Meta-analysis Of Studies Research Articles

An evaluation of computational methods for aggregate data meta-analyses of diagnostic test accuracy studies

BackgroundA Generalized Linear Mixed Model (GLMM) is recommended to meta-analyze diagnostic test accuracy studies (DTAs) based on aggregate or individual participant data. Since a GLMM does not have a closed-form likelihood function or parameter solutions, computational methods are conventionally used to approximate the likelihoods and obtain parameter estimates. The most commonly used computational methods are the Iteratively Reweighted Least Squares (IRLS), the Laplace approximation (LA), and the Adaptive Gauss-Hermite quadrature (AGHQ). Despite being widely used, it has not been clear how these computational methods compare and perform in the context of an aggregate data meta-analysis (ADMA) of DTAs.MethodsWe compared and evaluated the performance of three commonly used computational methods for GLMM - the IRLS, the LA, and the AGHQ, via a comprehensive simulation study and real-life data examples, in the context of an ADMA of DTAs. By varying several parameters in our simulations, we assessed the performance of the three methods in terms of bias, root mean squared error, confidence interval (CI) width, coverage of the 95% CI, convergence rate, and computational speed.ResultsFor most of the scenarios, especially when the meta-analytic data were not sparse (i.e., there were no or negligible studies with perfect diagnosis), the three computational methods were comparable for the estimation of sensitivity and specificity. However, the LA had the largest bias and root mean squared error for pooled sensitivity and specificity when the meta-analytic data were sparse. Moreover, the AGHQ took a longer computational time to converge relative to the other two methods, although it had the best convergence rate.ConclusionsWe recommend practitioners and researchers carefully choose an appropriate computational algorithm when fitting a GLMM to an ADMA of DTAs. We do not recommend the LA for sparse meta-analytic data sets. However, either the AGHQ or the IRLS can be used regardless of the characteristics of the meta-analytic data.

The impact of monotherapies for male androgenetic alopecia: A network meta-analysis study.

The evidence base pertaining to the efficacy of monotherapies for androgenetic alopecia (AGA), the most common form of hair loss, is ever expanding-and this warrants a formal comparison therapies' effect on a frequent basis. The objective of the current study was to determine the comparative effect of relevant monotherapies for male AGA. Our aim was achieved by conducting Bayesian network meta-analysis (NMA), under a random effects model, for two outcomes: 6-month change in (1) total and (2) terminal hair density in adult (i.e., aged 18 years and above) men with AGA; these analyses were preceded by a systematic search of the peer-reviewed literature for suitable data. Interventions' surface under the cumulative ranking curve (SUCRA) and pairwise relative effects (quantified as mean differences) were estimated through the NMAs. We determined the comparative effect of 20 active comparators and a control (i.e., placebo/vehicle). "Dutasteride 0.5 mg once daily for 24 weeks" was ranked the most effective in terms of 6-month change in (1) total hair density (SUCRA = 87%) and terminal hair density (SUCRA = 98%). Our results showed that interventions' effectiveness can be dose dependent. Our updated analyses of the up-to-date evidence regarding monotherapies for male AGA showed that the oral form of 5-alpha reductase inhibitors are more effective than oral minoxidil and other newer agents like Botox, microneedling, and photobiomodulation. Our findings can better inform clinical decision making and design of future research studies.

Elucidating the association of obstructive sleep apnea with brain structure and cognitive performance

BackgroundObstructive sleep apnea (OSA) is a pervasive, chronic sleep-related respiratory condition that causes brain structural alterations and cognitive impairments. However, the causal association of OSA with brain morphology and cognitive performance has not been determined.MethodsWe conducted a two-sample bidirectional Mendelian randomization (MR) analysis to investigate the causal relationship between OSA and a range of neurocognitive characteristics, including brain cortical structure, brain subcortical structure, brain structural change across the lifespan, and cognitive performance. Summary-level GWAS data for OSA from the FinnGen consortium was used to identify genetically predicted OSA. Data regarding neurocognitive characteristics were obtained from published meta-analysis studies. Linkage disequilibrium score regression analysis was employed to reveal genetic correlations between OSA and related traits.ResultsOur MR study provided evidence that OSA was found to significantly increase the volume of the hippocampus (IVW β (95% CI) = 158.997 (76.768 to 241.227), P = 1.51e-04), with no heterogeneity and pleiotropy detected. Nominally causal effects of OSA on brain structures, such as the thickness of the temporal pole with or without global weighted, amygdala structure change, and cerebellum white matter change covering lifespan, were observed. Bidirectional causal links were also detected between brain cortical structure, brain subcortical, cognitive performance, and OSA risk. LDSC regression analysis showed no significant correlation between OSA and hippocampus volume.ConclusionsOverall, we observed a positive association between genetically predicted OSA and hippocampus volume. These findings may provide new insights into the bidirectional links between OSA and neurocognitive features, including brain morphology and cognitive performance.

The effects of psychosocial interventions applied to forensic psychiatry patients on social functioning and anger level: a meta-analysis study

ABSTRACT This study was conducted to determine the effects of psychosocial interventions on social functioning and anger levels in forensic psychiatry patients. Data for this meta-analysis study were gathered by searching databases such as PubMed, Web of Science, EBSCOhost, Google Scholar, and YÖK Thesis Center, without any year restriction, from September to December 2023. After a thorough review, 12 studies were deemed appropriate for the analysis. The findings of this meta-analysis indicate that psychosocial treatments administered to forensic psychiatry patients led to an increase in their level of social functioning (SMD: 0.513, 95% CI: 0.072 – 0.995; Z = 2.280; p < .05) and a decrease in their level of anger (SMD: −0.701, 95% CI: −1.301 to −0.100;Z = −2.287; p < .05). It was also observed that the effectiveness of the psychosocial intervention was not influenced by the type of psychotherapy, the country where the study was conducted, or the duration of the treatment. Psychosocial interventions for forensic psychiatry patients positively affect the mental health of individuals.

Effects of micro/nanoplastics on oxidative damage and serum biochemical parameters in rats and mice: a meta-analysis.

Micro/nanoplastics (MNPs) are emerging as environmental pollutants with potential threats to human health. The accumulation of MNPs in the body can cause oxidative stress and increase the risk of cardiovascular disease (CVD). With the aim to systematically evaluate the extent of MNPs-induced oxidative damage and serum biochemical parameters in rats and mice, a total of 36 eligible articles were included in this meta-analysis study. The results reported that MNPs can significantly increase the levels of oxidants such as reactive oxygen species (ROS) and malondialdehyde (MDA) (P < 0.05), and resulted in notable increase in serum biochemical parameters including aspartate aminotransferase (AST) and alanine aminotransferase (ALT) (P < 0.05). Conversely, MNPs significantly reduced levels of antioxidants such as superoxide dismutase (SOD), glutathione (GSH), glutathione peroxidase (GPx) and catalase (CAT) (P < 0.05). Subgroup analysis revealed that smaller MNPs with oral administration and prolonged treatment, were associated with more pronounced oxidative stress and enhanced serum biochemical parameters alteration. In addition, after affected by MNPs, the levels of ALT and AST in liver group (SMD = 2.26, 95% CI = [1.59, 2.94] and SMD = 3.10, 95% CI = [1.25, 4.94]) were higher than those in other organs. These comprehensive results provide a scientific foundation for devising strategies to prevent MNPs-induced damage, contributing to solution of this environmental and health challenge.

Something Out of Nothing? The Influence of Double-Zero Studies in Meta-analysis of Adverse Events in Clinical Trials

AbstractIn addition to clinical efficacy, safety is another important outcome to assess in randomized controlled trials. It focuses on the occurrence of adverse events, such as stroke, deaths, and other rare events. Because of the low or very low rates of observing adverse events, meta-analysis is often used to pooled together evidence from dozens or even hundreds of similar clinical trials to strengthen inference. A well-known issue in rare-event meta-analysis is that some or even majority of the available studies may observe zero events in both the treatment and control groups. The influence of these so-called double-zero studies has been researched in the literature, which nevertheless focuses on reaching a dichotomous conclusion—whether or not double-zero studies should be included in the analysis. It has not been addressed when and how they contribute to inference, especially for the odds ratio. This paper fills this gap using comparative analysis of real and simulated data sets. We find that a double-zero study contributes to the odds ratio inference through its sample sizes in the two arms. When a double-zero study has an unequal allocation of patients in its two arms, it may contain non-ignorable information. Exclusion of these studies, if taking a significant proportion of the study cohort, may result in inflated type I error, deteriorated testing power, and increased estimation bias.

A-17 | Revascularization rates post percutaneous coronary intervention in chronic kidney disease patients: A meta-analysis study

A-17 | Revascularization rates post percutaneous coronary intervention in chronic kidney disease patients: A meta-analysis study

Can modulation of gut microbiota affect anthropometric indices in patients with non-alcoholic fatty liver disease? An umbrella meta-analysis of randomized controlled trials.

Modulating the gut microbiota population by administration of probiotics, prebiotics, and synbiotics has shown to have a variety of health benefits in different populations, particularly those with metabolic disorders. Although the promising effects of these compounds have been observed in the management of patients with non-alcoholic fatty liver disease (NAFLD), the exact effects and the mechanisms of action are yet to be understood. In the present study, we aimed to evaluate how gut microbiota modulation affects anthropometric indices of NAFLD patients to achieve a comprehensive summary of current evidence-based knowledge. Two researchers independently searched international databases, including PubMed, Scopus, and Web of Science, from inception to June 2023. Meta-analysis studies that evaluated the effects of probiotics, prebiotics, and synbiotics on patients with NAFLD were entered into our umbrella review. The data regarding anthropometric indices, including body mass index, weight, waist circumference (WC), and waist-to-hip ratio (WHR), were extracted by the investigators. The authors used random effect model for conducting the meta-analysis. Subgroup analysis and sensitivity analysis were also performed. A total number of 13 studies were finally included in our study. Based on the final results, BMI was significantly decreased in NAFLD patients by modulation of gut microbiota [effect size (ES): -0.18, 05% CI: -0.25, -0.11, P<0.001]; however, no significant alteration was observed in weight and WC (ES: -1.72, 05% CI: -3.48, 0.03, P=0.055, and ES: -0.24, 05% CI: -0.75, 0.26, P=0.353, respectively). The results of subgroup analysis showed probiotics had the most substantial effect on decreasing BMI (ES: -0.77, 95% CI: -1.16, -0.38, P<0.001) followed by prebiotics (ES: -0.51, 95% CI: -0.76, -0.27, P<0.001) and synbiotics (ES: -0.12, 95% CI: -0.20, -0.04, P=0.001). In conclusion, the present umbrella meta-analysis showed that although modulation of gut microbiota by administration of probiotics, prebiotics, and synbiotics had promising effects on BMI, no significant change was observed in the WC and weight of the patients. No sufficient data were available for other anthropometric indices including waist-to-hip ratio and waist-to-height ratio and future meta-analyses should be done in this regard.

A systematic review and meta-analysis of extra-intestinal manifestation of inflammatory bowel disease in the Eastern Mediterranean Region (EMRO) countries.

Inflammatory bowel disease which is subgrouped mainly to ulcerative colitis and Crohn's disease is thought to be a multi-organ disease. Most organs can be involved in the disease course in addition to gastrointestinal tract involvement. In this systematic review we aimed to assess the prevalence of these manifestations in Eastern Mediterranean Regional Office (EMRO) countries. The present systematic review and meta-analysis study was performed according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guideline. Joanna Briggs Institute (JBI) Critical Appraisal Checklist was admired for the quality evaluation of the included studies. For determining the heterogeneity, we used Cochran test and I2 statistics. Finally, 12 studies were included in our study. Based on the results of our study the prevalence of arthritis in ulcerative colitis and Crohn's disease patients was 7.1% (95% CI: 2.6-18.2%) and 13.5% (95% CI: 2.6-47.3%), respectively. Prevalence of arthralgia in ulcerative colitis patients was 18.4% (95% CI: 14.3-23.3%). skin involvement prevalence was 9.9% (95% CI 4.7-19.6%) in inflammatory bowel disease (IBD) patients. ocular involvement prevalence was 7.2% (95% CI 17-25.8%) in IBD patients. PSC prevalence in ulcerative colitis and Crohn's disease patients was 3.5% (95% CI: 1.7-7.3%) and 2.7% (95% CI: 1.3-5.5%), respectively. Based on the results of this study arthralgia and arthritis were the most common extra-intestinal manifestation of IBD followed by dermatologic and ocular involvements. This extra-intestinal manifestation can challenge the patients' management and identifying their pattern is important during the disease course.

Absence of causal relationship between Parkinson’s disease and subsequent prostate cancer: Evidence from meta-analysis and Mendelian randomization studies

Absence of causal relationship between Parkinson’s disease and subsequent prostate cancer: Evidence from meta-analysis and Mendelian randomization studies

Causal association and shared genetics between telomere length and COVID-19 outcomes: new evidence from the latest large-scale summary statistics

BackgroundObservational studies suggested that leukocyte telomere length (LTL) is shortened in COVID-19 patients. However, the genetic association and causality remained unknown. MethodsBased on the genome-wide association of LTL (N = 472,174) and COVID-19 phenotypes (N = 1,086,211-2,597,856), LDSC and SUPERGNOVA were used to estimate the genetic correlation. Cross-trait GWAS meta-analysis, colocalization, fine-mapping analysis and transcriptome-wide association study were conducted to explore the shared genetic etiology. Mendelian randomization (MR) was utilized to infer the causality. Upstream and downstream two-step MR was performed to investigate the potential mediating effects. ResultsLDSC identified a significant genetic association between LTL and all COVID-19 phenotypes (rG < 0, p < 0.05). Six significant regions were observed for LTL and COVID-19 susceptibility and hospitalization, respectively. Colocalization analysis found rs144204502, rs34517439, and rs56255908 were shared causal variants between LTL and COVID-19 phenotypes. Numerous biological pathways associated with LTL and COVID-19 outcomes were identified, mainly involved in immune related pathways. MR showed that longer LTL was significantly associated with a lower risk of COVID-19 severity (OR [95% CI] = 0.81 [0.71-0.92], p = 1.24×10-3) and suggestively associated with lower risks of COVID-19 susceptibility (OR [95% CI] = 0.96 [0.92-1.00], p = 3.44×10-2) and COVID-19 hospitalization (OR [95% CI] = 0.89 [0.80-0.98], p = 1.89×10-2). LTL partially mediated the effects of BMI, smoking, and education on COVID-19 outcomes. Furthermore, six proteins partially mediated the causality of LTL on COVID-19 outcomes, including BNDF, QPCT, FAS, MPO, SFTPB, and APOF. ConclusionsOur findings suggested that shorter LTL was genetically associated with higher risk of COVID-19 phenotypes, with shared genetic etiology and potential causality.

Genetic variations in immune mediators and prostate cancer risk: A field synopsis with Bayesian calculations

ObjectiveOur study aimed to revaluate the significant data from meta-analyses on genetic variations in immune mediators and the risk of prostate cancer (PCa) by Bayesian approaches. MethodsWe performed a search on the literature before September 5th, 2023, for meta-analytic studies on polymorphisms in immune mediator genes and the risk of PCa. Two Bayesian approaches were used to assess the level of noteworthiness in the meta-analytic data: the False-Positive Rate Probability (FPRP) and the Bayesian False Discovery Probability (BFDP) with a statistical power of 1.2 and 1.5 of Odds Ratio at a prior probability of 10−3 and 10−6. The quality evaluation of studies was performed with the Venice criteria. Gene-gene and protein–protein networks were designed for the genes and products enrolled in the results. ResultsAs results, 18 meta-analyses on 17 polymorphisms in several immune mediator genes were included (IL1B rs16944/rs1143627, IL4 rs2243250/rs2227284/rs2070874, IL6 1800795/rs1800796/rs1800797, IL8 rs4073, IL10 rs1800896/rs1800871/rs1800872, IL18 rs1946518, COX2 rs2745557, TNFA rs361525 and PTGS2 rs20417/689470). The Bayesian calculations showed the rs1143627 and the rs1946518 polymorphisms in IL1B and IL18 genes, respectively, were noteworthy. The Venice criteria showed that only four studies received the highest level of evidence. The gene-gene and protein–protein networks reinforced the findings on IL1B and IL18 genes. ConclusionIn conclusion, this current Bayesian revaluation showed that the rs1143627 and the rs1946518 polymorphisms in the IL1B and IL18 genes, respectively, were noteworthy biomarker candidates for PCa risk.

Safety of surgery: quality assessment of meta-analyses on the WHO checklist.

To assess the quality of the meta-analyses that review the WHO surgical safety checklist. A systematic review of meta-analysis studies was undertaken using the search terms "World Health Organization Surgical Safety Checklist" in PubMed, Embase, and Lilacs databases. The selected meta-analyses were rated using the AMSTAR 2 assessment tool. In the three meta-analyses evaluated, the checklist was associated with a decrease in the rates of complications and mortality. Overall confidence in the results of the evaluated meta-analysis was critically low. The meta-analysis coincides with obtaining lower complications and mortality rates with the WHO surgical safety checklist. However, the studies included in the meta-analyses were mostly observational, with potential biases, and according to the AMSTAR 2 tool, the overall confidence in the results of the evaluated studies was critically low.

Meta-analysis study: Risk analysis of eating habits, smoking habits, physical activity, and stress on the incidence of hypertension in Indonesia

Hypertension which is included in the class of non-communicable diseases, is a condition where systolic and diastolic blood pressure exceeds the limit. The blood pressure limit is 140/90 mmHg (systolic/diastolic). This meta-analysis study aims to analyze the relationship between risk factors for hypertension in Indonesia, which is limited to eating habits, smoking habits, physical activity, and stress. This study used the meta-analysis method by collecting 52 previous research articles. Data were processed using Microsoft Excel and analyzed using JASP (Jeffrey's Amazing Statistics Program) software. The results of the meta-analysis study showed that the risk factors of eating habits had a value of 9,583 times greater, smoking habits 2,857 times greater, physical activity 3,896 times greater, and stress 4,349 times greater to develop hypertension. Based on these results, it can be concluded that the most influential factor for hypertension is eating habits, while the least influential factor is smoking habits.

The Effect of Student-Centered Strategies, Methods and Techniques Used in Mathematics Teaching on Problem Solving Skills: A Meta-Analysis Study

The main purpose of this research is to synthesize the experimental studies which refer to the effect of student-centred strategies, methods and techniques used in mathematics lessons on problem solving skills in mathematics. Publication bias was tested to evaluate the validity of the study and no bias was found out. Meta-analysis results show that student- centred strategy methods or techniques are more effective than traditional teaching methods. 69 effect sizes from 55 studies were analyzed under the random effects model according to heterogeneity test results. Since the experimental and control groups had different sample sizes, Hedge's g was used to calculate the effect size and it was calculated as g=0.868. The overall effect value achieved shows a large effect according to the classifications of Cohen (1988). In order to examine the factors that will change the effect size, moderator variables were determined and sub-analysis was performed. In the analyzes of the moderator variables; while there was a significant difference for the learning areas and research design moderators, no significant difference was found for the other moderators.

Cachexia Index in Patients with Gastrointestinal Cancer: A Systematic Review and Meta-Analysis.

The cachexia index is a novel biomarker of cancer cachexia. This systematic review and meta-analysis aimed to evaluate the prognostic impact of cachexia index on prognosis after surgery for gastrointestinal cancer. In August 2023, we systematically searched PubMed, the Cochrane Library, and Ovid for relevant studies on the oncological outcome after gastrointestinal cancer surgery and analyzed the findings from these studies for meta-analysis. Our systematic and meta-analysis review identified eight studies involving 1876 patients. The number of patients with low cachexia index accounted for 813 patients (43.3%). We found that low cachexia index was associated with worse overall survival (pooled HR, 2.30; 95% CI, 1.85-2.87; z = 7.49; P < 0.001) and disease/relapse/progression-free survival (pooled HR, 1.77; 95% CI, 1.45-2.18; z = 5.50; P < 0.001). Our meta-analysis showed that cachexia index was associated with oncological outcome after gastrointestinal cancer surgery. However, the limitations of this meta-analysis should be taken into consideration when interpreting the results.

Meta-Analysis: Job Satisfaction and Job Performance Moderated by National Economic Development and Performance Scales

Job satisfaction and job performance are some of the most researched topics in the organizational literature. These have prompted academics to test the strength of this relationship with meta-analysis. However, some academics state that job satisfaction contributes to job performance while others say that it might be that job performance leads to job satisfaction. The most probable explanation is that this relationship is affected by moderators and mediators. This paper tests the moderators of national economic development (developed vs developing countries) and the moderator of self vs other-rated job performance in a meta-analysis study.

The maternal factors associated with infant low birth weight: an umbrella review

BackgroundIn this umbrella review, we systematically evaluated the evidence from meta-analyses and systematic reviews of maternal factors associated with low birth weight.MethodsPubMed, Scopus, and Web of Science were searched to identify all relevant published studies up to August 2023. We included all meta-analysis studies (based on cohort, case-control, cross-sectional studies) that examined the association between maternal factors (15 risk factors) and risk of LBW, regardless of publication date. A random-effects meta-analysis was conducted to estimate the summary effect size along with the 95% confidence interval (CI), 95% prediction interval, and heterogeneity (I2) in all meta-analyses. Hedges’ g was used as the effect size metric. The effects of small studies and excess significance biases were assessed using funnel plots and the Egger’s test, respectively. The methodological quality of the included studies was assessed using the AMSTAR 2 tool.ResultsWe included 13 systematic Review with 15 meta-analysis studies in our study based on the inclusion criteria. The following 13 maternal factors were identified as risk factors for low birth weight: crack/cocaine (odds ratio [OR] 2.82, 95% confidence interval [CI] 2.26–3.52), infertility (OR 1.34, 95% CI 1.2–1.48), smoking (OR 2.00, 95% CI 1.76–2.28), periodontal disease (OR 2.41, 95% CI 1.67–3.47), depression (OR 1.84, 95% CI 1.34–2.53), anemia (OR 1.32, 95% CI 1.13–1.55), caffeine/coffee (OR 1.34, 95% CI 1.14–1.57), heavy physical workload (OR 1.87, 95% CI 1.00-3.47), lifting ≥ 11 kg (OR 1.59, 95% CI 1.02–2.48), underweight (OR 1.79, 95% CI 1.20–2.67), alcohol (OR 1.23, 95% CI 1.04–1.46), hypertension (OR 3.90, 95% CI 2.73–5.58), and hypothyroidism (OR 1.40, 95% CI 1.01–1.94). A significant negative association was also reported between antenatal care and low birth weight.ConclusionsThis umbrella review identified drug use (such as crack/cocaine), infertility, smoking, periodontal disease, depression, caffeine and anemia as risk factors for low birth weight in pregnant women. These findings suggest that pregnant women can reduce the risk of low birth weight by maintaining good oral health, eating a healthy diet, managing stress and mental health, and avoiding smoking and drug use.

Satisfaction unveiled: decoding the antecedents and consequences of halal tourism – a metaanalytical approach

Purpose This study aims to identify the dimensions of satisfaction in the halal tourism literature by analyzing the identified antecedents and outcomes. The study aims to synthesize the current empirical findings in halal tourism. Additionally, this study provides a comprehensive understanding of the factors that lead to halal traveller satisfaction. Design/methodology/approach Using a meta-analysis approach, this paper synthesizes the fragmented and conflicting findings of 56 quantitative studies focusing on satisfaction and its antecedents and consequences in the halal tourism context. Data from 145 relationships representing an aggregate sample size of 21,173 were used. Additionally, this study extends the analysis by incorporating contemporary factors such as the impact of COVID-19, sample size and gender as moderators. Findings The findings indicate that both physical characteristics and psychological aspects are positively related to satisfaction. Further, this study reported that endorsement and revisit intention are the significant consequences of satisfaction. Lastly, this study identifies the significant moderating effect of the COVID-19 pandemic, sample size and gender on the relationship between satisfaction and its antecedents/consequences. Research limitations/implications Global halal tourism industry caters to Muslim and non-Muslim tourists across the globe; this article identifies the contributing factors of satisfaction in the halal tourism context. Policymakers can adapt according to their needs and preferences. Originality/value This study provides cumulative evidence to the literature regarding the relationship between satisfaction and its antecedents/consequences in halal tourism. This is the first meta-analysis study on the mentioned topic, making significant theoretical, managerial and methodological contributions to halal tourism research.

Comparative efficacy of five approved Janus kinase inhibitors as monotherapy and combination therapy in patients with moderate-to-severe active rheumatoid arthritis: a systematic review and network meta-analysis of randomized controlled trials.

The European League of Rheumatology(EULAR)guidelines recommend Janus kinase (JAK) inhibitors for patients with moderate to severe rheumatoid arthritis (RA) who are insensitive or under-responsive to conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). But there was no recommendation for which one was preferred in five currently approved JAK inhibitors. The objective of this network meta-analysis study was to evaluate the efficacy of five JAK inhibitors as monotherapy and combination therapy in patients with moderate-to-severe active rheumatoid arthritis. The randomized controlled trials (RCTs) of tofacitinib, baricitinib, upadacitinib, filgotinib and peficitinib as monotherapy or combined with csDMARD in the treatment of active RA were searched in database of PubMed, Embase, Web of Science and Cochrane Library, up to December 2023. The control group included placebo or csDMARD. Outcome indicators included American College of Rheumatology 20% response (ACR20), ACR50, ACR70 and the percentage of patients achieving 28-joint disease activity score using C-reactive protein (DAS28(CRP))<2.6at 12 weeks and 24 weeks. The statistical analysis was performed by Stata14 and RevMan5.4. Data processing, network evidence plots, surface under the cumulative ranking curve (SUCRA) ranking, league plots and funnel plots were generated. Risk ratio (RR) and 95% confidence interval (95%CI) as effect sizes to analyze the statistics. This study included thirty-six RCTs with 16,713 patients. All JAK inhibitors were more effective than placebo in ACR20 (RRs ranging between 1.74 and 3.08), ACR50 (RRs ranging between 2.02 and 7.47), ACR70 (RRs ranging between 2.68 and 18.13), DAS28(CRP) < 2.6 (RRs ranging between 2.70 and 7.09) at 12 weeks. Upadacitinib 30mg and upadacitinib 15mg showed relatively good efficacy according to their relative SUCRA ranking. All JAK inhibitors were more effective than csDMARD or placebo in ACR20 (RRs ranging between 1.16 and 1.86), ACR50 (RRs ranging between 1.69 and 2.84), ACR70 (RRs ranging between 1.50 and 4.47), DAS28(CRP) < 2.6 (RRs ranging between 2.28 and 7.56) at 24 weeks. Upadacitinib 15mg + csDMARD and baricitinib 4mg + csDMARD showed relatively good efficacy according to their relative SUCRA ranking. The safety analysis results such as serious infection, malignancy, major adverse cardiovascular event (MACE), and venous thromboembolic events (VTE) showed no statistical difference. This NMA study indicated that all JAK inhibitors performed better than placebo. Based on the results of this study, upadacitinib 30mg, upadacitinib 15mg, upadacitinib 15mg + csDMARD and baricitinib 4mg + csDMARD were recommended treatment options with relatively good efficacy and safety. However, attention should be paid to monitoring the occurrence of adverse events in high-risk RA patients with medication. Combination therapy with csDMARD might be more suitable for the maintenance of long-term efficacy. However, in clinical practice, it is still necessary to select the appropriate therapeutic regimen based on the actual clinical situation.