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Meta-analyses are commonly performed based on random-effects models, while in certain cases one might also argue in favour of a common-effect model. One such case may be given by the example of two "study twins" that are performed according to a common (or at least very similar) protocol. Here we investigate the particular case of meta-analysis of a pair of studies, e.g. summarizing the results of two confirmatory clinical trials in phase III of a clinical development programme. Thereby, we focus on the question of to what extent homogeneity or heterogeneity may be discernible, and include an empirical investigation of published ("twin") pairs of studies. A pair of estimates from two studies only provides very little evidence on homogeneity or heterogeneity of effects, and ad-hoc decision criteria may often be misleading., Comment: 18 pages, 5 figures

The trace plot is seldom used in meta-analysis, yet it is a very informative plot. In this article we define and illustrate what the trace plot is, and discuss why it is important. The Bayesian version of the plot combines the posterior density of tau, the between-study standard deviation, and the shrunken estimates of the study effects as a function of tau. With a small or moderate number of studies, tau is not estimated with much precision, and parameter estimates and shrunken study effect estimates can vary widely depending on the correct value of tau. The trace plot allows visualization of the sensitivity to tau along with a plot that shows which values of tau are plausible and which are implausible. A comparable frequentist or empirical Bayes version provides similar results. The concepts are illustrated using examples in meta-analysis and meta-regression; implementaton in R is facilitated in a Bayesian or frequentist framework using the bayesmeta and metafor packages, respectively., Comment: 14 pages, 18 Figures

Background: The COVID-19 pandemic has had a profound impact on health, everyday life and economics around the world. An important complication that can arise in connection with a COVID-19 infection is acute kidney injury. A recent observational cohort study of COVID-19 patients treated at multiple sites of a tertiary care center in Berlin, Germany identified risk factors for the development of (severe) acute kidney injury. Since inferring results from a single study can be tricky, we validate these findings and potentially adjust results by including external information from other studies on acute kidney injury and COVID-19. Methods: We synthesize the results of the main study with other trials via a Bayesian meta-analysis. The external information is used to construct a predictive distribution and to derive posterior estimates for the study of interest. We focus on various important potential risk factors for acute kidney injury development such as mechanical ventilation, use of vasopressors, hypertension, obesity, diabetes, gender and smoking. Results: Our results show that depending on the degree of heterogeneity in the data the estimated effect sizes may be refined considerably with inclusion of external data. Our findings confirm that mechanical ventilation and use of vasopressors are important risk factors for the development of acute kidney injury in COVID-19 patients. Hypertension also appears to be a risk factor that should not be ignored. Shrinkage weights depended to a large extent on the estimated heterogeneity in the model. Conclusions: Our work shows how external information can be used to adjust the results from a primary study, using a Bayesian meta-analytic approach. How much information is borrowed from external studies will depend on the degree of heterogeneity present in the model., Comment: 20 pages (including Appendix), 2 Tables, 8 figures

BACKGROUND: Random-effects meta-analysis within a hierarchical normal modeling framework is commonly implemented in a wide range of evidence synthesis applications. More general problems may even be tackled when considering meta-regression approaches that in addition allow for the inclusion of study-level covariables. METHODS: We describe the Bayesian meta-regression implementation provided in the bayesmeta R package including the choice of priors, and we illustrate its practical use. RESULTS: A wide range of example applications are given, such as binary and continuous covariables, subgroup analysis, indirect comparisons, and model selection. Example R code is provided. CONCLUSIONS: The bayesmeta package provides a flexible implementation. Due to the avoidance of MCMC methods, computations are fast and reproducible, facilitating quick sensitivity checks or large-scale simulation studies., Comment: 17 pages, 8 figures

The variance-stabilizing Freeman-Tukey double arcsine transform was originally proposed for inference on single proportions. Subsequently, its use has been suggested in the context of meta-analysis of proportions. While some erratic behaviour has been observed previously, here we point out and illustrate general issues of monotonicity and invertibility that make this transform unsuitable for meta-analysis purposes., Comment: 4 pages, 2 figures, 1 table

In Bayesian meta-analysis, the specification of prior probabilities for the between-study heterogeneity is commonly required, and is of particular benefit in situations where only few studies are included. Among the considerations in the set-up of such prior distributions, the consultation of available empirical data on a set of relevant past analyses sometimes plays a role. How exactly to summarize historical data sensibly is not immediately obvious; in particular, the investigation of an empirical collection of heterogeneity estimates will not target the actual problem and will usually only be of limited use. The commonly used normal-normal hierarchical model for random-effects meta-analysis is extended to infer a heterogeneity prior. Using an example data set, we demonstrate how to fit a distribution to empirically observed heterogeneity data from a set of meta-analyses. Considerations also include the choice of a parametric distribution family. Here, we focus on simple and readily applicable approaches to then translate these into (prior) probability distributions., Comment: 18 pages, 5 tables, 4 figures

Meta-analysis methods are used to combine evidence from multiple studies. Meta-regression as well as model-based meta-analysis are extensions of standard pairwise meta-analysis in which information about study-level covariates and (arm-level) dosing amount or exposure may be taken into account. A Bayesian approach to inference is very attractive in this context, especially when a meta-analysis is based on few studies only or rare events. In this article, we present the R package MetaStan which implements a wide range of pairwise and model-based meta-analysis models. A generalised linear mixed model (GLMM) framework is used to describe the pairwise meta-analysis, meta-regression and model-based meta-analysis models. Within the GLMM framework, the likelihood and link functions are adapted to reflect the nature of the data. For example, a binomial likelihood with a logit link is used to perform a meta-analysis based on datasets with dichotomous endpoints. Bayesian computations are conducted using Stan via the rstan interface. Stan uses a Hamiltonian Monte Carlo sampler which belongs to the family of Markov chain Monte Carlo methods. Stan implementations are done by using suitable parametrizations to ease computations. The user-friendly R package MetaStan, available on CRAN, supports a wide range of pairwise and model-based meta-analysis models. MetaStan provides fitting functions for pairwise meta-analysis with the option of including covariates and model-based meta-analysis. The supported outcome types are continuous, binary, and count. Forest plots for the pairwise meta-analysis and dose-response plots for the model-based meta-analysis can be obtained from the package. The use of MetaStan is demonstrated through clinical examples., Comment: 18 pages, 2 figures, 4 tables

Phase I early-phase clinical studies aim at investigating the safety and the underlying dose-toxicity relationship of a drug or combination. While little may still be known about the compound's properties, it is crucial to consider quantitative information available from any studies that may have been conducted previously on the same drug. A meta-analytic approach has the advantages of being able to properly account for between-study heterogeneity, and it may be readily extended to prediction or shrinkage applications. Here we propose a simple and robust two-stage approach for the estimation of maximum tolerated dose(s) (MTDs) utilizing penalized logistic regression and Bayesian random-effects meta-analysis methodology. Implementation is facilitated using standard R packages. The properties of the proposed methods are investigated in Monte-Carlo simulations. The investigations are motivated and illustrated by two examples from oncology., Comment: 30 pages, 11 figures, 8 tables

The normal-normal hierarchical model (NNHM) constitutes a simple and widely used framework for meta-analysis. In the common case of only few studies contributing to the meta-analysis, standard approaches to inference tend to perform poorly, and Bayesian meta-analysis has been suggested as a potential solution. The Bayesian approach, however, requires the sensible specification of prior distributions. While non-informative priors are commonly used for the overall mean effect, the use of weakly informative priors has been suggested for the heterogeneity parameter, in particular in the setting of (very) few studies. To date, however, a consensus on how to generally specify a weakly informative heterogeneity prior is lacking. Here we investigate the problem more closely and provide some guidance on prior specification., Comment: 42 pages, 10 figures, 20 tables

Shrinkage estimation in a meta-analysis framework may be used to facilitate dynamical borrowing of information. This framework might be used to analyze a new study in the light of previous data, which might differ in their design (e.g., a randomized controlled trial (RCT) and a clinical registry). We show how the common study weights arise in effect and shrinkage estimation, and how these may be generalized to the case of Bayesian meta-analysis. Next we develop simple ways to compute bounds on the weights, so that the contribution of the external evidence may be assessed a priori. These considerations are illustrated and discussed using numerical examples, including applications in the treatment of Creutzfeldt-Jakob disease and in fetal monitoring to prevent the occurrence of metabolic acidosis. The target study's contribution to the resulting estimate is shown to be bounded below. Therefore, concerns of evidence being easily overwhelmed by external data are largely unwarranted., Comment: 14 pages, 1 figure, 5 tables

BACKGROUND: An important goal of chronic obstructive pulmonary disease (COPD) treatment is to reduce the frequency of exacerbations. Some observations suggest a decline in exacerbation rates in clinical trials over time. A more systematic understanding would help to improve the design and interpretation of COPD trials. METHODS: We performed a systematic review and meta-regression of the placebo groups in published randomized controlled trials reporting exacerbations as an outcome. A Bayesian negative binomial model was developed to accommodate results that are reported in different formats; results are reported with credible intervals (CI) and posterior tail probabilities ($p_B$). RESULTS: Of 1114 studies identified by our search, 55 were ultimately included. Exacerbation rates decreased by 6.7% (95% CI (4.4, 9.0); $p_B$ < 0.001) per year, or 50% (95% CI (36, 61)) per decade. Adjusting for available study and baseline characteristics such as forced expiratory volume in 1 s (FEV1) did not alter the observed trend considerably. Two subsets of studies, one using a true placebo group and the other allowing inhaled corticosteroids in the "placebo" group, also yielded consistent results. CONCLUSIONS: In conclusion, this meta-regression indicates that the rate of COPD exacerbations decreased over the past two decades to a clinically relevant extent independent of important prognostic factors. This suggests that care is needed in the design of new trials or when comparing results from older trials with more recent ones. Also a considerable effect of adjunct therapy on COPD exacerbations can be assumed., Comment: 11 pages, 4 figures

Phase I dose-finding studies aim at identifying the maximal tolerated dose (MTD). It is not uncommon that several dose-finding studies are conducted, although often with some variation in the administration mode or dose panel. For instance, sorafenib (BAY 43-900) was used as monotherapy in at least 29 phase I trials according to a recent search in clinicaltrials.gov. Since the toxicity may not be directly related to the specific indication, synthesizing the information from several studies might be worthwhile. However, this is rarely done in practice and only a fixed-effect meta-analysis framework was proposed to date. We developed a Bayesian random-effects meta-analysis methodology to pool several phase I trials and suggest the MTD. A curve free hierarchical model on the logistic scale with random effects, accounting for between-trial heterogeneity, is used to model the probability of toxicity across the investigated doses. An Ornstein-Uhlenbeck Gaussian process is adopted for the random effects structure. Prior distributions for the curve free model are based on a latent Gamma process. An extensive simulation study showed good performance of the proposed method also under model deviations. Sharing information between phase I studies can improve the precision of MTD selection, at least when the number of trials is reasonably large., Comment: 23 pages, 6 figures, 7 tables

Contribution to the discussion of "When should meta-analysis avoid making hidden normality assumptions?" by Dan Jackson and Ian R. White (2018; https://doi.org/10.1002/bimj.201800071)., Comment: 3 pages, 1 figure

Meta-analyses of clinical trials targeting rare events face particular challenges when the data lack adequate numbers of events for all treatment arms. Especially when the number of studies is low, standard meta-analysis methods can lead to serious distortions because of such data sparsity. To overcome this, we suggest the use of weakly informative priors (WIP) for the treatment effect parameter of a Bayesian meta-analysis model, which may also be seen as a form of penalization. As a data model, we use a binomial-normal hierarchical model (BNHM) which does not require continuity corrections in case of zero counts in one or both arms. We suggest a normal prior for the log odds ratio with mean 0 and standard deviation 2.82, which is motivated (1) as a symmetric prior centred around unity and constraining the odds ratio to within a range from 1/250 to 250 with 95 % probability, and (2) as consistent with empirically observed effect estimates from a set of $\mbox{$37\,773$}$ meta-analyses from the Cochrane Database of Systematic Reviews. In a simulation study with rare events and few studies, our BNHM with a WIP outperformed a Bayesian method without a WIP and a maximum likelihood estimator in terms of smaller bias and shorter interval estimates with similar coverage. Furthermore, the methods are illustrated by a systematic review in immunosuppression of rare safety events following paediatric transplantation. A publicly available $\textbf{R}$ package, $\texttt{MetaStan}$, is developed to automate the $\textbf{Stan}$ implementation of meta-analysis models using WIPs.

Standard random-effects meta-analysis methods perform poorly when applied to few studies only. Such settings however are commonly encountered in practice. It is unclear, whether or to what extent small-sample-size behaviour can be improved by more sophisticated modeling. We consider several likelihood-based inference methods. Confidence intervals are based on normal or Student-t approximations. We extract an empirical data set of 40 meta-analyses from recent reviews published by the German Institute for Quality and Efficiency in Health Care (IQWiG). Methods are then compared empirically as well as in a simulation study, considering odds-ratio and risk ratio effect sizes. Empirically, a majority of the identified meta-analyses include only 2 studies. In the simulation study, coverage probability is, in the presence of heterogeneity and few studies, below the nominal level for all frequentist methods based on normal approximation, in particular when sizes in meta-analyses are not balanced, but improve when confidence intervals are adjusted. Bayesian methods result in better coverage than the frequentist methods with normal approximation in all scenarios. Credible intervals are empirically and in the simulation study wider than unadjusted confidence intervals, but considerably narrower than adjusted ones. Confidence intervals based on the generalized linear mixed models are in general, slightly narrower than those from other frequentist methods. Certain methods turned out impractical due to frequent numerical problems. In the presence of between-study heterogeneity, especially with unbalanced study sizes, caution is needed in applying meta-analytical methods to few studies, as either coverage probabilities might be compromised, or intervals are inconclusively wide. Bayesian estimation with a sensibly chosen prior for between-trial heterogeneity may offer a promising compromise., Comment: 22 pages

Meta-analytic methods may be used to combine evidence from different sources of information. Quite commonly, the normal-normal hierarchical model (NNHM) including a random-effect to account for between-study heterogeneity is utilized for such analyses. The same modeling framework may also be used to not only derive a combined estimate, but also to borrow strength for a particular study from another by deriving a shrinkage estimate. For instance, a small-scale randomized controlled trial could be supported by a non-randomized study, e.g. a clinical registry. This would be particularly attractive in the context of rare diseases. We demonstrate that a meta-analysis still makes sense in this extreme two-study setup, as illustrated using a recent trial and a clinical registry in Creutzfeld-Jakob disease. Derivation of a shrinkage estimate within a Bayesian random-effects meta-analysis may substantially improve a given estimate even based on only a single additional estimate while accounting for potential effect heterogeneity between the studies. Alternatively, inference may equivalently be motivated via a model specification that does not require a common overall mean parameter but considers the treatment effect in one study, and the difference in effects between the studies. The proposed approach is quite generally applicable to combine different types of evidence originating e.g. from meta-analyses or individual studies. An application of this more general setup is provided in immunosuppression following liver transplantation in children., Comment: 23 pages, 3 figures, 4 tables

Extrapolation from a source to a target, e.g., from adults to children, is a promising approach to utilizing external information when data are sparse. In the context of meta-analysis, one is commonly faced with a small number of studies, while potentially relevant additional information may also be available. Here we describe a simple extrapolation strategy using heavy-tailed mixture priors for effect estimation in meta-analysis, which effectively results in a model-averaging technique. The described method is robust in the sense that a potential prior-data conflict, i.e., a discrepancy between source and target data, is explicitly anticipated. The aim of this paper to develop a solution for this particular application, to showcase the ease of implementation by providing R code, and to demonstrate the robustness of the general approach in simulations., Comment: 18 pages, 7 figures, 5 tables

The random-effects or normal-normal hierarchical model is commonly utilized in a wide range of meta-analysis applications. A Bayesian approach to inference is very attractive in this context, especially when a meta-analysis is based only on few studies. The bayesmeta R package provides readily accessible tools to perform Bayesian meta-analyses and generate plots and summaries, without having to worry about computational details. It allows for flexible prior specification and instant access to the resulting posterior distributions, including prediction and shrinkage estimation, and facilitating for example quick sensitivity checks. The present paper introduces the underlying theory and showcases its usage., Comment: 51 pages, 8 figures

BACKGROUND: Some but not all prior studies have shown that women receiving a primary prophylactic implantable cardioverter defibrillator (ICD) have a lower risk of death and appropriate shocks than men. PURPOSE: To evaluate the effect of gender on the risk of appropriate shock, all-cause mortality and inappropriate shock in contemporary studies of patients receiving a primary prophylactic ICD. DATA SOURCE: PubMed, LIVIVO, Cochrane CENTRAL between 2010 and 2016. STUDY SELECTION: Studies providing at least 1 gender-specific risk estimate for the outcomes of interest. DATA EXTRACTION: Abstracts were screened independently for potentially eligible studies for inclusion. Thereby each abstract was reviewed by at least two authors. DATA SYNTHESIS: Out of 680 abstracts retained by our search strategy, 20 studies including 46'657 patients had gender-specific information on at least one of the relevant endpoints. Mean age across the individual studies varied between 58 and 69 years. The proportion of women enrolled ranged from 10% to 30%. Across 6 available studies, women had a significantly lower risk of first appropriate shock compared with men (pooled multivariable adjusted hazard ratio 0.62 (95% CI [0.44; 0.88]). Across 14 studies reporting multivariable adjusted gender-specific hazard ratio estimates for all-cause mortality, women had a lower risk of death than men (pooled hazard ratio 0.75 (95% CI [0.66; 0.86]). There was no statistically significant difference for the incidence of first inappropriate shocks (3 studies, pooled hazard ratio 0.99 (95% CI [0.56; 1.73]). CONCLUSION: In this large contemporary meta-analysis, women had a significantly lower risk of appropriate shocks and death than men, but a similar risk of inappropriate shocks. These data may help to select patients who benefit from primary prophylactic ICD implantation., Comment: 15 pages, 4 figures, 4 tables

Clinical research and drug development in orphan diseases is challenging, since large-scale randomized studies are difficult to conduct. Formally synthesizing the evidence is therefore of great value, yet this is rarely done in the drug approval process. Phase III designs that make better use of phase II data can facilitate drug development in orphan diseases. A Bayesian meta-analytic approach is used to inform the phase III study with phase II data. It is particularly attractive, since uncertainty of between-trial heterogeneity can be dealt with probabilistically, which is critical if the number of studies is small. Furthermore, it allows quantifying and discounting the phase II data through the predictive distribution relevant for phase III. A phase III design is proposed which uses the phase II data and considers approval based on a phase III interim analysis. The design is illustrated with a non-inferiority case study from an FDA approval in herpetic keratitis (an orphan disease). Design operating characteristics are compared to those of a traditional design, which ignores the phase II data. An analysis of the phase II data reveals good but insufficient evidence for non-inferiority, highlighting the need for a phase III study. For the phase III study supported by phase II data, the interim analysis is based on half of the patients. For this design, the meta-analytic interim results are conclusive and would justify approval. In contrast, based on the phase III data only, interim results are inconclusive and would require further evidence. To accelerate drug development for orphan diseases, innovative study designs and appropriate methodology are needed. Taking advantage of randomized phase II data when analyzing phase III studies looks promising because the evidence from phase II supports informed decision making. The implementation of the Bayesian design is straightforward., Comment: 25 pages, 3 tables, 2 figures

Random-effects meta-analyses are used to combine evidence of treatment effects from multiple studies. Since treatment effects may vary across trials due to differences in study characteristics, heterogeneity in treatment effects between studies must be accounted for to achieve valid inference. The standard model for random-effects meta-analysis assumes approximately normal effect estimates and a normal random-effects model. However, standard methods based on this model ignore the uncertainty in estimating the between-trial heterogeneity. In the special setting of only two studies and in the presence of heterogeneity we investigate here alternatives such as the Hartung-Knapp-Sidik-Jonkman method (HKSJ), the modified Knapp-Hartung method (mKH, a variation of the HKSJ method) and Bayesian random-effects meta-analyses with priors covering plausible heterogeneity values. The properties of these methods are assessed by applying them to five examples from various rare diseases and by a simulation study. Whereas the standard method based on normal quantiles has poor coverage, the HKSJ and mKH generally lead to very long, and therefore inconclusive, confidence intervals. The Bayesian intervals on the whole show satisfying properties and offer a reasonable compromise between these two extremes., Comment: 12 pages, 4 figures

BACKGROUND: Randomized controlled trials (RCTs) are the gold standard design of clinical research to assess interventions. However, RCTs cannot always be applied for practical or ethical reasons. To investigate the current practices in rare diseases, we review evaluations of therapeutic interventions in paediatric multiple sclerosis (MS) and Creutzfeldt-Jakob disease (CJD). In particular, we shed light on the endpoints used, the study designs implemented and the statistical methodologies applied. METHODS: We conducted literature searches to identify relevant primary studies. Data on study design, objectives, endpoints, patient characteristics, randomization and masking, type of intervention, control, withdrawals and statistical methodology were extracted from the selected studies. The risk of bias and the quality of the studies were assessed. RESULTS: Twelve (seven) primary studies on paediatric MS (CJD) were included in the qualitative synthesis. No double-blind, randomized placebo-controlled trial for evaluating interventions in paediatric MS has been published yet. Evidence from one open-label RCT is available. The observational studies are before-after studies or controlled studies. Three of the seven selected studies on CJD are RCTs, of which two received the maximum mark on the Oxford Quality Scale. Four trials are controlled observational studies. CONCLUSIONS: Evidence from double-blind RCTs on the efficacy of treatments appears to be variable between rare diseases. With regard to paediatric conditions it remains to be seen what impact regulators will have through e.g., paediatric investigation plans. Overall, there is space for improvement by using innovative trial designs and data analysis techniques., Comment: 11 pages, 2 figures, 3 tables

Mixture distributions arise in many application areas, for example as marginal distributions or convolutions of distributions. We present a method of constructing an easily tractable discrete mixture distribution as an approximation to a mixture distribution with a large to infinite number, discrete or continuous, of components. The proposed DIRECT (Divergence Restricting Conditional Tesselation) algorithm is set up such that a pre-specified precision, defined in terms of Kullback-Leibler divergence between true distribution and approximation, is guaranteed. Application of the algorithm is demonstrated in two examples., Comment: 16 pages, 4 figures

Meta-analyses in orphan diseases and small populations generally face particular problems including small numbers of studies, small study sizes, and heterogeneity of results. However, the heterogeneity is difficult to estimate if only very few studies are included. Motivated by a systematic review in immunosuppression following liver transplantation in children we investigate the properties of a range of commonly used frequentist and Bayesian procedures in extensive simulation studies. Furthermore, the consequences for interval estimation of the common treatment effect in random effects meta-analysis are assessed. The Bayesian credibility intervals using weakly informative priors for the between-trial heterogeneity exhibited coverage probabilities in excess of the nominal level for a range of scenarios considered. However, they tended to be shorter than those obtained by the Knapp-Hartung method, which were also conservative. In contrast, methods based on normal quantiles exhibited coverages well below the nominal levels in many scenarios. With very few studies, the performance of the Bayesian credibility intervals is of course sensitive to the specification of the prior for the between trial heterogeneity. In conclusion, the use of weakly informative priors as exemplified by half-normal priors (with scale 0.5 or 1.0) for log odds ratios is recommended for applications in rare diseases., Comment: 23 pages, 6 figures, 3 tables

BACKGROUND: Random-effects meta-analysis is commonly performed by first deriving an estimate of the between-study variation, the heterogeneity, and subsequently using this as the basis for combining results, i.e., for estimating the effect, the figure of primary interest. The heterogeneity variance estimate however is commonly associated with substantial uncertainty, especially in contexts where there are only few studies available, such as in small populations and rare diseases. METHODS: Confidence intervals and tests for the effect may be constructed via a simple normal approximation, or via a Student-t distribution, using the Hartung-Knapp-Sidik-Jonkman (HKSJ) approach, which additionally uses a refined estimator of variance of the effect estimator. The modified Knapp-Hartung method (mKH) applies an ad hoc correction and has been proposed to prevent counterintuitive effects and to yield more conservative inference. We performed a simulation study to investigate the behaviour of the standard HKSJ and modified mKH procedures in a range of circumstances, with a focus on the common case of meta-analysis based on only a few studies. RESULTS: The standard HKSJ procedure works well when the treatment effect estimates to be combined are of comparable precision, but nominal error levels are exceeded when standard errors vary considerably between studies (e.g. due to variations in study size). Application of the modification on the other hand yields more conservative results with error rates closer to the nominal level. Differences are most pronounced in the common case of few studies of varying size or precision. CONCLUSIONS: Use of the modified mKH procedure is recommended, especially when only a few studies contribute to the meta-analysis and the involved studies' precisions (standard errors) vary., Comment: 7 pages, 3 figures

AIM: To investigate the predictability of interleukin-28B single nucleotide polymorphism rs12979860 with respect to sustained virological response (SVR) in chronically hepatitis C virus (HCV) genotype-1 patients treated with a protease-inhibitor and pegylated interferon-$\alpha$ (Peg-INF-$\alpha$) based triple-therapy. METHODS: We searched PubMed, the Cochrane Library and Web of Knowledge for studies regarding the interleukin 28B (IL-28B)-genotype and protease-inhibitor based triple-therapy. Ten studies with 2707 patients were included into this meta-analysis. We used regression methods in order to investigate determinants of SVR. RESULTS: IL-28B-CC-genotype patients achieved higher SVR rates (odds 5.34, CI: 3.81-7.49) than IL-28B-non-CC-genotype patients (1.88, CI: 1.43-2.48) receiving triple-therapy. The line of therapy (treatment-na\"ive or -experienced for Peg-INF-$\alpha$) did not affect the predictive value of IL-28B (p=0.1). IL-28B-CC-genotype patients treated with protease inhibitor-based triple-therapy consisting of Boceprevir, Simeprevir, Telaprevir or Vaniprevir showed odds of 1.86, 9.77, 4.51 and 0.89, respectively. The odds for CC genotype patients treated with Faldaprevir cannot be quantified, as only a single study with a 100% SVR rate was available. CONCLUSION: IL-28B-SNP predicts the outcome for chronic HCV genotype-1 patients receiving protease inhibitor-based triple-therapy. The predictive value varies between the different protease inhibitors., Comment: 21 pages, 3 figures, 1 table

The Advanced LIGO and Advanced Virgo gravitational wave (GW) detectors will begin operation in the coming years, with compact binary coalescence events a likely source for the first detections. The gravitational waveforms emitted directly encode information about the sources, including the masses and spins of the compact objects. Recovering the physical parameters of the sources from the GW observations is a key analysis task. This work describes the LALInference software library for Bayesian parameter estimation of compact binary signals, which builds on several previous methods to provide a well-tested toolkit which has already been used for several studies. We show that our implementation is able to correctly recover the parameters of compact binary signals from simulated data from the advanced GW detectors. We demonstrate this with a detailed comparison on three compact binary systems: a binary neutron star, a neutron star black hole binary and a binary black hole, where we show a cross-comparison of results obtained using three independent sampling algorithms. These systems were analysed with non-spinning, aligned spin and generic spin configurations respectively, showing that consistent results can be obtained even with the full 15-dimensional parameter space of the generic spin configurations. We also demonstrate statistically that the Bayesian credible intervals we recover correspond to frequentist confidence intervals under correct prior assumptions by analysing a set of 100 signals drawn from the prior. We discuss the computational cost of these algorithms, and describe the general and problem-specific sampling techniques we have used to improve the efficiency of sampling the compact binary coalescence parameter space.

Interleukin-2 receptor antagonists (IL-2RA) are frequently used as induction therapy in liver transplant recipients to decrease the risk of acute rejection while allowing the reduction of concomitant immunosuppression. The exact association with the use of IL-2RA however is uncertain. We performed a systematic literature search for relevant studies. Random effects models were used to assess the incidence of acute rejection, steroid-resistant rejection, graft loss, patient death, and adverse drug reaction, with or without IL-2RA. Six studies (2 randomized and 4 nonrandomized) met the elegibility criteria. Acute rejection at 6 months or later favored the use of IL-2RA significantly (relative risk (RR) 0.38; 95% confidence interval (CI) 0.22-0.66, p = 0.0005). Although not statistically significant, IL-2RA showed a substantial reduction of the risk of steroid-resistant rejection (RR 0.32; CI 0.19-1.03, p = 0.0594). Graft loss and patient death showed a reductive tendency through the use of IL-2RA. The use of IL-2RA is safe and is associated with a statistically significantly lower incidence of acute rejection after transplantation and substantial reduction of steroid-resistant rejection, graft loss and patient death., Comment: 18 pages, 3 tables, 3 figures

The problem of reconstructing the sky position of compact binary coalescences detected via gravitational waves is a central one for future observations with the ground-based network of gravitational-wave laser interferometers, such as Advanced LIGO and Advanced Virgo. Different techniques for sky localisation have been independently developed. They can be divided in two broad categories: fully coherent Bayesian techniques, which are high-latency and aimed at in-depth studies of all the parameters of a source, including sky position, and "triangulation-based" techniques, which exploit the data products from the search stage of the analysis to provide an almost real-time approximation of the posterior probability density function of the sky location of a detection candidate. These techniques have previously been applied to data collected during the last science runs of gravitational-wave detectors operating in the so-called initial configuration. Here, we develop and analyse methods for assessing the self-consistency of parameter estimation methods and carrying out fair comparisons between different algorithms, addressing issues of efficiency and optimality. These methods are general, and can be applied to parameter estimation problems other than sky localisation. We apply these methods to two existing sky localisation techniques representing the two above-mentioned categories, using a set of simulated inspiral-only signals from compact binary systems with total mass $\le 20\,M_\odot$ and non-spinning components. We compare the relative advantages and costs of the two techniques and show that sky location uncertainties are on average a factor $\approx 20$ smaller for fully coherent techniques than for the specific variant of the "triangulation-based" technique used during the last science runs, at the expense of a factor $\approx 1000$ longer processing time.

The analysis of count data is commonly done using Poisson models. Negative binomial models are a straightforward and readily motivated generalization for the case of overdispersed data, i.e., when the observed variance is greater than expected under a Poissonian model. Rate and overdispersion parameters then need to be considered jointly, which in general is not trivial. Here we are concerned with evidence synthesis in the case where the reporting of data is rather heterogeneous, i.e., events are reported either in terms of mean event counts, the proportion of event-free patients, or rate estimates and standard errors. Either figure carries some information about the relevant parameters, and it is the joint modeling that allows for coherent inference on the parameters of interest. The methods are motivated and illustrated by a systematic review in chronic obstructive pulmonary disease., Comment: 17 pages, 3 figures, 2 tables

Background: Recent systematic reviews of randomised controlled trials (RCTs) in relapsing multiple sclerosis (RMS) revealed a decrease in placebo annualized relapse rates (ARR) over the past two decades. Furthermore, regression to the mean effects were observed in ARR and MRI lesion counts. It is unclear whether disease progression measured by the expanded disability status scale (EDSS) exhibits similar features. Methods: A systematic review of RCTs in RMS was conducted extracting data on EDSS and baseline characteristics. The logarithmic odds of disease progression were modelled to investigate time trends. Random-effects models were used to account for between-study variability; all investigated models included trial duration as a predictor to correct for unequal study durations. Meta-regressions were conducted to assess the prognostic value of a number of baseline variables. Results: The systematic literature search identified 39 studies, including a total of 19,714 patients. The proportion of patients in placebo controls experiencing a disease progression decreased over the years (p<0.001). Meta regression identified associated covariates including the size of the study and its duration that in part explained the time trend. Progression probabilities tended to be lower in the second year compared to the first year with a reduction of 24% in progression probability from year 1 to year 2 (p=0.014). Conclusion: EDSS disease progression exhibits similar behaviour over time as the ARR and point to changes in trial characteristics over the years, questioning comparisons between historical and recent trials., Comment: 17 pages, 2 figures

Background: Recent studies have shown a decrease in annualised relapse rates (ARRs) in placebo groups of randomised controlled trials (RCTs) in relapsing multiple sclerosis (RMS). Methods: We conducted a systematic literature search of RCTs in RMS. Data on eligibility criteria and baseline characteristics were extracted and tested for significant trends over time. A meta-regression was conducted to estimate their contribution to the decrease of trial ARRs over time. Results: We identified 56 studies. Patient age at baseline (p < 0.001), mean duration of multiple sclerosis (MS) at baseline (p = 0.048), size of treatment groups (p = 0.003), Oxford Quality Scale scores (p = 0.021), and the number of eligibility criteria (p<0.001) increased significantly, whereas pre-trial ARR (p = 0.001), the time span over which pre-trial ARR was calculated (p < 0.001), and the duration of placebo-controlled follow-up (p = 0.006) decreased significantly over time. In meta-regression of trial placebo ARR, the temporal trend was found to be insignificant, with major factors explaining the variation: pre-trial ARR, the number of years used to calculate pre-trial ARR and study duration. Conclusion: The observed decline in trial ARRs may result from decreasing pre-trial ARRs and a shorter time period over which pre-trial ARRs were calculated. Increasing patient age and duration of illness may also contribute., Comment: 20 pages, 4 figures (main article) + 13 pages (web appendix)

Extreme mass ratio inspirals (EMRIs) are thought to be one of the most exciting gravitational wave sources to be detected with LISA. Due to their complicated nature and weak amplitudes the detection and parameter estimation of such sources is a challenging task. In this paper we present a statistical methodology based on Bayesian inference in which the estimation of parameters is carried out by advanced Markov chain Monte Carlo (MCMC) algorithms such as parallel tempering MCMC. We analysed high and medium mass EMRI systems that fall well inside the low frequency range of LISA. In the context of the Mock LISA Data Challenges, our investigation and results are also the first instance in which a fully Markovian algorithm is applied for EMRI searches. Results show that our algorithm worked well in recovering EMRI signals from different (simulated) LISA data sets having single and multiple EMRI sources and holds great promise for posterior computation under more realistic conditions. The search and estimation methods presented in this paper are general in their nature, and can be applied in any other scenario such as AdLIGO, AdVIRGO and Einstein Telescope with their respective response functions., Comment: 18 pages, 8 figures

The search for gravitational-wave signals in detector data is often hampered by the fact that many data analysis methods are based on the theory of stationary Gaussian noise, while actual measurement data frequently exhibit clear departures from these assumptions. Deriving methods from models more closely reflecting the data's properties promises to yield more sensitive procedures. The commonly used matched filter is such a detection method that may be derived via a Gaussian model. In this paper we propose a generalized matched-filtering technique based on a Student-t distribution that is able to account for heavier-tailed noise and is robust against outliers in the data. On the technical side, it generalizes the matched filter's least-squares method to an iterative, or adaptive, variation. In a simplified Monte Carlo study we show that when applied to simulated signals buried in actual interferometer noise it leads to a higher detection rate than the usual ("Gaussian") matched filter., Comment: 17 pages, 6 figures

While gravitational waves have not yet been measured directly, data analysis from detection experiments commonly includes an upper limit statement. Such upper limits may be derived via a frequentist or Bayesian approach; the theoretical implications are very different, and on the technical side, one notable difference is that one case requires maximization of the likelihood function over parameter space, while the other requires integration. Using a simple example (detection of a sinusoidal signal in white Gaussian noise), we investigate the differences in performance and interpretation, and the effect of the "trials factor", or "look-elsewhere effect"., Comment: http://cdsweb.cern.ch/record/1306523/files/CERN-2011-006.pdf, http://indico.cern.ch/materialDisplay.py?contribId=52&materialId=paper&confId=107747

In signal detection problems, one is usually faced with the task of searching a parameter space for peaks in the likelihood function which indicate the presence of a signal. Random searches have proven to be very efficient as well as easy to implement, compared e.g. to searches along regular grids in parameter space. Knowledge of the parameterised shape of the signal searched for adds structure to the parameter space, i.e., there are usually regions requiring to be densely searched while in other regions a coarser search is sufficient. On the other hand, prior information identifies the regions in which a search will actually be promising or may likely be in vain. Defining specific figures of merit allows one to combine both template metric and prior distribution and devise optimal sampling schemes over the parameter space. We show an example related to the gravitational wave signal from a binary inspiral event. Here the template metric and prior information are particularly contradictory, since signals from low-mass systems tolerate the least mismatch in parameter space while high-mass systems are far more likely, as they imply a greater signal-to-noise ratio (SNR) and hence are detectable to greater distances. The derived sampling strategy is implemented in a Markov chain Monte Carlo (MCMC) algorithm where it improves convergence., Comment: Proceedings of the 8th Edoardo Amaldi Conference on Gravitational Waves. 7 pages, 4 figures

Presented in this paper is a technique that we propose for extracting the physical parameters of a rotating stellar core collapse from the observation of the associated gravitational wave signal from the collapse and core bounce. Data from interferometric gravitational wave detectors can be used to provide information on the mass of the progenitor model, precollapse rotation and the nuclear equation of state. We use waveform libraries provided by the latest numerical simulations of rotating stellar core collapse models in general relativity, and from them create an orthogonal set of eigenvectors using principal component analysis. Bayesian inference techniques are then used to reconstruct the associated gravitational wave signal that is assumed to be detected by an interferometric detector. Posterior probability distribution functions are derived for the amplitudes of the principal component analysis eigenvectors, and the pulse arrival time. We show how the reconstructed signal and the principal component analysis eigenvector amplitude estimates may provide information on the physical parameters associated with the core collapse event., Comment: 17 pages, 9 figures

The 2008 NRDA conference introduced the Numerical INJection Analysis project (NINJA), a new collaborative effort between the numerical relativity community and the data analysis community. NINJA focuses on modeling and searching for gravitational wave signatures from the coalescence of binary system of compact objects. We review the scope of this collaboration and the components of the first NINJA project, where numerical relativity groups shared waveforms and data analysis teams applied various techniques to detect them when embedded in colored Gaussian noise., Comment: Proceedings of Numerical Relativity and Data Analysis NRDA 2008 (Syracuse NY, August 2008) - 14 pages, 1 figure