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melanoma (ML), immune chekpoint inhibitors versus ipilimumab alone, 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) 0.74 [0.63, 0.87]< 164%8 studies (8/-)100.0 %lownot evaluable highcrucial-
deaths (OS) (extension) 0.62 [0.55, 0.70]< 121%4 studies (4/-)100.0 %lownot evaluable highimportant-
MFS 0.73 [0.56, 0.96]< 10%1 study (1/-)98.8 %NAnot evaluable important-
PFS (extension) 0.51 [0.43, 0.61]< 167%5 studies (5/-)100.0 %lownot evaluable highimportant-
progression or deaths (PFS) 0.56 [0.46, 0.69]< 166%6 studies (6/-)100.0 %lownot evaluable highimportant-
RFS (extension) 0.71 [0.59, 0.85]< 10%1 study (1/-)100.0 %NAnot evaluable important-
RFS/DFS 0.65 [0.51, 0.83]< 10%1 study (1/-)100.0 %NAnot evaluable important-
DCR 1.19 [0.86, 1.63]> 10%1 study (1/-)85.6 %NAnot evaluable non important-
objective responses (ORR) 3.12 [1.57, 6.17]> 192%7 studies (7/-)99.9 %lownot evaluable highnon important-
objective responses (ORR) (extension) 5.68 [3.20, 10.11]> 175%3 studies (3/-)100.0 %lownot evaluable highnon important-

safety endpoints 00

AE (any grade) 0.91 [0.24, 3.51]< 166%2 studies (2/-)55.4 %lownot evaluable highnon important-
AE (grade 3-4) 0.52 [0.15, 1.81]< 196%2 studies (2/-)84.8 %lownot evaluable highnon important-
AE leading to treatment discontinuation (any grade) 0.15 [0.10, 0.21]< 10%1 study (1/-)100.0 %NAnot evaluable non important-
AE leading to treatment discontinuation (grade 3-4) 0.11 [0.07, 0.18]< 10%1 study (1/-)100.0 %NAnot evaluable non important-
STRAE (any grade) 0.65 [0.46, 0.92]< 10%2 studies (2/-)99.3 %some concernnot evaluable moderatenon important-
STRAE (grade 3-4) 0.92 [0.06, 14.79]< 10%2 studies (2/-)52.3 %some concernnot evaluable moderatenon important-
TRAE (any grade) 1.29 [0.76, 2.21]< 190%8 studies (8/-)17.2 %lownot evaluable highnon important-
TRAE (grade 3-4) 1.19 [0.54, 2.61]< 197%8 studies (8/-)33.3 %lownot evaluable highnon important-
TRAE leading to death (grade 5) 1.21 [0.38, 3.91]< 10%6 studies (6/-)37.3 %lownot evaluable highnon important-
TRAE leading to discontinuation (any grade) 1.13 [0.41, 3.10]< 197%7 studies (7/-)40.8 %lownot evaluable highnon important-
TRAE leading to discontinuation (grade 3-4) 1.00 [0.30, 3.37]< 196%7 studies (7/-)50.1 %lownot evaluable highnon important-

TRAE (grade 3-4) endpoints 00

Abdominal pain TRAE (grade 3-4) 0.45 [0.12, 1.68]< 10%6 studies (6/-)88.1 %lownot evaluable highnon important-
Adrenal insufficiency TRAE (grade 3-4) 1.13 [0.42, 3.01]< 14%6 studies (6/-)40.3 %lownot evaluable highnon important-
Alopecia TRAE (grade 3-4) 0.92 [0.06, 14.79]< 10%2 studies (2/-)52.3 %some concernnot evaluable moderatenon important-
Anaemia TRAE (grade 3-4) 1.16 [0.16, 8.29]< 10%2 studies (2/-)44.1 %some concernnot evaluable moderatenon important-
Arthralgia TRAE (grade 3-4) 1.05 [0.27, 4.00]< 10%6 studies (6/-)47.2 %lownot evaluable highnon important-
Asthenia TRAE (grade 3-4) 0.38 [0.13, 1.09]< 10%6 studies (6/-)96.3 %lownot evaluable highnon important-
Chills TRAE (grade 3-4) 0.75 [0.08, 7.20]< 10%3 studies (3/-)59.9 %some concernnot evaluable moderatenon important-
Colitis TRAE (grade 3-4) 0.62 [0.28, 1.37]< 180%7 studies (7/-)87.9 %lownot evaluable highnon important-
Constipation TRAE (grade 3-4) 0.94 [0.11, 8.13]< 10%3 studies (3/-)52.1 %some concernnot evaluable moderatenon important-
Cough TRAE (grade 3-4) 1.56 [0.25, 9.72]< 10%4 studies (4/-)31.8 %lownot evaluable highnon important-
Decreased appetite TRAE (grade 3-4) 1.42 [0.34, 5.93]< 10%5 studies (5/-)31.7 %lowserious highnon important-
Diabetes TRAE (grade 3-4) 1.93 [0.17, 21.31]< 10%2 studies (2/-)29.8 %lownot evaluable highnon important-
Diarrhoea TRAE (grade 3-4) 0.73 [0.38, 1.40]< 179%8 studies (8/-)82.8 %lownot evaluable highnon important-
Dry skin TRAE (grade 3-4) 1.32 [0.62, 2.79]< 10%4 studies (4/-)23.5 %lownot evaluable highnon important-
Dyspnoea TRAE (grade 3-4) 1.78 [0.45, 7.09]< 10%5 studies (5/-)20.7 %lownot evaluable highnon important-
Endocrine disorders TRAE (grade 3-4) 0.96 [0.24, 3.80]< 172%3 studies (3/-)52.2 %lownot evaluable highnon important-
Eye disorders TRAE (grade 3-4) 0.50 [0.02, 14.85]< 10%1 study (1/-)65.5 %NAnot evaluable non important-
Fatigue TRAE (grade 3-4) 1.25 [0.51, 3.02]< 134%6 studies (6/-)31.3 %lownot evaluable highnon important-
Febrile neutropenia TRAE (grade 3-4) 3.99 [0.18, 88.89]< 10%1 study (1/-)19.4 %NAnot evaluable non important-
Gastrointestinal disorders TRAE (grade 3-4) 0.73 [0.18, 3.06]< 194%4 studies (4/-)66.5 %lownot evaluable highnon important-
Guillain-Barré syndrome TRAE (grade 3-4) 3.99 [0.18, 88.89]< 10%1 study (1/-)19.4 %NAnot evaluable non important-
Headache TRAE (grade 3-4) 0.64 [0.20, 2.07]< 10%6 studies (6/-)77.4 %lownot evaluable highnon important-
Hepatitis TRAE (grade 3-4) 2.90 [1.14, 7.34]< 10%7 studies (7/-)1.3 %lownot evaluable highnon important-
Hepatobiliary disorders TRAE (grade 3-4) 1.48 [0.06, 34.16]< 184%3 studies (3/-)40.5 %lownot evaluable highnon important-
Hypersensitivity TRAE (grade 3-4) 3.72 [0.39, 35.19]< 10%2 studies (2/-)12.8 %lownot evaluable highnon important-
Hyperthyroidism TRAE (grade 3-4) 1.03 [0.27, 4.02]< 10%6 studies (6/-)48.0 %lownot evaluable highnon important-
Hypophysitis TRAE (grade 3-4) 0.58 [0.31, 1.08]< 112%8 studies (8/-)95.6 %lowserious highnon important-
Hypothyroidism TRAE (grade 3-4) 0.96 [0.29, 3.12]< 10%8 studies (8/-)52.9 %lownot evaluable highnon important-
Increase AST TRAE (grade 3-4) 1.31 [0.31, 5.56]< 173%8 studies (8/-)35.6 %lownot evaluable highnon important-
Increased ALT TRAE (grade 3-4) 1.32 [0.36, 4.77]< 179%8 studies (8/-)33.8 %lownot evaluable highnon important-
Increased lipase level TRAE (grade 3-4) 2.09 [1.14, 3.84]< 119%4 studies (4/-)0.9 %lownot evaluable highnon important-
Infusion-related reactions TRAE (grade 3-4) 3.99 [0.18, 88.89]< 10%1 study (1/-)19.4 %NAnot evaluable non important-
Maculopapular rash TRAE (grade 3-4) 1.25 [0.38, 4.09]< 122%7 studies (7/-)35.6 %lownot evaluable highnon important-
Myalgia TRAE (grade 3-4) 0.99 [0.22, 4.36]< 10%5 studies (5/-)50.6 %lownot evaluable highnon important-
Myositis TRAE (grade 3-4) 0.92 [0.06, 14.79]< 10%2 studies (2/-)52.3 %some concernnot evaluable moderatenon important-
Nausea TRAE (grade 3-4) 1.45 [0.49, 4.30]< 10%6 studies (6/-)25.0 %lownot evaluable highnon important-
Nephritis TRAE (grade 3-4) 0.46 [0.04, 5.09]< 10%2 studies (2/-)73.5 %some concernnot evaluable moderatenon important-
Nervous system disorders TRAE (grade 3-4) 8.03 [0.42, 152.51]< 10%1 study (1/-)8.5 %NAnot evaluable non important-
Neutropenia TRAE (grade 3-4) 0.92 [0.06, 14.79]< 10%2 studies (2/-)52.3 %some concernnot evaluable moderatenon important-
Pancreatitis TRAE (grade 3-4) 1.99 [0.07, 59.56]< 10%1 study (1/-)34.8 %NAnot evaluable non important-
Pancytopenia TRAE (grade 3-4) 1.99 [0.07, 59.56]< 10%1 study (1/-)34.8 %NAnot evaluable non important-
Paraesthesia TRAE (grade 3-4) 0.46 [0.04, 5.09]< 10%2 studies (2/-)73.5 %some concernnot evaluable moderatenon important-
Pericarditis TRAE (grade 3-4) 1.99 [0.07, 59.56]< 10%1 study (1/-)34.8 %NAnot evaluable non important-
Peripheral neuropathy TRAE (grade 3-4) 3.99 [0.18, 88.89]< 10%1 study (1/-)19.4 %NAnot evaluable non important-
Pneumonitis TRAE (grade 3-4) 1.57 [0.52, 4.72]< 10%6 studies (6/-)21.2 %lownot evaluable highnon important-
Polymyalgia Rheumatica TRAE (grade 3-4) 0.50 [0.02, 14.85]< 10%1 study (1/-)65.5 %NAnot evaluable non important-
Pruritic rash TRAE (grade 3-4) 0.75 [0.16, 3.57]< 10%6 studies (6/-)64.1 %lownot evaluable highnon important-
Pruritus TRAE (grade 3-4) 1.08 [0.40, 2.89]< 10%8 studies (8/-)43.9 %lownot evaluable highnon important-
Pyrexia TRAE (grade 3-4) 1.04 [0.29, 3.78]< 10%6 studies (6/-)47.5 %lownot evaluable highnon important-
Rash TRAE (grade 3-4) 1.03 [0.46, 2.33]< 133%8 studies (8/-)46.9 %lownot evaluable highnon important-
Renal and urinary disorders TRAE (grade 3-4) 0.99 [0.08, 12.98]< 10%2 studies (2/-)50.3 %lownot evaluable highnon important-
Respiratory, thoracic and mediastinal disorders TRAE (grade 3-4) 1.17 [0.13, 10.40]< 149%3 studies (3/-)44.6 %lownot evaluable highnon important-
Skin and subcutaneous tissue disorders TRAE (grade 3-4) 1.03 [0.23, 4.70]< 177%4 studies (4/-)48.3 %lownot evaluable highnon important-
Thyroiditis TRAE (grade 3-4) 1.65 [0.21, 12.78]< 10%3 studies (3/-)31.7 %lownot evaluable highnon important-
Uveitis TRAE (grade 3-4) 0.72 [0.08, 6.18]< 10%3 studies (3/-)61.7 %some concernnot evaluable moderatenon important-
Vitiligo TRAE (grade 3-4) 0.82 [0.12, 5.39]< 10%4 studies (4/-)58.3 %lownot evaluable highnon important-
Vomiting TRAE (grade 3-4) 2.28 [0.62, 8.34]< 10%5 studies (5/-)10.7 %lowserious highnon important-
Weight decreased TRAE (grade 3-4) 0.48 [0.09, 2.61]< 10%4 studies (4/-)80.2 %lownot evaluable highnon important-

AE (grade 3-4) endpoints 00

Abdominal pain AE (grade 3-4) 1.03 [0.21, 5.19]< 10%1 study (1/-)48.3 %NAnot evaluable non important-
Anaemia AE (grade 3-4) 0.95 [0.30, 3.03]< 10%1 study (1/-)53.7 %NAnot evaluable non important-
Constipation AE (grade 3-4) 0.34 [0.07, 1.70]< 10%1 study (1/-)90.5 %NAnot evaluable non important-
Cough AE (grade 3-4) 0.69 [0.02, 20.65]< 10%1 study (1/-)58.4 %NAnot evaluable non important-
Decreased appetite AE (grade 3-4) 1.03 [0.21, 5.19]< 10%1 study (1/-)48.3 %NAnot evaluable non important-
Diarrhoea AE (grade 3-4) 0.83 [0.34, 2.05]< 10%1 study (1/-)65.7 %NAnot evaluable non important-
Dyspnoea AE (grade 3-4) 0.96 [0.34, 2.73]< 10%1 study (1/-)52.8 %NAnot evaluable non important-
Fatigue AE (grade 3-4) 0.71 [0.31, 1.62]< 10%1 study (1/-)79.0 %NAnot evaluable non important-
Headache AE (grade 3-4) 0.45 [0.10, 2.06]< 10%1 study (1/-)84.7 %NAnot evaluable non important-
Nausea AE (grade 3-4) 0.68 [0.17, 2.78]< 10%1 study (1/-)70.2 %NAnot evaluable non important-
Pyrexia AE (grade 3-4) 1.38 [0.06, 30.82]< 10%1 study (1/-)42.0 %NAnot evaluable non important-
Vomiting AE (grade 3-4) 0.80 [0.20, 3.14]< 10%1 study (1/-)62.5 %NAnot evaluable non 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.