Summary of findings 2. Anti‐PD1 monoclonal antibodies versus anti‐CTLA4 monoclonal antibodies.
| Anti‐PD1 monoclonal antibodies compared with anti‐CTLA4 monoclonal antibodies for the treatment of metastatic melanoma | ||||||
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Patient or population: people with cutaneous melanoma Settings: hospital (metastatic disease) Intervention: anti‐PD1 monoclonal antibodies Comparison: anti‐CTLA4 monoclonal antibodies | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Anti‐CTLA4 | Anti‐PD1 | |||||
| Overall survival† | 600 per 1000† | 438 per 1000† (423 to 454) |
HR 0.63 (0.60 to 0.66) |
N = 764 (n = 1) | ⊕⊕⊕⊕ higha | ‐ |
| Progression‐free survival† | 850 per 1000† | 641 per 1000† (612 to 679) |
HR 0.54 (0.50 to 0.60) |
n = 1465 (n = 2) | ⊕⊕⊕⊕ higha | ‐ |
| Tumour response | 157 per 1000 | 388 per 1000 (315 to 477) |
RR 2.47 (2.01 to 3.04) |
N = 1465 (n = 2) | ⊕⊕⊕⊕ higha | ‐ |
| Toxicity (≥ G3) | 398 per 1000 | 278 per 1000 (215 to 362) |
RR 0.70 (0.54 to 0.91) |
N = 1465 (n = 2) | ⊕⊕⊝⊝ lowb | ‐ |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). † Numbers presented refer to event rates (i.e. death rates and progression rates). CI: confidence interval; RR: risk ratio; HR: hazard ratio. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
Assumed risk in the control population: 1‐year overall survival rate = 40%.
Assumed risk in the control population: 1‐year progression‐free survival rate = 15%.
Assumed risk in the control population: tumour response rate across control arms of included trials.
Assumed risk in the control population: toxicity rate across control arms of included trials.
a Not downgraded: high‐quality evidence.
b Downgraded by two levels: inconsistency (between‐study heterogeneity) and imprecision (CI includes both a meaningful benefit (relative risk reduction > 25%) and a small/null benefit (relative risk reduction < 10%).