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melanoma (ML), nivolumab based treatment versus anti-CTLA-4, 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 [0.54, 1.01]< 164%2 studies (2/-)97.0 %lownot evaluable highcrucial-
deaths (OS) (extension) 0.63 [0.52, 0.76]< 10%1 study (1/-)100.0 %NAnot evaluable important-
MFS 0.73 [0.56, 0.96]< 10%1 study (1/-)98.8 %NAnot evaluable important-
PFS (extension) 0.53 [0.44, 0.64]< 10%1 study (1/-)100.0 %NAnot evaluable important-
progression or deaths (PFS) 0.57 [0.43, 0.76]< 10%1 study (1/-)100.0 %NAnot evaluable important-
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-
objective responses (ORR) 3.40 [2.02, 5.72]> 10%1 study (1/-)100.0 %NAnot evaluable non important-
objective responses (ORR) (extension) 3.54 [2.46, 5.10]> 10%1 study (1/-)100.0 %NAnot evaluable non important-

safety endpoints 00

AE (any grade) 0.49 [0.20, 1.23]< 10%1 study (1/-)93.6 %NAnot evaluable non important-
AE (grade 3-4) 0.28 [0.21, 0.37]< 10%1 study (1/-)100.0 %NAnot evaluable non 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-
TRAE (any grade) 0.51 [0.13, 1.97]< 193%2 studies (2/-)83.6 %lownot evaluable highnon important-
TRAE (grade 3-4) 0.37 [0.11, 1.31]< 196%2 studies (2/-)93.7 %lownot evaluable highnon important-
TRAE leading to death (grade 5) 0.42 [0.04, 4.84]< 10%2 studies (2/-)75.3 %lownot evaluable highnon important-
TRAE leading to discontinuation (any grade) 0.29 [0.05, 1.70]< 197%2 studies (2/-)91.4 %lownot evaluable highnon important-
TRAE leading to discontinuation (grade 3-4) 0.21 [0.04, 1.23]< 195%2 studies (2/-)95.8 %lownot evaluable highnon important-

TRAE (grade 3-4) endpoints 00

Abdominal pain TRAE (grade 3-4) 0.34 [0.03, 3.37]< 10%2 studies (2/-)82.0 %lownot evaluable highnon important-
Adrenal insufficiency TRAE (grade 3-4) 0.79 [0.20, 3.18]< 10%2 studies (2/-)62.9 %lownot evaluable highnon important-
Arthralgia TRAE (grade 3-4) 0.79 [0.11, 5.64]< 10%2 studies (2/-)59.1 %lownot evaluable highnon important-
Asthenia TRAE (grade 3-4) 0.34 [0.07, 1.72]< 10%2 studies (2/-)90.3 %lownot evaluable highnon important-
Colitis TRAE (grade 3-4) 0.12 [0.03, 0.39]< 10%1 study (1/-)100.0 %NAnot evaluable non important-
Cough TRAE (grade 3-4) 3.99 [0.18, 88.92]< 10%1 study (1/-)19.4 %NAnot evaluable non important-
Decreased appetite TRAE (grade 3-4) 0.50 [0.02, 14.84]< 10%1 study (1/-)65.5 %NAnot evaluable non important-
Diabetes TRAE (grade 3-4) 2.01 [0.07, 59.97]< 10%1 study (1/-)34.6 %NAnot evaluable non important-
Diarrhoea TRAE (grade 3-4) 0.27 [0.09, 0.84]< 175%2 studies (2/-)98.8 %lownot evaluable highnon important-
Dry skin TRAE (grade 3-4) 0.99 [0.02, 50.24]< 10%1 study (1/-)50.1 %NAnot evaluable non important-
Dyspnoea TRAE (grade 3-4) 1.99 [0.07, 59.55]< 10%1 study (1/-)34.8 %NAnot evaluable non important-
Fatigue TRAE (grade 3-4) 0.72 [0.22, 2.31]< 10%2 studies (2/-)71.0 %lownot evaluable highnon important-
Gastrointestinal disorders TRAE (grade 3-4) 0.10 [0.05, 0.20]< 10%1 study (1/-)100.0 %NAnot evaluable non important-
Headache TRAE (grade 3-4) 0.20 [0.03, 1.19]< 10%2 studies (2/-)96.1 %lownot evaluable highnon important-
Hepatitis TRAE (grade 3-4) 0.99 [0.02, 50.24]< 10%1 study (1/-)50.1 %NAnot evaluable non important-
Hepatobiliary disorders TRAE (grade 3-4) 0.15 [0.07, 0.32]< 10%1 study (1/-)100.0 %NAnot evaluable non important-
Hypersensitivity TRAE (grade 3-4) 2.01 [0.07, 59.97]< 10%1 study (1/-)34.6 %NAnot evaluable non important-
Hyperthyroidism TRAE (grade 3-4) 1.00 [0.10, 9.63]< 10%2 studies (2/-)50.0 %lownot evaluable highnon important-
Hypophysitis TRAE (grade 3-4) 0.18 [0.05, 0.63]< 10%2 studies (2/-)99.6 %lownot evaluable highnon important-
Hypothyroidism TRAE (grade 3-4) 0.60 [0.08, 4.68]< 10%2 studies (2/-)68.5 %lownot evaluable highnon important-
Increase AST TRAE (grade 3-4) 0.37 [0.03, 5.15]< 181%2 studies (2/-)76.9 %lownot evaluable highnon important-
Increased ALT TRAE (grade 3-4) 0.35 [0.09, 1.47]< 167%2 studies (2/-)92.2 %lownot evaluable highnon important-
Increased lipase level TRAE (grade 3-4) 1.17 [0.53, 2.56]< 10%1 study (1/-)35.1 %NAnot evaluable non important-
Maculopapular rash TRAE (grade 3-4) 0.36 [0.01, 12.15]< 172%2 studies (2/-)71.3 %lownot evaluable highnon important-
Myalgia TRAE (grade 3-4) 1.99 [0.07, 59.55]< 10%1 study (1/-)34.8 %NAnot evaluable non important-
Nausea TRAE (grade 3-4) 0.64 [0.06, 6.33]< 10%2 studies (2/-)64.7 %lownot evaluable highnon important-
Pneumonitis TRAE (grade 3-4) 0.99 [0.06, 15.96]< 10%1 study (1/-)50.2 %NAnot evaluable non important-
Pruritic rash TRAE (grade 3-4) 0.99 [0.02, 50.24]< 10%1 study (1/-)50.1 %NAnot evaluable non important-
Pruritus TRAE (grade 3-4) 0.33 [0.03, 3.13]< 121%2 studies (2/-)83.2 %lownot evaluable highnon important-
Pyrexia TRAE (grade 3-4) 0.34 [0.03, 3.37]< 10%2 studies (2/-)82.0 %lownot evaluable highnon important-
Rash TRAE (grade 3-4) 0.31 [0.12, 0.80]< 10%2 studies (2/-)99.3 %lownot evaluable highnon important-
Renal and urinary disorders TRAE (grade 3-4) 1.00 [0.02, 50.62]< 10%1 study (1/-)50.0 %NAnot evaluable non important-
Respiratory, thoracic and mediastinal disorders TRAE (grade 3-4) 0.12 [0.01, 2.36]< 10%1 study (1/-)91.5 %NAnot evaluable non important-
Skin and subcutaneous tissue disorders TRAE (grade 3-4) 0.18 [0.07, 0.46]< 10%1 study (1/-)100.0 %NAnot evaluable non important-
Thyroiditis TRAE (grade 3-4) 0.99 [0.02, 50.24]< 10%1 study (1/-)50.1 %NAnot evaluable non important-
Vitiligo TRAE (grade 3-4) 1.99 [0.07, 59.55]< 10%1 study (1/-)34.8 %NAnot evaluable non important-
Vomiting TRAE (grade 3-4) 0.99 [0.06, 15.96]< 10%1 study (1/-)50.2 %NAnot evaluable non important-
Weight decreased TRAE (grade 3-4) 0.50 [0.02, 14.84]< 10%1 study (1/-)65.5 %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.