Table 2.

GRADE approach to rate certainty of effect estimates

No of studies	Design	Risk of bias	Inconsistency	Indirectness	Imprecision	Publication bias	Certainty (overall score)*
(a) Primary outcome: MMF effect in %FVC delta difference at follow-up relative to comparators
3	RCTs	Moderate	High inconsistency	Moderate indirectness	High imprecision	Low	⨁〇〇〇 Very Low
(b) Primary outcome: MMF effect in %DLCO delta difference at follow-up relative to comparators
3	RCTs	Moderate	Moderate inconsistency	Moderate indirectness	High imprecision	Low	⨁〇〇〇 Very Low
(c) Secondary outcome: MMF effect in %FVC change from baseline
4	RCTs	Moderate	Moderate inconsistency	Moderate indirectness	High imprecision	Low	⨁〇〇〇 Very Low
(d) Secondary outcome: MMF effect in %DLCO change from baseline
3	RCTs	Moderate	Low inconsistency	Moderate indirectness	High imprecision	Low	⨁〇〇〇 Very Low

*4 ⨁⨁⨁⨁ High=This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different† is low. 3 ⨁⨁⨁〇 Moderate=This research provides a good indication of the likely effect. The likelihood that the effect will be substantially different† is moderate. 2 ⨁⨁〇〇 Low=This research provides some indication of the likely effect. However, the likelihood that it will be substantially different† is high. 1 ⨁〇〇〇 Very low=This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different† is very high.

†Substantially different=a large enough difference that it might affect a decision.

%DL_CO, per cent predicted diffusion lung capacity of carbon monoxide; FVC, forced vital capacity; GRADE, Grading of Recommendations, Assessment, Development and Evaluation; MMF, mycophenolate mofetil; RCT, randomised controlled trial.