Objective The current practice in meta-analysis of the effects of psychopharmacological interventions ignors the administered dose or restricts the analysis in a dose range. This may introduce unnecessary uncertainty and heterogeneity. Methods have been developed to integrate the dose–effect models in meta-analysis. Methods We describe the two-stage and the one-stage models to conduct a dose–effect meta-analysis using common or random effects methods. We illustrate the methods on a dataset of selective serotonin reuptake inhibitor antidepressants. The dataset comprises 60 randomised controlled trials. The dose–effect is measured on an odds ratio scale and is modelled using restricted cubic splines to detect departure from linearity. Results The estimated summary curve indicates that the probability of response increases up to 30 mg/day of fluoxetine-equivalent which results in reaching 50% probability to respond. Beyond 40 mg/day, no further increase in the response is observed. The one-stage model includes all studies, resulting in slightly less uncertainty than the two-stage model where only part of the data is analysed. Conclusions The dose–effect meta-analysis enables clinicians to understand how the effect of a drug changes as a function of its dose. Such analysis should be conducted in practice using the one-stage model that incorporates evidence from all available studies.

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使用随机数据进行精神药理学干预的剂量效应荟萃分析

目的 目前对精神药理学干预效果的荟萃分析实践忽略了给药剂量或将分析限制在剂量范围内。这可能会引入不必要的不​​确定性和异质性。已经开发出将剂量效应模型整合到荟萃分析中的方法。方法我们描述了两阶段和一阶段模型，以使用常见或随机效应方法进行剂量效应荟萃分析。我们在选择性血清素再摄取抑制剂抗抑郁药数据集上说明了该方法。该数据集包含 60 项随机对照试验。剂量效应是在优势比尺度上测量的，并使用受限三次样条进行建模以检测线性偏离。结果 估计汇总曲线表明，氟西汀当量剂量达到 30 毫克/天时，反应概率增加至 50%，从而达到 50% 的反应概率。超过 40 毫克/天，没有观察到反应进一步增加。一阶段模型包括所有研究，其不确定性比仅分析部分数据的两阶段模型稍低。结论剂量效应荟萃分析使临床医生能够了解药物的效果如何随剂量变化。此类分析应在实践中使用包含所有现有研究证据的一阶段模型进行。