Michael R Jaff1, Teresa Nelson2, Nicole Ferko3, Melissa Martinson2, Louise H Anderson2, Sarah Hollmann3. 1. Department of Medicine, Newton-Wellesley Hospital, 2014 Washington Street, Newton, MA 02462. Electronic address: mjaff@partners.org. 2. Technomics Research, LLC, Minneapolis, Minnesota. 3. Cornerstone Research Group, Burlington, Ontario, Canada.
Abstract
PURPOSE: To use network meta-analysis (NMA) to determine the optimal endovascular strategy for management of femoropopliteal peripheral artery disease (PAD) given the lack of multiple prospective randomized trials to guide treatment decisions. MATERIALS AND METHODS: NMA is a new meta-analytic method that permits comparisons among any 2 therapies by combining results of a collection of clinical trials conducted in the same or similar patient population. NMA was used to analyze data from 15 randomized controlled trials (RCTs) and 10 prospective, multicenter, single-arm trials (combined evidence [CE] NMA) that evaluated target lesion revascularization (TLR) for 5 endovascular strategies: bare metal stent (BMS), polymer-covered metal stent (CMS), drug-eluting stent (DES), drug-coated balloon (DCB) and percutaneous transluminal angioplasty (PTA). RESULTS: The RCT and CE NMAs included 2,912 (6,091) patients with 3,151 (6,786) person-years of follow-up. In the CE NMA, DCB provided a statistically significant 68% reduction in TLR compared with PTA and a statistically significant 53% reduction in TLR compared with BMS. BMS, CMS, and DES provided reductions in TLR of 33%, 48%, and 58% compared with PTA, with statistical significance achieved for CMS and DES. The significant reductions in TLR for DCB compared with PTA and BMS were replicated in the RCT NMA. CONCLUSIONS: This NMA demonstrated that DCB provided better reduction in TLR rates compared with PTA and BMS.
PURPOSE: To use network meta-analysis (NMA) to determine the optimal endovascular strategy for management of femoropopliteal peripheral artery disease (PAD) given the lack of multiple prospective randomized trials to guide treatment decisions. MATERIALS AND METHODS: NMA is a new meta-analytic method that permits comparisons among any 2 therapies by combining results of a collection of clinical trials conducted in the same or similar patient population. NMA was used to analyze data from 15 randomized controlled trials (RCTs) and 10 prospective, multicenter, single-arm trials (combined evidence [CE] NMA) that evaluated target lesion revascularization (TLR) for 5 endovascular strategies: bare metal stent (BMS), polymer-covered metal stent (CMS), drug-eluting stent (DES), drug-coated balloon (DCB) and percutaneous transluminal angioplasty (PTA). RESULTS: The RCT and CE NMAs included 2,912 (6,091) patients with 3,151 (6,786) person-years of follow-up. In the CE NMA, DCB provided a statistically significant 68% reduction in TLR compared with PTA and a statistically significant 53% reduction in TLR compared with BMS. BMS, CMS, and DES provided reductions in TLR of 33%, 48%, and 58% compared with PTA, with statistical significance achieved for CMS and DES. The significant reductions in TLR for DCB compared with PTA and BMS were replicated in the RCT NMA. CONCLUSIONS: This NMA demonstrated that DCB provided better reduction in TLR rates compared with PTA and BMS.
Authors: Susanne Schmitz; Áine Maguire; James Morris; Kai Ruggeri; Elisa Haller; Isla Kuhn; Joy Leahy; Natalia Homer; Ayesha Khan; Jack Bowden; Vanessa Buchanan; Michael O'Dwyer; Gordon Cook; Cathal Walsh Journal: BMC Med Res Methodol Date: 2018-06-28 Impact factor: 4.615
Authors: John A Laird; Peter A Schneider; Michael R Jaff; Marianne Brodmann; Thomas Zeller; D Chris Metzger; Prakash Krishnan; Dierk Scheinert; Antonio Micari; Hong Wang; Michele Masters; Gunnar Tepe Journal: Circ Cardiovasc Interv Date: 2019-06-14 Impact factor: 6.546