Is there any similarity between Uncle Scrooge and the pharmaceutical companies in anesthesia clinical outcomes? A systematic survey




Poster session 1 Wednesday: Evidence production and synthesis


Wednesday 13 September 2017 - 12:30 to 14:00


All authors in correct order:

El Dib R1, Gameiro M2, Petenati da Rovare V2, Módulo N2
1 Institute of Science and Technology, Unesp—Univ Estadual Paulista, São José dos Campos, Brazil, Brazil
2 Department of Anaesthesiology, Botucatu Medical School, Unesp – Univ Estadual Paulista, São Paulo, Brazil
Presenting author and contact person

Presenting author:

Regina El Dib

Contact person:

Abstract text
Background: There is evidence in the literature that research sponsored by the pharmaceutical industry is more likely to have favourable outcomes.

Objectives: To determine whether there is an overestimation of the true intervention effect in clinical trials sponsored by pharmaceutical companies compared to non-industry-sponsored studies in anaesthesia clinical outcomes.

Methods: We searched Medline, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and LILACS for randomised-controlled trials comparing inhalation versus intravenous anaesthetics for adults undergoing on-pump or off-pump coronary artery bypass grafting that reported mortality within 180 days of surgery and/or use of inotropes. Studies should have also reported the funding source.

Results: Twelve studies (n=1782 participants) were included. Pooled estimates of 7 RCTs suggested a significantly increased risk of mortality on studies sponsored by pharmaceutical companies [Relative risk (RR) 0.45, 95% confidence interval (CI) 0.23 to 0.89; I2 = 2%; p = 0.02] versus non-industry-sponsored studies (RR 0.21, 95% CI 0.01 to 4.24; I2 = not applicable; p = 0.31). Estimates of the use of inotropes suggested similar results (RR 0.71, 95% CI 0.48, 1.06; I2 = 27%; p = 0.09 versus; RR 0.77, 95% CI 0.47 to 1.26; I2 = 74%; p = 0.30, respectively), although there is a larger absolute risk reduction (ARR) in the studies sponsored by pharmaceutical companies (29%) compared to those non-industry-sponsored (23%).

Conclusions: There is a similarity between drug companies and Uncle Scrooge related to some economic interests that can cause biased actions. Like Uncle Scrooge, who sometimes takes questionable paths to get to his money, pharmaceutical companies may be using overestimation of the magnitude of treatment effects on their clinical trials. Current evidence is not definitive nor generally realistic, and more careful research is warranted to verify this tendency in other medical areas.