メタアナリシスの原理と 医療 ... - biostar.co.jp

1 2008 5 17 2 (STED) PMDA 1 Albert A Meta-Analysis of 16 randomized Trials of Sirolimus-Eluting tents Versus Paclitaxel-Eluting Stents in Patients With Coronary Artery DiseaseAlbert Sch mig, MD, Alban Dibra, MD, Stephan Windecker, MD,Julinda Mehilli, MD,Jos Suarez de Lezo.

2 MD, Christoph Kaiser, MD,Seung-Jung Park, MD, Jean-Jacque Goy, MD,Jae-Hwan Lee, MD,Emilio Di Lorenzo, MD,Jinjin Wu, MD, Peter J ni, MD,Matthias E. Pfisterer, MD, Bernhard Meier, MD, Adnan Kastrati, MDJournal of the American College of Cardiology Vol. 50, No. 14, 2007 2002 -1 -2 -3 = 60% 95% 110100100010000020406080100 600/1000 60/100 12/20 6/10 3/5 se

3 Se nn11se+ -1 No B-A 20 20/10045 40/10025 80 8/1016 2/10 -64 20 40/20045 80/20025 40 35 -5A B 0100 100 10 200 A B A B B-A 20 100 45 100 25 40 80 10 16 10 -64 320 20 200 45 200 25 20 40 35 22 39 B -80-40040 100 10 200 B-A B-A -1 -2 Simpson's Paradox A-B 70% (14/20) 50% (40/80) 20 30% (24/80) 10% (2/20)20 38% (38/100) 42% (42/100) -4 20A B %) Simpson's Paradox 020406080100A B (%)

4 -2 A B outcome RCT -3 SE 2 1/ irbrainbnawDseDwdwDDnbrbnbrbnaranarawinb rbpbnarapapapbDDpbpaiiiiikiiKiiKiiiiiiii iiiiiiiiiiiiiiii.

5 K1i1)()()(,)(B)(A11133 ==== = + === =Q B-A 1/ 100 20 100 45 100 25 40 10 80 10 16 10 -64 320 200 20 200 45 200 25 20 B Ia Ib IIa IIb III

6 IV Centre of Evidence-Based Medicine 1998 outcome Albert Methods clinical trial selection SES PES key (2007 4 PubMed, NIH database, Cochrane Central Register of Controlled Trial, American Heart Association, American College of cardiology, European Society of CardiologyInternet WHO UMIN JAPIC Albert Methods Data collection and assessment of quality)

7 Outcome MI TLR 9 16 11 QC ITT outcome QC QC Q&A Albert forest plot ( )p< SES PES I2 I2 I2 I2 0 25% I2=50% 75% I2 H0 I2 0 I2= p= I2 I2= p= SES PES I2 I2 Q Q di dm wi

8 (1) Q Q (2) :K(2)1))/Q-(K - (Q100% = I)1(~)(Q sCochran'21122QM = = KiKmiiddw I2= < = evidence Hylan Versus Hyaluronic Acid for Osteoarthritis of the Knee: A Systematic Review and Meta-Analysis STEPHAN REICHENBACH, SACHA BLANK, ANNE W. S. RUTJES, AIJING SHANG,ELIZABETH A. KING, PAUL A.

9 DIEPPE, PETER JU NI, AND SVEN TRELLE Albert ( ) p< I2= p= Albert Limitation TLR MI TLR Albert vs The Emperor s New Clothes VS p FDA RCT

10 (meta-analysis) EBM con RCT RCT RCT Randomized Controlled Trial) pros con 1 p RCT pros RCT RCT con OPC