TY - JOUR T1 - The complexity underlying treatment rankings: how to use them and what to look at JF - BMJ Evidence-Based Medicine JO - BMJ EBM DO - 10.1136/bmjebm-2021-111904 SP - bmjebm-2021-111904 AU - Virginia Chiocchia AU - Ian R. White AU - Georgia Salanti Y1 - 2022/05/02 UR - http://ebm.bmj.com/content/early/2022/05/02/bmjebm-2021-111904.abstract N2 - Highlights/key pointsTreatment hierarchies obtained by SUCRA, , mean ranks and mean relative effects might differ when there are large differences in the amount of data for each treatment.Different hierarchies do not imply that one is wrong or better than the others, because the methods used to rank treatments address different ‘treatment hierarchy questions’ based on how the ‘preferable treatment’ is defined.The treatment at the top of the ranking may not reflect the ‘best clinical choice’: rankings must be considered together with relative treatment effects and quality of the evidence.Researchers should specify in the protocol whether among the aims of the synthesis is to obtain a treatment hierarchy and, if yes, which is the ‘treatment hierarchy question’ they aim to answer.In clinical fields where several competing treatments are available, network meta-analysis (NMA) has become an established tool to inform evidence-based decisions.1 2 To determine which treatment is the most preferable, decision-makers must account for both the quantity and the quality of the available evidence by considering both efficacy and safety outcomes as well as assessing the confidence in the obtained results.3 It is, however, increasingly common to include in the NMA output a ranking of the competing interventions for a specific outcome of interest.4 This article focuses on this type of rankings.A hierarchy of treatments (or ranking) is obtained by ordering a specific ranking metric. A ranking metric is a statistic measuring the performance of an intervention and is calculated from the estimated relative treatment effects and their uncertainty in NMA.5 A commonly used ranking metric is the point estimate of the relative treatment effects against a natural common comparator such as placebo. The rankings are unaffected by choice of comparator, so any comparator may be chosen.6 Other commonly used metrics are … ER -