Isabelle Boutron1, Perrine Créquit2, Hywel Williams3, Joerg Meerpohl4, Jonathan C Craig5, Philippe Ravaud6. 1. INSERM, UMR1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS Team, Paris, France; Centre d'Epidémiologie Clinique, AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Hôtel Dieu, Paris, France; French Cochrane Center, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Faculté de Médecine, Paris, France. Electronic address: isabelle.boutron@aphp.fr. 2. INSERM, UMR1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS Team, Paris, France; French Cochrane Center, Paris, France; Direction de la recherche Clinique, Hôpital Foch, Suresnes, France. 3. Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, United Kingdom. 4. Institute for Evidence in Medicine (For Cochrane Germany Foundation), Medical Centre of the University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. 5. College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia. 6. INSERM, UMR1153, Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), METHODS Team, Paris, France; Centre d'Epidémiologie Clinique, AP-HP (Assistance Publique des Hôpitaux de Paris), Hôpital Hôtel Dieu, Paris, France; French Cochrane Center, Paris, France; Paris Descartes University, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Abstract
OBJECTIVES: This article presents why the planning, conduct, and reporting of systematic reviews and meta-analyses of therapeutic interventions are suboptimal. STUDY DESIGN AND SETTING: We present an overview of the limitations of the current system of evidence synthesis for therapeutic interventions. RESULTS: Systematic reviews and meta-analyses are a cornerstone of health care decisions. However, despite the increasing a number of published systematic reviews of therapeutic interventions, the current evidence synthesis ecosystem is not properly addressing stakeholders' needs. The current production process leads to a series of disparate systematic reviews because of erratic and inefficient planning with a process that is not always comprehensive and is prone to bias. Evidence synthesis depends on the quality of primary research, so primary research that is not available is biased or selectively reported raises important concerns. Moreover, the lack of interactions between the community of primary research producers and systematic reviewers impedes the optimal use of data. The context has considerably evolved, with ongoing research innovations, a new medical approach with the end of the one-size-fits-all approach, more available data, and new patient expectations. All these changes must be introduced into the future evidence ecosystem. CONCLUSION: Dramatic changes are needed to enable this future ecosystem to become user driven and user oriented and more useful for decision-making.
OBJECTIVES: This article presents why the planning, conduct, and reporting of systematic reviews and meta-analyses of therapeutic interventions are suboptimal. STUDY DESIGN AND SETTING: We present an overview of the limitations of the current system of evidence synthesis for therapeutic interventions. RESULTS: Systematic reviews and meta-analyses are a cornerstone of health care decisions. However, despite the increasing a number of published systematic reviews of therapeutic interventions, the current evidence synthesis ecosystem is not properly addressing stakeholders' needs. The current production process leads to a series of disparate systematic reviews because of erratic and inefficient planning with a process that is not always comprehensive and is prone to bias. Evidence synthesis depends on the quality of primary research, so primary research that is not available is biased or selectively reported raises important concerns. Moreover, the lack of interactions between the community of primary research producers and systematic reviewers impedes the optimal use of data. The context has considerably evolved, with ongoing research innovations, a new medical approach with the end of the one-size-fits-all approach, more available data, and new patient expectations. All these changes must be introduced into the future evidence ecosystem. CONCLUSION: Dramatic changes are needed to enable this future ecosystem to become user driven and user oriented and more useful for decision-making.
Authors: Van Thu Nguyen; Philippe Rivière; Pierre Ripoll; Julien Barnier; Romain Vuillemot; Gabriel Ferrand; Sarah Cohen-Boulakia; Philippe Ravaud; Isabelle Boutron Journal: J Clin Epidemiol Date: 2020-10-21 Impact factor: 6.437
Authors: Isabelle Boutron; Anna Chaimani; Joerg J Meerpohl; Asbjørn Hróbjartsson; Declan Devane; Gabriel Rada; David Tovey; Giacomo Grasselli; Philippe Ravaud Journal: Ann Intern Med Date: 2020-09-15 Impact factor: 25.391