ArticlePloS one2026
Methodological quality of systematic reviews and meta-analyses of rheumatoid arthritis pharmacotherapy: A protocol for a meta-epidemiological study using AMSTAR 2.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
5 authors.
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Abstract
backgroundWith the exponential growth of systematic reviews and meta-analyses on RA pharmacotherapy, a comprehensive and up-to-date assessment of methodological quality is urgently needed to gauge the credibility of this evidence base.
objectiveThis protocol describes a meta-epidemiological study that will systematically appraise the methodological quality of published systematic reviews and meta-analyses of RA pharmacotherapy (csDMARDs, bDMARDs, and tsDMARDs) using the AMSTAR 2 instrument and explore study-level factors associated with methodological quality.
methodsWe will systematically search PubMed, Embase, the Cochrane Library and three Chinese databases-China National Knowledge Infrastructure (CNKI), Wanfang Data and China Science and Technology Journal Database-from inception to June 1, 2026. Two independent reviewers will screen studies, extract data and assess methodological quality using the AMSTAR 2 instrument; an overall rating (high, moderate, low, critically low) will be derived for each review. Binary logistic regression comparing "Adequate" (High/Moderate) versus "Inadequate" (Low/Critically Low) reviews will be used for the primary analysis, with ordinal logistic regression fitted as a pre-specified exploratory analysis; pre-specified sensitivity and robustness analyses (including penalized and Bayesian estimation for sparse categories) will test the stability of findings.
resultsThe results will provide a descriptive overview of the methodological quality landscape, highlighting common strengths and critical weaknesses across published RA meta-analyses. The regression analysis will quantify the relationship between specific study characteristics and methodological quality.
conclusionThis study will provide a comprehensive, cross-drug-class AMSTAR 2-based methodological assessment of the RA pharmacotherapy evidence-synthesis field, complementing prior appraisals limited to specific complementary or single-agent interventions. The findings will offer clinicians and guideline developers a graded framework for judging evidence credibility and will provide empirical, actionable guidance for researchers to enhance the design, conduct, and reporting of future systematic reviews in RA.
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