The need to consider the wider agenda in systematic reviews and meta-analyses: breadth, timing, and depth of the evidence

Ref ID	493
First Author	J. P. Ioannidis
Journal	BMJ
Year Of Publishing	2010
URL	https://pubmed.ncbi.nlm.nih.gov/20837576/
Keywords	• Pharmacological • Open data • Multiplicity • Publication bias • Pre-specification • External validity
Problem(s)	• Ignores setting or context of included studies which limits review applicability • Overly stringent inclusion criteria affecting external validity • Perpetuates citation of poor quality primary study data
Number of systematic reviews included	34
Summary of Findings	All systematic reviews dealt with a single indication (for either one agent or multiple agents) but none considered several indications. 188 relevant trials were identified for 42 indications-pairs. Only 5 compared head to head different anti-TNF agents, and another 32 trials compared an anti-TNF agent with one or more active comparators (only 4 published at time of writing). All other trials were comparisons against placebo or no treatment. Overall, the published trials represented only 34% of the total evidence (46% if ongoing trials were excluded).
Did the article find that the problem(s) led to qualitative changes in interpretation of the results?	N/A
Are the methods of the article described in enough detail to replicate the study?	Yes