the sample size). We also found that increasing sample size substantially increases the accuracy of BACI designs but only increases the precision of simpler designs around a biased estimate; only by using more robust designs can accuracy increase. Modestly increasing replication of both control and impact sites also increased the accuracy of BACI designs more than substantially increasing replicates in just one of these groups.We argue that investment into using more robust designs in ecology, where possible, is extremely worthwhile given the inaccuracy of simpler designs, even when using large sample sizes. Based on our results we propose a weighting system that quantitatively ranks the accuracy of studies based on their study design and the number of replicates used. We hope these ‘accuracy weights’ enable researchers to better account for study design in evidence synthesis when assessing the reliability of a range of studies using a variety of designs.

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