[R-meta] What asymmetry test to use?

[Martin Lobo]

Dear Guido, thank you so much for your answer.

I already downloaded the article to have it among my methodological appointments.

On the other hand, when I look at the funnel plot, if there seems to be a certain asymmetry.

Another question that always arises is whether the publication bias should be carried out for each sub-analysis or for the global analysis. That is, I analyzed the subgroups of drugs vs. placebo and drugs vs. other drugs. You should evaluate the bias of all included studies or that of each subgroup separately. The results I show are from the global analysis. I share a link to see the funnel plot.

<https://1drv.ms/i/s!Ao1t9qGYkJ0rpbYRQtPrNRyOfZVb9Q?e=fSf1yD>
[https://sat02pap003files.storage.live.com/y4mcubhS2neYbUqJenfbbFJjWLPITb8eyxCNO6IIYkB3iQWIHavTNo7A9wvUXCkFxxSrGH2l0-dzxbyMRTZzpM7DzLFYAlEwDOQoCtDUCA4_WSiq0KNG29_jkdguja2QNbMpe06jxOzzTOmKqrq1oVTZv5XBYUIrjkkKG9Gg3G5De0?width=200&height=150&cropmode=center]
[https://res-h3.public.cdn.office.net/assets/mail/file-icon/png/cloud_blue_16x16.png]Funnel Inflamacion 2.jpg


thanks for your time

Best regards




Lorenzo Mart�n Lobo MTSAC, FACC, FESC
Especialista Jerarquizado en Cardiolog�a
Jefe de Dpto Enf. Cardiovasculares y Cardiometabolismo Hospital Militar Campo de Mayo.
Jefe de Cardiolog�a Hospital Militar Campo de Mayo
Ex Jefe de Unidad Coronaria Hospital Militar Campo de Mayo
Miembro Titular de la Sociedad Argentina de Cardiolog�a
Fellow American College of Cardiology
Fellow European Society of Cardiology
Ex Miembro del Area de Investigaci�n de la SAC
Ex Director del Consejo de Aterosclerosis y Trombosis de la SAC
Miembro Asesor del Consejo de Aterosclerosis y Trombosis de la SAC
Ex Director del Consejo de Epidemiolog�a y Prevenci�n Cardiovascular de la SAC
Miembro Asesor del Consejo de Epidemiolog�a y Prevenci�n Cardiovascular de la SAC
Experto en Lipidos de la Sociedad Argentina de Lipidos.
Miembro de la Sociedad Argentina de Lipidos.
Instructor de ACLS de la American Heart Association

________________________________
De: Dr. Guido Schwarzer <guido.schwarzer using uniklinik-freiburg.de>
Enviado: viernes, 3 de mayo de 2024 04:50
Para: R Special Interest Group for Meta-Analysis <r-sig-meta-analysis using r-project.org>
Cc: Martin Lobo <mlobo4370 using hotmail.com>
Asunto: Re: What asymmetry test to use?

Martin,

We recently published the results of a simulation study evaluating the LFK index test (https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fonlinelibrary.wiley.com%2Fdoi%2F10.1002%2Fjrsm.1714&data=05%7C02%7C%7C99c20da422a54033186408dc6b45a3de%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C638503194052868012%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C0%7C%7C%7C&sdata=wrWqPHPdH8fXAMufPIQNChsxkllQzZyc9Xeeg9%2BQ07Y%3D&reserved=0<https://onlinelibrary.wiley.com/doi/10.1002/jrsm.1714>). We compared this method with the classic Egger and Thompson-Sharp test (aka Egger test with mixed effects model). Our simulations were for meta-analyses with the mean difference but I guess they are useful for the SMD.

The Thompson-Sharp test was conservative under homogeneity but hold the significance level under heterogeneity. The Egger test was either too liberal or conservative under heterogeneity.

Accordingly, I would lean to rely on the results of the Thompson-Sharp test as you observe high heterogeneity.

This said, typically a significance level of 10 percent is recommended for tests of funnel plot asymmetry (Sterne et al., 2011, BMJ) and the p-value of the Thompson-Sharp test is just above this value.

Best,
Guido

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