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• W2899733675 abstract "Potential conflict of interest: Nothing to report. To the Editor: We read with great interest the network meta‐analysis by Sharma et al.1 The authors compared different therapies for the first prophylaxis of esophageal variceal bleeding, based on the direct and indirect evidence, and concluded that nonselective β‐blockers (NSBBs) could be the optimization. We commend the authors for undertaking such a rigorous network meta‐analysis and would like to share our opinion on the details in methods. The authors mentioned that the network evaluating mortality had some inconsistency in the comparison of NSBBs and variceal band ligation (VBL), thus indicating that there existed biases in the research. Considering the source of inconsistency, the main assumption underpinning the transitivity of direct evidence from pairwise meta‐analysis and indirect evidence from network meta‐analysis is that there exists a common comparator between the trials.2 In the meantime, the placebo effect itself—symptom improvement after inert treatments in clinical trials—is composed of different factors, such as the natural history of a disease or fluctuation of symptoms, response biases, effects of cointerventions, or statistical phenomena.3 Doubtless, “no intervention” in VBL trials was equated with “placebo” in NSBB trials in the indirect comparison between NSBBs and VBL with the outcome of all‐cause death, irrespective of the placebo effect. This is a matter of concern because the conceptual heterogeneity could be derived from inconsistency based on the improper conducting of the indirect comparison.4 In the Bayesian network meta‐analysis, indirect evidence was compared with direct evidence from a pairwise meta‐analysis to evaluate the data credibility.2 As for the outcome of all‐cause death, the P value of the comparison between VBL and NSBBs equals 0.07, which indicates that the difference between VBL and NSBBs does not reach statistical significance according to the normal cutoff, 0.05; and there is no explicit description of the cutoff P value in this article.1 Considering the inaccurate equating of different control groups and inconsistency across indirect and direct evidence estimates derived from statistical test, results and inferences from this network meta‐analysis need to be interpreted with great caution. We suggest that a sensitivity analysis in which the control groups of “no intervention” and “placebo” are set separately into two nodes could be a supplement to this network meta‐analysis." @default.
• W2899733675 created "2018-11-16" @default.
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• W2899733675 date "2019-06-27" @default.
• W2899733675 modified "2023-09-27" @default.
• W2899733675 title "Letter to the Editor: Confirmation of the Optimization to Prevent the First Esophageal Variceal Bleeding?" @default.
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• W2899733675 doi "https://doi.org/10.1002/hep.30344" @default.
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