In Reply to Angiotensin and Renal Disease: The Jury Still Out

Article Outline

• Reference
• Copyright

We thank Drs Blecker and Shah for their analysis of our report. We agree and have outlined within the report that both clinical and statistical heterogeneity are a limitation of our study. Significant heterogeneity (assessed by means of Cochrane Q test) often was observed when a fixed-effect model was used, in which case we reported the more conservative estimate of treatment effect by using a random-effects model.¹ We agree that the observed statistical heterogeneity in part reflected clinical differences between the included studies. There were differences between study sample sizes, protocols, and treatment effects that resulted in large SDs in clinical outcome measures, particularly within the smallest of trials. However, despite these limitations, both the review of individual trials and the pooled analysis strongly suggested that combination therapy is safe in a diverse population of patients. Ultimately, our conclusion does not differ significantly from that expressed by Blecker and Shah. Larger well-designed randomized trials are required to more precisely define the efficacy and relative benefits of combination therapy in different patient populations.

Back to Article Outline

Reference 

1. Deeks JJAD, Bradburn MJ. Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In:  Egger MD-SG,  Altman DG editor. Systematic Reviews in Health Care. (ed 2). London, UK: BMJ; 2001;p. 285–312
   • View In Article