Threshold analysis has recently been proposed to be used in combination with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) in order to assess the sensitivity to plausible bias of treatment recommendations derived from Bayesian network meta‐analysis (NMA). Here, it was aimed to apply the combination of threshold analysis and GRADE to judge quantitative and qualitative information on risk of bias in antidepressant treatment recommendations. The analysis was based on the data set provided by Cipriani et al. (The Lancet 2018) comparing 21 antidepressants in adult major depressive disorder (MDD). Primary outcomes were efficacy (response rate) and acceptability (dropout rate) adjusted for the covariate depression severity. The combined approach suggested sensitivity to plausible bias to be largest for antidepressant recommendations top ranked by Cipriani et al., that is, amitriptyline, duloxetine, paroxetine, and venlafaxine in terms of efficacy and agomelatine, escitalopram, paroxetine, and venlafaxine in terms of acceptability. Covariate ranges within which recommendations were most sensitive to plausible bias were very severe depression in terms of efficacy (smallest threshold, ie, the largest sensitivity, around 39 Hamilton Depression Rating Scale [HDRS]) and moderate depression in terms of acceptability (smallest thresholds around 16 and 35 HDRS). This indicates that treatment recommendations within these ranges may likely change if plausible bias adjustments take place. The present findings may support decision makers in judging the sensitivity to plausible bias of current antidepressant treatment recommendations to accurately guide treatment decisions in MDD depending on depression severity.

中文翻译：

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结合阈值分析和 GRADE 来评估针对抑郁严重程度调整的抗抑郁治疗建议对偏倚的敏感性。

最近有人提议将阈值分析与建议评估、制定和评估分级 (GRADE) 结合使用，以评估对源自贝叶斯网络荟萃分析 (NMA) 的治疗建议的合理偏差的敏感性。在这里，旨在应用阈值分析和 GRADE 的组合来判断抗抑郁治疗建议中偏倚风险的定量和定性信息。该分析基于 Cipriani 等人提供的数据集。(The Lancet 2018) 比较了成人重度抑郁症 (MDD) 中的 21 种抗抑郁药。主要结果是根据协变量抑郁严重程度调整的疗效（反应率）和可接受性（退出率）。联合方法表明，对于 Cipriani 等人排名靠前的抗抑郁药推荐，即阿米替林、度洛西汀、帕罗西汀和文拉法辛的疗效和阿戈美拉汀、依他普仑、帕罗西汀和文拉法辛的可接受性，对合理偏差的敏感性最大. 建议对似是而非的偏见最敏感的协变量范围是疗效方面的非常严重的抑郁症（最小阈值，即最大的敏感性，大约 39 汉密尔顿抑郁评定量表 [HDRS]）和可接受性方面的中度抑郁症（最小阈值大约16 和 35 HDR）。这表明如果进行合理的偏差调整，这些范围内的治疗建议可能会发生变化。