丹麦欧登塞大学医院Camilla H Nejstgaard团队研究了利益冲突与临床指南等文件中偏好推荐之间的相关性。2020年12月9日，该研究发表在《英国医学杂志》上。

为了调查利益冲突与临床指南、咨询委员会报告、意见书和叙述性评论中的偏好推荐之间的相关性，研究组在PubMed、Embase、科学引文索引等大型数据库中检索相关文献，进行了一项系统性审查。

研究组共纳入了21项研究，分析了106份临床指南、1809份咨询委员会的报告、340份意见书和497篇叙述性评论；以及11项已接收但尚未发布数据的研究。15项研究存在混淆的风险，因为比较的文件可能在利益冲突之外的其他因素上有所不同（例如，针对不同人群使用不同药物）。

财务利益冲突和临床指南偏好推荐有关联的相对风险为1.26，咨询委员会报告为1.20，意见书为2.62，叙述性评论为1.20。综合所有四种类型的文件分析支持了这些发现。在一项调查专业兴趣的研究中，将放射科医生作为指南作者与常规推荐乳腺癌筛查有关的相对风险为2.10。

研究结果表明，财务利益冲突与临床指南、咨询委员会报告、意见书和叙述性评论中对药物和设备的偏好推荐有关。

附：英文原文

Title: Association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews: systematic review

Author: Camilla H Nejstgaard, Lisa Bero, Asbjrn Hróbjartsson, Anders W Jrgensen, Karsten J Jrgensen, Mary Le, Andreas Lundh

Issue&Volume: 2020/12/09

Abstract: Objective To investigate the association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews.

Design Systematic review.

Eligibility criteria Studies that compared the association between conflicts of interest and favourable recommendations of drugs or devices (eg, recommending a drug) in clinical guidelines, advisory committee reports, opinion pieces (eg, editorials), or narrative reviews.

Data sources PubMed, Embase, Cochrane Methodology Register (from inception to February 2020), reference lists, Web of Science, and grey literature.

Data extraction and analysis Two authors independently extracted data and assessed the methodological quality of the studies. Pooled relative risks and 95% confidence intervals were estimated using random effects models (relative risk >1 indicates that documents with conflicts of interest more often had favourable recommendations than documents with no conflicts of interest). Financial and non-financial conflicts of interest were analysed separately, and the four types of documents were analysed separately (preplanned) and combined (post hoc).

Results 21 studies that analysed 106 clinical guidelines, 1809 advisory committee reports, 340 opinion pieces, and 497 narrative reviews were included. Unpublished data were received for 11 studies (eight full datasets and three summary datasets). 15 studies showed risk of confounding because the compared documents could differ in factors other than conflicts of interest (eg, different drugs used for different populations). The relative risk for associations between financial conflicts of interest and favourable recommendations for clinical guidelines was 1.26 (95% confidence interval 0.93 to 1.69; four studies of 86 clinical guidelines), for advisory committee reports was 1.20 (0.99 to 1.45; four studies of 629 advisory committee reports), for opinion pieces was 2.62 (0.91 to 7.55; four studies of 284 opinion pieces), and for narrative reviews was 1.20 (0.97 to 1.49; four studies of 457 narrative reviews). An analysis of all four types of documents combined supported these findings (1.26, 1.09 to 1.44). In one study that investigated specialty interests, the association between including radiologists as authors of guidelines and recommending routine breast cancer was: relative risk 2.10, 95% confidence interval 0.92 to 4.77; 12 clinical guidelines).

Conclusions We interpret our findings to indicate that financial conflicts of interest are associated with favourable recommendations of drugs and devices in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews. Limitations of this review were risk of confounding in the included studies and the statistical imprecision of individual analyses of each document type. It is not certain whether non-financial conflicts of interest influence recommendations.

DOI: 10.1136/bmj.m4234

Source: https://www.bmj.com/content/371/bmj.m4234