{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T09:33:36Z","timestamp":1763458416749,"version":"3.32.0"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2024,12,26]],"date-time":"2024-12-26T00:00:00Z","timestamp":1735171200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Systematic reviews, such as those prepared by Cochrane, are the strongest evidence on which to base recommendations in clinical guidelines. Network meta-analysis (NMA) can be used to combine the results of studies to compare multiple treatments, which is advantageous over pair-wise meta-analysis (PW-MA) that compares two treatments. We aimed to summarise which, when, where, who, and why Cochrane Reviews that applied NMA were cited in guidelines; and to compare the citation of NMA reviews in guidelines with PW-MA reviews.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>We carried out a systematic review of Cochrane reviews that applied NMA and we summarised their citation in guidelines. The Cochrane Database of Systematic Reviews was searched (15<jats:sup>th<\/jats:sup> January 2024). Additionally, a cohort of Cochrane reviews that applied PW-MA was matched to the NMA reviews. Two authors assessed eligibility and extracted data. We summarised review and guideline characteristics, and the use of the review in guidelines.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of the 60 included NMA reviews, 26 reviews (43%) were cited in 89 guidelines (1\u201313 per review). 15 NMA reviews (58%) were first cited within two years of publication, with the remaining 11 reviews (42%) cited 2\u20136 years later. 52 guideline developers authored the guidelines. The number of citations was higher for NMA than PW-MA reviews (rate ratio 1.53 (1.08 to 2.19), p = 0.02). The number of times reviews were commissioned or cited alongside a recommendation was also higher for NMA than PW-MA reviews (rate ratio 4.40 (1.80 to 13.14), p = 0.003). NMA reviews were more likely to be cited in the text surrounding a recommendation or used for NICE guideline development (1.94 (1.08 to 3.63), p = 0.03).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Cochrane NMA reviews appear to have more impact than PW-MA reviews, but many are not cited in guidelines. Further work is needed to explore the barriers to use of NMAs and promote their use.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0315563","type":"journal-article","created":{"date-parts":[[2024,12,26]],"date-time":"2024-12-26T18:33:43Z","timestamp":1735238023000},"page":"e0315563","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["The impact of Cochrane Reviews that apply network meta-analysis in clinical guidelines: A systematic review"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1709-2290","authenticated-orcid":true,"given":"Sarah","family":"Donegan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Connor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zarko","family":"Alfirevic","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catrin","family":"Tudur-Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2024,12,26]]},"reference":[{"issue":"17","key":"pone.0315563.ref001","doi-asserted-by":"crossref","first-page":"2096","DOI":"10.1001\/jama.1993.03510170086037","article-title":"Users\u2019 Guides to the Medical Literature","volume":"270","author":"GH Guyatt","year":"1993","journal-title":"JAMA"},{"issue":"3","key":"pone.0315563.ref002","doi-asserted-by":"crossref","first-page":"210","DOI":"10.7326\/0003-4819-127-3-199708010-00006","article-title":"The Relation between Systematic Reviews and Practice Guidelines","volume":"127","author":"DJ Cook","year":"1997","journal-title":"Ann Intern Med"},{"key":"pone.0315563.ref003","doi-asserted-by":"crossref","DOI":"10.1002\/9781119536604","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions.","author":"TJ Higgins JPT","year":"2019","edition":"2"},{"issue":"2","key":"pone.0315563.ref004","doi-asserted-by":"crossref","first-page":"103","DOI":"10.4097\/kjae.2018.71.2.103","article-title":"Introduction to systematic review and meta-analysis","volume":"71","author":"E Ahn","year":"2018","journal-title":"Korean J Anesthesiol"},{"issue":"2","key":"pone.0315563.ref005","doi-asserted-by":"crossref","first-page":"e012545","DOI":"10.1136\/bmjopen-2016-012545","article-title":"Analysis of the time and workers needed to conduct systematic reviews of medical interventions using data from the PROSPERO registry","volume":"7","author":"R Borah","year":"2017","journal-title":"BMJ Open"},{"key":"pone.0315563.ref006","volume-title":"Methodological Expectations of Cochrane Intervention Reviews","author":"JPT Higgins","year":"2023"},{"key":"pone.0315563.ref007","volume-title":"WHO handbook for guideline development","author":"World Health Organization","year":"2014"},{"key":"pone.0315563.ref008","unstructured":"Institute of Medicine (US) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. 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