Understanding network meta-analysis

Recently, in the <i>World Journal of Clinical Cases</i>, studied the different non-steroidal anti-inflammatory drugs (meloxicam, celecoxib, naproxen, and rofecoxib) for juvenile idiopathic arthritis with network meta-analysis (NMA). This manuscript aims to introduce to clinicians what NMA is. NMA represents a fundamental technique for simultaneously comparing three or more interventions within a single analysis, harnessing both direct and indirect evidence derived from a network of studies. It surpasses pair-wise meta-analysis which are confined to direct comparison of two items in clinical trials. This approach can estimate the relative effects between any pair of interventions within the network, often yielding more precise estimations than those generated from single direct or indirect analyses. NMA necessitates steps akin to those of conventional meta-analysis, involving a thorough literature search, assessment of potential trial biases, statistical analysis of reported pairwise comparisons for all relevant outcomes, and evaluation of overall certainty of evidence on an outcome-specific basis. However, NMA demands substantial resources, given its propensity to address broader inquiries, typically involving a larger number of studies at each phase of the systematic review, from screening to analysis, compared to traditional meta-analyses.