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melanoma (ML), nivolumab plus ipilimumab versus immune chekpoint inhibitors, 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 0.40 [0.20, 0.79]< 10%1 study (1/-)99.6 %NAnot evaluable important-
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) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
AE leading to treatment discontinuation (any grade) 11.33 [4.34, 29.62]< 10%1 study (1/-)0.0 %NAnot evaluable non important-
AE leading to treatment discontinuation (grade 3-4) 11.38 [3.94, 32.84]< 10%1 study (1/-)0.0 %NAnot evaluable non important-
SAE (any grade) 3.69 [1.68, 8.08]< 10%1 study (1/-)0.1 %NAnot evaluable non important-
SAE (grade 3-4) 3.48 [1.58, 7.66]< 10%1 study (1/-)0.1 %NAnot evaluable non important-
STRAE (any grade) 5.69 [2.43, 13.31]< 10%1 study (1/-)0.0 %NAnot evaluable non important-
STRAE (grade 3-4) 4.68 [1.93, 11.38]< 10%1 study (1/-)0.0 %NAnot evaluable non important-
TRAE (any grade) 3.01 [1.67, 5.43]< 139%4 studies (4/-)0.0 %lownot evaluable highnon important-
TRAE (grade 3-4) 4.37 [3.50, 5.46]< 10%4 studies (4/-)0.0 %lownot evaluable highnon important-
TRAE leading to death (grade 5) 1.00 [0.10, 9.70]< 10%3 studies (3/-)49.9 %lownot evaluable highnon important-
TRAE leading to discontinuation (any grade) 4.79 [3.49, 6.58]< 125%4 studies (4/-)0.0 %lownot evaluable highnon important-
TRAE leading to discontinuation (grade 3-4) 4.49 [2.64, 7.66]< 164%4 studies (4/-)0.0 %lownot evaluable highnon important-

TRAE (grade 3-4) endpoints 00

Abdominal pain TRAE (grade 3-4) 0.64 [0.13, 3.06]< 10%4 studies (4/-)71.1 %lownot evaluable highnon important-
Acute kidney injury TRAE (grade 3-4) 2.06 [0.07, 62.55]< 10%1 study (1/-)34.2 %NAnot evaluable non important-
Adrenal insufficiency TRAE (grade 3-4) 1.97 [0.52, 7.51]< 130%4 studies (4/-)16.1 %lownot evaluable highnon important-
Alopecia TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Anaemia TRAE (grade 3-4) 2.06 [0.07, 62.55]< 10%1 study (1/-)34.2 %NAnot evaluable non important-
Arthralgia TRAE (grade 3-4) 1.18 [0.26, 5.31]< 10%4 studies (4/-)41.4 %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) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Chills TRAE (grade 3-4) 0.70 [0.04, 11.39]< 10%2 studies (2/-)59.7 %lownot evaluable highnon important-
Colitis TRAE (grade 3-4) 3.12 [0.93, 10.46]< 174%4 studies (4/-)3.3 %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) 0.54 [0.07, 4.28]< 10%3 studies (3/-)71.9 %lownot evaluable highnon important-
Decreased appetite TRAE (grade 3-4) 2.92 [0.66, 12.93]< 10%4 studies (4/-)8.0 %lownot evaluable highnon important-
Diabetes TRAE (grade 3-4) 0.50 [0.02, 15.35]< 10%1 study (1/-)65.1 %NAnot evaluable non important-
Diarrhoea TRAE (grade 3-4) 1.89 [1.09, 3.27]< 125%4 studies (4/-)1.2 %lownot evaluable highnon important-
Dizziness TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Dry skin TRAE (grade 3-4) 1.00 [0.10, 9.70]< 10%3 studies (3/-)49.9 %lownot evaluable highnon important-
Dysgeusia TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Dyspepsia TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Dyspnoea TRAE (grade 3-4) 3.06 [0.72, 12.94]< 10%4 studies (4/-)6.5 %lownot evaluable highnon important-
Ear and labyrinth disorders TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Endocrine disorders TRAE (grade 3-4) 2.20 [0.53, 9.16]< 112%2 studies (2/-)13.9 %lownot evaluable highnon important-
Eye disorders TRAE (grade 3-4) 2.06 [0.07, 62.55]< 10%1 study (1/-)34.2 %NAnot evaluable non important-
Fatigue TRAE (grade 3-4) 4.22 [1.83, 9.74]< 10%4 studies (4/-)0.0 %lownot evaluable highnon important-
Gastritis TRAE (grade 3-4) 4.19 [0.18, 95.03]< 10%1 study (1/-)18.7 %NAnot evaluable non important-
Gastrointestinal disorders TRAE (grade 3-4) 3.36 [0.93, 12.09]< 130%2 studies (2/-)3.2 %lownot evaluable highnon important-
General disorders and administration site conditions TRAE (grade 3-4) 4.19 [0.18, 95.03]< 10%1 study (1/-)18.7 %NAnot evaluable non important-
Headache TRAE (grade 3-4) 2.13 [0.47, 9.54]< 10%4 studies (4/-)16.3 %lownot evaluable highnon important-
Hepatitis TRAE (grade 3-4) 4.71 [1.44, 15.37]< 10%4 studies (4/-)0.5 %lownot evaluable highnon important-
Hepatobiliary disorders TRAE (grade 3-4) 8.94 [2.29, 34.87]< 10%2 studies (2/-)0.1 %lownot evaluable highnon important-
Hypertension TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Hyperthyroidism TRAE (grade 3-4) 4.07 [0.83, 19.91]< 10%4 studies (4/-)4.2 %lownot evaluable highnon important-
Hypophysitis TRAE (grade 3-4) 1.09 [0.44, 2.72]< 10%4 studies (4/-)42.8 %lownot evaluable highnon important-
Hypothyroidism TRAE (grade 3-4) 1.28 [0.21, 7.89]< 10%4 studies (4/-)39.6 %lownot evaluable highnon important-
Increase AST TRAE (grade 3-4) 5.90 [2.78, 12.52]< 10%4 studies (4/-)0.0 %lownot evaluable highnon important-
Increased ALT TRAE (grade 3-4) 6.35 [3.44, 11.74]< 10%4 studies (4/-)0.0 %lownot evaluable highnon important-
Increased lipase level TRAE (grade 3-4) 2.87 [1.86, 4.42]< 10%4 studies (4/-)0.0 %lownot evaluable highnon important-
Infusion-related reactions TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Leucopenia TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Maculopapular rash TRAE (grade 3-4) 3.52 [1.15, 10.73]< 10%4 studies (4/-)1.4 %lownot evaluable highnon important-
Metabolism and nutrition disorders TRAE (grade 3-4) 1.02 [0.06, 16.70]< 10%1 study (1/-)49.5 %NAnot evaluable non important-
Musculoskeletal and connective tissue disorders TRAE (grade 3-4) 0.16 [0.01, 3.31]< 10%1 study (1/-)87.9 %NAnot evaluable non important-
Myalgia TRAE (grade 3-4) 0.88 [0.17, 4.61]< 10%4 studies (4/-)55.8 %lownot evaluable highnon important-
Myositis TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Nausea TRAE (grade 3-4) 2.78 [0.83, 9.38]< 13%4 studies (4/-)5.0 %lownot evaluable highnon important-
Nervous system disorders TRAE (grade 3-4) 0.50 [0.04, 5.68]< 10%1 study (1/-)71.0 %NAnot evaluable non important-
Neutropenia TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Palmar-plantar erythrodysaesthesia syndrome TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Pancreatitis TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Paraesthesia TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Peripheral neuropathy TRAE (grade 3-4) 2.06 [0.07, 62.55]< 10%1 study (1/-)34.2 %NAnot evaluable non important-
Pneumonitis TRAE (grade 3-4) 1.98 [0.56, 7.03]< 10%4 studies (4/-)14.6 %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) 3.85 [1.05, 14.07]< 10%4 studies (4/-)2.1 %lownot evaluable highnon important-
Pyrexia TRAE (grade 3-4) 2.96 [0.71, 12.38]< 10%4 studies (4/-)6.9 %lownot evaluable 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) 1.35 [0.19, 9.77]< 10%2 studies (2/-)38.4 %lownot evaluable highnon important-
Sarcoidosis TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Skin and subcutaneous tissue disorders TRAE (grade 3-4) 4.89 [0.81, 29.38]< 10%2 studies (2/-)4.2 %lownot evaluable highnon important-
Stomatitis TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Thrombocytopenia TRAE (grade 3-4) 2.06 [0.07, 62.55]< 10%1 study (1/-)34.2 %NAnot evaluable non important-
Thyroiditis TRAE (grade 3-4) 1.66 [0.21, 12.94]< 10%3 studies (3/-)31.4 %lownot evaluable highnon important-
Uveitis TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Vitiligo TRAE (grade 3-4) 0.69 [0.10, 4.53]< 10%4 studies (4/-)65.2 %lownot evaluable highnon important-
Vomiting TRAE (grade 3-4) 4.36 [1.20, 15.79]< 10%4 studies (4/-)1.3 %lownot evaluable highnon important-
Weight decreased TRAE (grade 3-4) 0.76 [0.09, 6.53]< 10%3 studies (3/-)59.9 %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.