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melanoma (ML), nivolumab plus ipilimumab , meta-analysis of study results

Outcome Relative effect 95%CI LoD Trt. better when I2 k (RCT/OBS) Bayesian probability Overall ROB Publication bias Degree of certainty Endpoint importance Published MA

efficacy endpoints 00

deaths (OS) 0.62 [0.53, 0.73]< 10%3 studies (3/-)100.0 %lownot evaluable highcrucial-
deaths (OS) (extension) 0.66 [0.42, 1.04]< 189%2 studies (2/-)96.4 %lownot evaluable highimportant-
PFS (extension) 0.50 [0.31, 0.83]< 191%3 studies (3/-)99.7 %lownot evaluable highimportant-
progression or deaths (PFS) 0.51 [0.32, 0.80]< 183%3 studies (3/-)99.8 %lownot evaluable highimportant-
RFS/DFS 0.30 [0.17, 0.52]< 123%2 studies (2/-)100.0 %lownot evaluable highimportant-
objective responses (ORR) 5.33 [1.47, 19.35]> 195%3 studies (3/-)99.4 %lownot evaluable highnon important-
objective responses (ORR) (extension) 6.41 [4.99, 8.23]> 10%3 studies (3/-)100.0 %lownot evaluable highnon important-

safety endpoints 00

AE leading to death (grade 5) 0.97 [0.06, 15.73]< 10%2 studies (2/-)50.8 %lownot evaluable highnon important-
AE leading to treatment discontinuation (any grade) 18.39 [5.56, 60.77]< 147%2 studies (2/-)0.0 %lownot evaluable highnon important-
AE leading to treatment discontinuation (grade 3-4) 19.58 [4.47, 85.82]< 145%2 studies (2/-)0.0 %lownot evaluable highnon important-
SAE (any grade) 4.08 [2.31, 7.19]< 10%2 studies (2/-)0.0 %lownot evaluable highnon important-
SAE (grade 3-4) 5.29 [2.15, 13.00]< 153%2 studies (2/-)0.0 %lownot evaluable highnon important-
STRAE (any grade) 12.43 [2.18, 70.81]< 176%2 studies (2/-)0.2 %lownot evaluable highnon important-
STRAE (grade 3-4) 14.97 [0.88, 254.99]< 174%2 studies (2/-)3.2 %lownot evaluable highnon important-
TRAE (any grade) 3.82 [1.82, 8.04]< 162%5 studies (5/-)0.0 %lownot evaluable highnon important-
TRAE (grade 3-4) 5.53 [3.48, 8.78]< 168%5 studies (5/-)0.0 %lownot evaluable highnon important-
TRAE leading to death (grade 5) 0.98 [0.14, 7.02]< 10%4 studies (4/-)50.6 %lownot evaluable highnon important-
TRAE leading to discontinuation (any grade) 5.94 [3.54, 9.94]< 165%5 studies (5/-)0.0 %lowserious highnon important-
TRAE leading to discontinuation (grade 3-4) 5.35 [2.83, 10.13]< 171%5 studies (5/-)0.0 %lowserious highnon important-

TRAE (grade 3-4) endpoints 00

Abdominal pain TRAE (grade 3-4) 0.67 [0.16, 2.88]< 10%5 studies (5/-)70.3 %lownot evaluable highnon important-
Acute kidney injury TRAE (grade 3-4) 1.96 [0.18, 21.95]< 10%2 studies (2/-)29.4 %lownot evaluable highnon important-
Adrenal insufficiency TRAE (grade 3-4) 2.06 [0.70, 6.03]< 16%5 studies (5/-)9.5 %lownot evaluable highnon important-
Alopecia TRAE (grade 3-4) 0.97 [0.06, 15.73]< 10%2 studies (2/-)50.8 %lownot evaluable highnon important-
Anaemia TRAE (grade 3-4) 1.96 [0.18, 21.95]< 10%2 studies (2/-)29.4 %lownot evaluable highnon important-
Arthralgia TRAE (grade 3-4) 1.15 [0.28, 4.66]< 10%5 studies (5/-)42.4 %lownot evaluable highnon important-
Asthenia TRAE (grade 3-4) 0.63 [0.12, 3.30]< 10%3 studies (3/-)70.6 %lownot evaluable highnon important-
Blood and lymphatic system disorders TRAE (grade 3-4) 1.44 [0.11, 19.02]< 10%2 studies (2/-)39.2 %lownot evaluable highnon important-
Blood creatinine increased TRAE (grade 3-4) 0.93 [0.02, 47.58]< 10%1 study (1/-)51.5 %NAnot evaluable non important-
Chills TRAE (grade 3-4) 0.77 [0.08, 7.49]< 10%3 studies (3/-)58.8 %lownot evaluable highnon important-
Colitis TRAE (grade 3-4) 3.27 [1.09, 9.81]< 166%5 studies (5/-)1.7 %lownot evaluable highnon important-
Constipation TRAE (grade 3-4) 0.98 [0.03, 29.71]< 10%1 study (1/-)50.5 %NAnot evaluable non important-
Cough TRAE (grade 3-4) 0.61 [0.10, 3.79]< 10%4 studies (4/-)70.2 %lownot evaluable highnon important-
Decreased appetite TRAE (grade 3-4) 2.53 [0.63, 10.18]< 10%5 studies (5/-)9.6 %lownot evaluable highnon important-
Diabetes TRAE (grade 3-4) 0.65 [0.05, 8.65]< 10%2 studies (2/-)62.5 %lownot evaluable highnon important-
Diarrhoea TRAE (grade 3-4) 1.92 [1.24, 2.97]< 11%5 studies (5/-)0.2 %lownot evaluable highnon important-
Dizziness TRAE (grade 3-4) 0.97 [0.06, 15.73]< 10%2 studies (2/-)50.8 %lownot evaluable highnon important-
Dry skin TRAE (grade 3-4) 0.98 [0.14, 7.02]< 10%4 studies (4/-)50.6 %lownot evaluable highnon important-
Dysgeusia TRAE (grade 3-4) 0.97 [0.06, 15.73]< 10%2 studies (2/-)50.8 %lownot evaluable highnon important-
Dyspepsia TRAE (grade 3-4) 0.97 [0.06, 15.73]< 10%2 studies (2/-)50.8 %lownot evaluable highnon important-
Dyspnoea TRAE (grade 3-4) 2.65 [0.68, 10.29]< 10%5 studies (5/-)8.0 %lownot evaluable highnon important-
Ear and labyrinth disorders TRAE (grade 3-4) 0.97 [0.06, 15.73]< 10%2 studies (2/-)50.8 %lownot evaluable highnon important-
Endocrine disorders TRAE (grade 3-4) 2.81 [0.83, 9.50]< 11%3 studies (3/-)4.8 %lownot evaluable highnon important-
Eye disorders TRAE (grade 3-4) 1.96 [0.18, 21.95]< 10%2 studies (2/-)29.4 %lownot evaluable highnon important-
Fatigue TRAE (grade 3-4) 3.95 [1.75, 8.96]< 10%5 studies (5/-)0.0 %lownot evaluable highnon important-
Gastritis TRAE (grade 3-4) 4.00 [0.44, 36.34]< 10%2 studies (2/-)11.1 %lownot evaluable highnon important-
Gastrointestinal disorders TRAE (grade 3-4) 4.34 [1.30, 14.54]< 127%3 studies (3/-)0.9 %lownot evaluable highnon important-
General disorders and administration site conditions TRAE (grade 3-4) 4.00 [0.44, 36.34]< 10%2 studies (2/-)11.1 %lownot evaluable highnon important-
Headache TRAE (grade 3-4) 1.91 [0.47, 7.78]< 10%5 studies (5/-)18.3 %lownot evaluable highnon important-
Hepatitis TRAE (grade 3-4) 5.40 [1.81, 16.16]< 10%5 studies (5/-)0.1 %lownot evaluable highnon important-
Hepatobiliary disorders TRAE (grade 3-4) 11.06 [3.24, 37.77]< 10%3 studies (3/-)0.0 %lownot evaluable highnon important-
Hypertension TRAE (grade 3-4) 0.97 [0.06, 15.73]< 10%2 studies (2/-)50.8 %lownot evaluable highnon important-
Hyperthyroidism TRAE (grade 3-4) 4.40 [1.08, 17.93]< 10%5 studies (5/-)2.0 %lowserious highnon important-
Hypophysitis TRAE (grade 3-4) 1.08 [0.44, 2.63]< 10%5 studies (5/-)43.3 %lownot evaluable highnon important-
Hypothyroidism TRAE (grade 3-4) 1.21 [0.23, 6.30]< 10%5 studies (5/-)41.1 %lowserious highnon important-
Increase AST TRAE (grade 3-4) 6.32 [3.05, 13.07]< 10%5 studies (5/-)0.0 %lownot evaluable highnon important-
Increased ALT TRAE (grade 3-4) 6.82 [3.74, 12.43]< 10%5 studies (5/-)0.0 %lownot evaluable highnon important-
Increased lipase level TRAE (grade 3-4) 2.85 [1.89, 4.31]< 10%5 studies (5/-)0.0 %lownot evaluable highnon important-
Infusion-related reactions TRAE (grade 3-4) 0.97 [0.06, 15.73]< 10%2 studies (2/-)50.8 %lownot evaluable highnon important-
Leucopenia TRAE (grade 3-4) 0.97 [0.06, 15.73]< 10%2 studies (2/-)50.8 %lownot evaluable highnon important-
Maculopapular rash TRAE (grade 3-4) 3.31 [1.15, 9.56]< 10%5 studies (5/-)1.4 %lownot evaluable highnon important-
Metabolism and nutrition disorders TRAE (grade 3-4) 1.30 [0.15, 11.32]< 10%2 studies (2/-)40.7 %lownot evaluable highnon important-
Musculoskeletal and connective tissue disorders TRAE (grade 3-4) 0.31 [0.03, 3.39]< 10%2 studies (2/-)83.0 %lownot evaluable highnon important-
Myalgia TRAE (grade 3-4) 0.89 [0.19, 4.08]< 10%5 studies (5/-)56.0 %lownot evaluable highnon important-
Myositis TRAE (grade 3-4) 0.97 [0.06, 15.73]< 10%2 studies (2/-)50.8 %lownot evaluable highnon important-
Nausea TRAE (grade 3-4) 2.56 [0.82, 7.94]< 10%5 studies (5/-)5.2 %lownot evaluable highnon important-
Nervous system disorders TRAE (grade 3-4) 0.78 [0.11, 5.64]< 10%2 studies (2/-)59.7 %lownot evaluable highnon important-
Neutropenia TRAE (grade 3-4) 0.97 [0.06, 15.73]< 10%2 studies (2/-)50.8 %lownot evaluable highnon important-
Palmar-plantar erythrodysaesthesia syndrome TRAE (grade 3-4) 0.97 [0.06, 15.73]< 10%2 studies (2/-)50.8 %lownot evaluable highnon important-
Pancreatitis TRAE (grade 3-4) 0.97 [0.06, 15.73]< 10%2 studies (2/-)50.8 %lownot evaluable highnon important-
Paraesthesia TRAE (grade 3-4) 0.97 [0.06, 15.73]< 10%2 studies (2/-)50.8 %lownot evaluable highnon important-
Peripheral neuropathy TRAE (grade 3-4) 1.96 [0.18, 21.95]< 10%2 studies (2/-)29.4 %lownot evaluable highnon important-
Pneumonitis TRAE (grade 3-4) 1.84 [0.55, 6.16]< 10%5 studies (5/-)16.0 %lownot evaluable highnon important-
Pruritic rash TRAE (grade 3-4) 0.79 [0.08, 7.59]< 10%3 studies (3/-)58.2 %lownot evaluable highnon important-
Pruritus TRAE (grade 3-4) 3.35 [0.98, 11.47]< 10%5 studies (5/-)2.8 %lowserious highnon important-
Pyrexia TRAE (grade 3-4) 3.10 [0.84, 11.36]< 10%5 studies (5/-)4.5 %lowserious highnon important-
Rash TRAE (grade 3-4) 3.05 [1.22, 7.65]< 11%3 studies (3/-)0.9 %lownot evaluable highnon important-
Renal and urinary disorders TRAE (grade 3-4) 0.98 [0.03, 29.71]< 10%1 study (1/-)50.5 %NAnot evaluable non important-
Respiratory, thoracic and mediastinal disorders TRAE (grade 3-4) 1.25 [0.21, 7.34]< 10%3 studies (3/-)40.3 %lownot evaluable highnon important-
Sarcoidosis TRAE (grade 3-4) 0.97 [0.06, 15.73]< 10%2 studies (2/-)50.8 %lownot evaluable highnon important-
Skin and subcutaneous tissue disorders TRAE (grade 3-4) 5.12 [1.10, 23.92]< 10%3 studies (3/-)1.9 %lownot evaluable highnon important-
Stomatitis TRAE (grade 3-4) 0.97 [0.06, 15.73]< 10%2 studies (2/-)50.8 %lownot evaluable highnon important-
Thrombocytopenia TRAE (grade 3-4) 1.96 [0.18, 21.95]< 10%2 studies (2/-)29.4 %lownot evaluable highnon important-
Thyroiditis TRAE (grade 3-4) 1.47 [0.24, 9.05]< 10%4 studies (4/-)34.0 %lownot evaluable highnon important-
Uveitis TRAE (grade 3-4) 0.97 [0.06, 15.73]< 10%2 studies (2/-)50.8 %lownot evaluable highnon important-
Vitiligo TRAE (grade 3-4) 0.73 [0.13, 3.98]< 10%5 studies (5/-)64.4 %lownot evaluable highnon important-
Vomiting TRAE (grade 3-4) 3.75 [1.10, 12.76]< 10%5 studies (5/-)1.7 %lowserious highnon important-
Weight decreased TRAE (grade 3-4) 0.79 [0.12, 5.25]< 10%4 studies (4/-)59.4 %lownot evaluable highnon important-

LoD: level of statistical demonstration: Statistically conclusive: statistically significant with a strict control of overall risk of type 1 error (statistically demonstrated), does not take into account the risk of bias; suggested: nominally statistically significant but without a strict control of overall risk of type 1 error; inconclusive: not nominally statistically significant; safety concerns;
Bayesian probability: Bayesian posterior probability of treatment effect (computed with a noninformative prior); ROB: risk of bias; k: number of studies; published MA: number of published meta-analysis on the same topic; degree of certainty adapted from GRADE. Trt. better when: indicates when the relative treatment effect shows that the studied treatment is better than control.