a statistic using modified ridit scores van Elteren test

A statistic using modified ridit scores van elteren

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a Cochran–Mantel–Haenszel statistic using modified ridit scores (van Elteren test) controlling for study centre.
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98 Assessment of clinical effectiveness FIGURE 49 Random-effects meta-analysis – CIBIC-plus at 24–28 weeks: memantine vs placebo. Memantine Placebo WMD (95% CI) Weight n Mean SD n Mean SD LOCF analysis Reisberg et al. (2003) 142 118 4.50 1.12 118 4.80 1.09 - 0.300 ( - 0.582 to - 0.018) 36.7 Van Dyck et al. (2007) 143 171 4.30 1.00 163 4.60 1.00 - 0.300 ( - 0.515 to - 0.085) 63.3 Subtotal [ Q = 0.0 ( p on 1 df = 1.000); I 2 = 0.0%; τ 2 = 0.000] - 0.300 ( - 0.471 to - 0.129) 100.0 p < 0.001 Overall pooled estimate - 0.300 ( - 0.471 to - 0.129) [ Q = 0.0 ( p on 1 df = 1.000); I 2 = 0.0%; τ 2 = 0.000] Small-study effects: not calculable p < 0.001 0 –0.6 –0.4 –0.2 0.2 Favours memantine Favours placebo
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© Queen’s Printer and Controller of HMSO 2012. This work was produced by Bond et al . under the terms of a commissioning contract issued by the Secretary of State for Health. 99 Health Technology Assessment 2012; Vol. 16: No. 21 DOI: 10.3310/hta16210 The meta-analysis of memantine versus placebo studies showed benefit from memantine at 12 weeks’ follow-up on the SIB. However, treatment gain, measured by functional outcome, depended on the type of instrument used, and no benefit was seen from behavioural outcomes. Nevertheless, pooled estimates of global outcomes showed a benefit from taking memantine at 24–28 weeks. Overall, the pooled results from these moderate-to-poor-quality studies showed inconclusive results for cognitive and behavioural outcomes. The results for functional outcomes were dependent on the measure used, but the pooled results of the new and existing evidence for global outcomes showed significant benefit from using memantine. Graphical summary of memantine versus placebo Figure 50 , below, illustrates how little the evidence has changed for memantine versus placebo. The cognitive benefits found in 2004 failed to be replicated; indeed the new study 143 favoured memantine on only one outcome measure. However, the quality of the new 143 and existing study 142 was not high; thus, these results cannot be considered conclusive. Head-to-head comparisons Identified evidence Alongside placebo-controlled trials, a certain amount of randomised evidence provides direct, head-to-head comparisons of two or more of the technologies under review. Three such RCTs were included in the 2004 review: 2 donepezil versus rivastigmine, 144 donepezil versus rivastigmine, 145 and donepezil versus galantamine. 146 TABLE 31 Adverse events in included studies: memantine vs placebo AE Van Dyck et al . (2007) 143 Memantine Placebo p -value N n (%) N n (%) Any AE 178 131 (73.6) 172 125 (72.7) 0.941 a Any serious AE 178 26 (14.6) 172 29 (16.9) 0.666 a Diarrhoea 178 10 (5.6) 172 8 (4.7) 0.867 a Agitation 178 16 (9.0) 172 24 (14.0) 0.197 a Anxiety 178 10 (5.6) 172 6 (3.5) 0.485 a Depression 178 9 (5.1) 172 5 (2.9) 0.451 a Injury 178 10 (5.6) 172 13 (7.6) 0.605 a Dizziness 178 12 (6.7) 172 11 (6.4) 0.932 a Headache 178 3 (1.7) 172 11 (6.4) 0.048 a Urinary tract infection 178 9 (5.1) 172 9 (5.2) 0.867 a Fall 178 10 (5.6) 172 17 (9.9) 0.195 a Influenza-like symptoms 178 10 (5.6) 172 8 (4.7) 0.867 a Confusion 178 9 (5.1) 172 8 (4.7) 0.942 a Hypertension 178 14 (7.9) 172 4 (2.3) 0.035 a Peripheral oedema 178 12 (6.7) 172 8 (4.7) 0.541 a Constipation 178 11 (6.2) 172 8 (4.7) 0.693 a Insomnia 178 4 (2.2) 172 9 (5.2) 0.233 a a Chi-squared test (Yates’ correction) (calculated by reviewer).
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100 Assessment of clinical effectiveness Our searches identified a further four RCTs of this type.
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