33567 Overview of the systematic reviews with network meta-analysis evaluating the efficacy or safety of the systemic treatments in moderate-to-severe psoriasis

Abstract

Background: Network meta-analyses (NMAs) have become successful in addressing gaps in comparative effectiveness of systemic treatments (ST) in psoriasis. Their increasing number carries a risk of overlap and reproducibility issues. We aimed to assess redundancy across these NMAs and to describe their characteristics. Methods: We considered all systematic reviews with NMAs of randomized controlled trials that included adult patients with moderate-to-severe psoriasis and that evaluated the efficacy and/or safety of ST compared with placebo or an active comparator. Four electronic databases were searched up to 02/25/2021. Our main outcome was the number of redundant NMAs and their overlaps. We described their characteristics, the confidence in the results, the reporting issues, the studies’ funding, and the presence of spin. Results: In total, 47 redundant NMAs were included. Two (4%) included all available treatments. Both efficacy and safety were evaluated in 14/47 (30%) NMAs and both short and long-term evaluations were assessed in 5/47 (11%). Confidence in the results was critically low for 39/47 (83%) NMAs. Only 10/47 (23%) registered a protocol. Pharmaceutical funding was present in 26/47 NMAs (55%). Spin was present in all of the abstracts and reporting was poor in most of them according to the PRISMA-checklist. Almost half of the NMA failed to check for heterogeneity or consistency. Discussion: Our overview showed heterogeneous methods and poor confidence in the results in a majority of the redundant NMAs, further distorted by reporting issues and spin. Clinicians need to interpret NMAs with caution when looking for the most reliable evidence.