USING MIXED TREATMENT COMPARISONS TO GENERATE RECOMMENDATIONS FOR OPTIMAL USE OF MEDICATIONS

Purpose: Despite the power of using mixed treatment comparisons meta-analysis (MTC) for synthesizing evidence when a policy or therapeutic decision requires consideration of multiple treatment options, MTC remains an infrequently used methodology in making recommendations or policy decisions.  The Canadian Agency for Drugs and Technologies in Health (CADTH) will highlight its experiences in applying MTC to make recommendations and identify key learnings for others who may wish to employ the results from MTC in decision-making.

Method: CADTH used MTC to evaluate the comparative efficacy of drugs used for second-line treatment of type 2 diabetes when poorly controlled on metformin monotherapy, and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology to facilitate development of recommendations for their optimal use.

Result: The presentation will briefly introduce CADTH and the project to assess second-line antidiabetes drugs. An overview of MTC methodology will be presented along with some common perceptions about MTC and barriers to accepting this approach to evidence synthesis. The presenter will share how CADTH overcame challenges by fostering understanding and acceptance of MTC methodology in an expert committee and explain how MTC results were incorporated within the GRADE approach to developing recommendations. Finally, the processes and framework used to develop recommendations based on MTC results will be described.

Conclusion: MTC meta-analysis can be a powerful method for comparing multiple treatment options. There may, however, be a degree of discomfort on the part of decision-makers to use results from MTC. To ensure a successful outcome, a strategic approach is required to educate decision-makers and to ensure that analyses are conducted and presented appropriately.