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melanoma (ML), nivolumab plus ipilimumab versus nivolumab 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) 0.65 [0.53, 0.80]< 10%1 study (1/-)100.0 %NAnot evaluable crucial-
deaths (OS) (extension) 0.83 [0.67, 1.03]< 10%1 study (1/-)95.5 %NAnot evaluable important-
PFS (extension) 0.79 [0.65, 0.97]< 10%1 study (1/-)98.9 %NAnot evaluable important-
progression or deaths (PFS) 0.74 [0.60, 0.92]< 10%1 study (1/-)99.7 %NAnot evaluable important-
RFS/DFS 0.40 [0.20, 0.79]< 10%1 study (1/-)99.6 %NAnot evaluable important-
objective responses (ORR) 1.76 [1.28, 2.41]> 10%1 study (1/-)100.0 %NAnot evaluable non important-
objective responses (ORR) (extension) 5.96 [4.16, 8.54]> 10%1 study (1/-)100.0 %NAnot evaluable non 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) 3.76 [2.07, 6.82]< 10%2 studies (2/-)0.0 %lownot evaluable highnon important-
TRAE (grade 3-4) 5.05 [3.67, 6.95]< 10%2 studies (2/-)0.0 %lownot evaluable highnon important-
TRAE leading to death (grade 5) 1.01 [0.06, 16.25]< 10%2 studies (2/-)49.7 %lownot evaluable highnon important-
TRAE leading to discontinuation (any grade) 6.60 [2.96, 14.68]< 161%2 studies (2/-)0.0 %lownot evaluable highnon important-
TRAE leading to discontinuation (grade 3-4) 6.58 [3.16, 13.70]< 146%2 studies (2/-)0.0 %lownot evaluable highnon important-

TRAE (grade 3-4) endpoints 00

Abdominal pain TRAE (grade 3-4) 1.50 [0.11, 19.66]< 10%2 studies (2/-)38.0 %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) 2.83 [0.66, 12.13]< 10%2 studies (2/-)8.1 %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) 0.90 [0.12, 6.61]< 18%2 studies (2/-)54.0 %lownot evaluable highnon important-
Asthenia TRAE (grade 3-4) 1.00 [0.06, 16.06]< 10%1 study (1/-)50.0 %NAnot evaluable non 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) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Colitis TRAE (grade 3-4) 8.88 [2.90, 27.22]< 10%2 studies (2/-)0.0 %lownot evaluable highnon important-
Cough TRAE (grade 3-4) 0.43 [0.04, 4.88]< 10%2 studies (2/-)75.2 %lownot evaluable highnon important-
Decreased appetite TRAE (grade 3-4) 3.85 [0.36, 40.67]< 10%2 studies (2/-)13.3 %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) 3.17 [1.51, 6.63]< 10%2 studies (2/-)0.1 %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) 1.01 [0.06, 16.25]< 10%2 studies (2/-)49.7 %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) 2.30 [0.32, 16.44]< 10%2 studies (2/-)20.4 %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) 5.50 [0.62, 48.70]< 10%1 study (1/-)6.4 %NAnot evaluable non 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) 3.90 [1.17, 13.00]< 10%2 studies (2/-)1.4 %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) 9.36 [1.13, 77.61]< 10%1 study (1/-)2.0 %NAnot evaluable non 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) 2.38 [0.21, 27.18]< 10%2 studies (2/-)24.5 %lownot evaluable highnon important-
Hepatitis TRAE (grade 3-4) 4.34 [1.03, 18.18]< 10%2 studies (2/-)2.3 %lownot evaluable highnon important-
Hepatobiliary disorders TRAE (grade 3-4) 7.53 [1.60, 35.49]< 10%1 study (1/-)0.5 %NAnot evaluable non 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) 6.22 [0.74, 52.20]< 10%2 studies (2/-)4.7 %lownot evaluable highnon important-
Hypophysitis TRAE (grade 3-4) 2.38 [0.28, 19.85]< 120%2 studies (2/-)21.3 %lownot evaluable highnon important-
Hypothyroidism TRAE (grade 3-4) 1.50 [0.11, 19.66]< 10%2 studies (2/-)38.0 %lownot evaluable highnon important-
Increase AST TRAE (grade 3-4) 4.70 [1.88, 11.77]< 10%2 studies (2/-)0.0 %lownot evaluable highnon important-
Increased ALT TRAE (grade 3-4) 6.51 [2.85, 14.89]< 10%2 studies (2/-)0.0 %lownot evaluable highnon important-
Increased lipase level TRAE (grade 3-4) 2.67 [1.49, 4.79]< 10%2 studies (2/-)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) 2.83 [0.66, 12.13]< 10%2 studies (2/-)8.1 %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) 0.76 [0.09, 6.57]< 10%2 studies (2/-)59.7 %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) 5.45 [0.45, 65.95]< 111%2 studies (2/-)9.3 %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) 2.30 [0.32, 16.44]< 10%2 studies (2/-)20.4 %lownot evaluable highnon important-
Pruritic rash TRAE (grade 3-4) 1.00 [0.02, 50.56]< 10%1 study (1/-)50.0 %NAnot evaluable non important-
Pruritus TRAE (grade 3-4) 4.08 [0.63, 26.40]< 10%2 studies (2/-)7.1 %lownot evaluable highnon important-
Pyrexia TRAE (grade 3-4) 4.10 [0.45, 37.05]< 10%2 studies (2/-)10.6 %lownot evaluable highnon important-
Rash TRAE (grade 3-4) 10.30 [1.31, 80.93]< 10%1 study (1/-)1.4 %NAnot evaluable non important-
Respiratory, thoracic and mediastinal disorders TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non 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) 3.17 [0.32, 31.48]< 10%1 study (1/-)16.4 %NAnot evaluable non 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) 1.50 [0.11, 19.66]< 10%2 studies (2/-)38.0 %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) 0.68 [0.05, 8.87]< 10%2 studies (2/-)61.6 %lownot evaluable highnon important-
Vomiting TRAE (grade 3-4) 4.64 [0.73, 29.59]< 10%2 studies (2/-)5.3 %lownot evaluable highnon important-
Weight decreased TRAE (grade 3-4) 1.01 [0.06, 16.25]< 10%2 studies (2/-)49.7 %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.