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Activity Number: 171 - SPAAC Poster Competition
Type: Topic Contributed
Date/Time: Tuesday, August 4, 2020 : 10:00 AM to 2:00 PM
Sponsor: Section on Statistics in Epidemiology
Abstract #312299
Title: Estimating Bias Due to Treatment Favoritism Using Network Meta-Regression: Disease-Modifying Drugs for Relapsing-Remitting Multiple Sclerosis (RRMS) Including Off-Label Rituximab
Author(s): Christopher James Rose* and Ingrid Kristine Ohm and Julia Bidonde and Lene Kristine Juvet and Torunn Elisabeth Tjelle and Atle Fretheim
Companies: Division of Health Services, Norwegian Institute of Public Health and Division of Health Services, Norwegian Institute of Public Health and Division of Health Services, Norwegian Institute of Public Health and Division of Infection Control & Environmental Health, Norwegian Institute of Public Health and Division of Health Services, Norwegian Institute of Public Health and Division of Health Services, Norwegian Institute of Public Health
Keywords: Heath Technology Assessment; Network meta-analysis; Network meta-regression; Bias; Relapsing-Remitting Multiple Sclerosis
Abstract:

Health technology assessments (HTAs) often compare multiple treatments, relying on primary study results that may be biased for various reasons. In 2019, we published an HTA on RRMS treatments that informed national reimbursement policy in Norway. We compared and ranked 27 treatments (including rituximab used off-label, placebo, and no treatment), and included 31 randomized (28 856 patient-years of follow-up) and 7 nonrandomized studies (60 448 patient-years). We used network meta-regression (NMR) to adjust for possible bias in nonrandomized evidence at study level. However, arm-level bias may also exist and be assumed to favor investigational treatments (e.g., a study sponsor’s treatment over active control). We developed a tool to judge treatment favoritism and used mixed-effects NMR to estimate relative treatment effects, adjusting for favoritism. With respect to 12- or 24-week confirmed disability progression (CDP) for example, adjusting revises RR of CDP for rituximab vs placebo from 0.54 (95% CI 0.19–1.55) to 0.35 (95% CI 0.11–1.10), and ranking of rituximab from 6th to 3rd best treatment (after ocrelizumab and alemtuzumab, which have been approved by the FDA for RRMS).


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