A Smarter Way to Guide Patient Care: The Impact of Network Meta-Analyses on Clinical Guidelines

by Jon Scaccia January 16, 2025

Imagine you’re a doctor deciding which treatment works best for a condition with multiple options. Would you rely on comparing just two treatments, or would you prefer a method that compares all options simultaneously, ranking them by effectiveness and safety? This is the promise of Network Meta-Analyses (NMAs)—a powerful tool in modern medicine. Unlike traditional pairwise meta-analyses (PW-MAs), which evaluate two treatments at a time, NMAs map a web of treatment comparisons to deliver a clearer, broader perspective.

But how well do NMAs influence real-world guidelines that doctors rely on? A recent study reviewed how often Cochrane NMAs—the gold standard of systematic reviews—are cited in clinical guidelines and compared their impact to PW-MAs. The findings reveal not just strengths but also surprising gaps in how research informs care.

What the Research Found: NMAs Pack More Power

The study examined 60 Cochrane NMAs, tracking their citation in clinical guidelines like those published by the World Health Organization and the UK’s National Institute for Health and Care Excellence (NICE). Key insights include:

• Higher Impact: NMAs were 1.5 times more likely to be cited in guidelines than PW-MAs. When cited, NMAs were more likely to shape actionable recommendations.
• Global Reach: These reviews were referenced by 52 different guideline development groups across the globe, spanning countries like the UK, Germany, and the USA.
• Timeliness Matters: While 58% of NMAs were cited within two years of publication, the rest took up to six years—or were never cited.

Yet, a troubling statistic emerged: 57% of NMAs weren’t cited in any guideline. This raises questions about barriers preventing their use despite their high potential.

Breaking Down Network Meta-Analyses: Why They Matter

To understand why NMAs stand out, let’s consider their advantages:

1. Holistic Comparisons: NMAs analyze results from multiple studies, connecting dots between treatments that haven’t been directly compared in trials. For example:
   • If Drug A was compared to Drug B in one trial, and Drug B to Drug C in another, an NMA uses indirect evidence to estimate how Drug A stacks up against Drug C.
2. Precision Through Data: By pooling results from more patients across multiple studies, NMAs generate more precise estimates. This leads to stronger evidence, even in areas where direct comparisons are missing.
3. Real-World Impact: NMAs empower guideline developers to prioritize treatments based on both efficacy and safety rankings, helping doctors make informed choices for their patients.

Challenges: Why Aren’t NMAs Fully Utilized?

Despite their promise, NMAs face hurdles that limit their uptake:

• Complexity and Caution: NMAs require sophisticated statistical methods that some guideline developers might not fully understand or trust.
• Familiarity Gaps: Traditional PW-MAs are more familiar and easier to interpret, making them a default choice in many cases.
• Timeliness: Some NMAs take years to be incorporated into guidelines, leading to outdated recommendations if new studies aren’t considered.

Moreover, citing an NMA doesn’t always mean it influences care. In some cases, NMAs were listed as references but didn’t directly shape recommendations—a missed opportunity for impact.

Bigger Picture: What NMAs Mean for Healthcare

The implications of this research stretch beyond citations. They highlight the need to bridge gaps between rigorous science and practical decision-making:

1. Collaboration Counts: Better communication between researchers and guideline developers could ensure NMAs address priority questions and are easier to understand and apply.
2. Education and Training: Familiarizing guideline developers with NMA methods can build confidence in using these reviews effectively.
3. Regular Updates: Ensuring NMAs remain current is vital. Guidelines relying on outdated reviews risk recommending less effective or safe treatments.

By addressing these barriers, NMAs could significantly enhance how clinical guidelines shape patient care.

Let’s Explore Together

What do you think about the potential of NMAs in improving healthcare decisions? Here are some questions to spark your thoughts:

• How might better use of NMAs influence treatments in everyday practice?
• What can be done to ensure healthcare providers trust and apply complex evidence like NMAs?
• Have you encountered medical guidelines that felt outdated or incomplete? How could research like this address those gaps?

Share your ideas in the comments or join the discussion on social media. Let’s work together to make science not just accessible, but impactful!

Unlock Science Secrets:

Discover revolutionary research and innovative discoveries with ‘This Week in Science’! Designed for educators and science lovers, our free weekly newsletter offers insights that can transform your approach to science. Sign up now and deepen your understanding and passion for science. If you liked this blog, please share it! Your referrals help This Week in Science reach new readers.