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Many thanks for your prompt and interesting responses on the more general question of discrepancies between large RCT's and meta-analysis. My question is more specifically for a meta-analysis that includes a large RCT with results contradictory to that of the meta-analysis. A current example I have in mind is a RCT on corticosteroids for sepsis (CORTICUS, NEJM 2008) showing no effect on mortality while a subsequent meta-analysis (including this RCT) concluded corticosteroids reduce mortality in sepsis (JAMA 2009). I'm looking for another example to better understand the problem. Sorry for not having being clear enough. Many thanks and best, Mayer Brezis From: [log in to unmask] [mailto:[log in to unmask]] On Behalf Of Dr. Carlos Cuello Sent: Tuesday, January 26, 2010 9:30 PM To: Mayer Brezis Cc: [log in to unmask] Subject: Re: meta-analysis vs. RCT contradictory conclusion Well, not a contradictory result, but different is the CRASH trial on corticosteroids for patients for head trauma injury. All previous meta-analysis were not sufficient for reaching a conclusion on whether to use or not CS, but the large RCT concluded that they increased the risk of death http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)66552-X/fu lltext I´ll keep looking for the contradictory ones Cheers 2010/1/26 Mayer Brezis <[log in to unmask]> Can anyone give me one or more good example(s) of a well done large RCT reaching a conclusion contradictory to a well done meta-analysis (including this RCT) and what are the potential or likely explanations for those discrepancies? Thanks in advance, Mayer Brezis, MD MPH Professor of Medicine Director, Center for Clinical Quality & Safety Hadassah Hebrew University Medical Center Jerusalem, Israel Office phone 02-6777110 Cellular 050-787-4596 Fax 02-643-9730 www.hadassah.org.il/departments/quality -- Carlos A. Cuello-García, MD Director, Centre for Evidence-Based Practice-Tecnologico de Monterrey Cochrane-ITESM coordinator. Professor of Paediatrics and Clinical Research Avda. Morones Prieto 3000 pte. Col. Doctores. CITES 3er. piso,Monterrey NL, México. CP64710 Phone. +52(81)88882154 & 2141. Fax: +52(81)88882148 www.cmbe.net http://twitter.com/CharlieNeck The content of this data transmission must not be considered an offer, proposal, understanding or agreement unless it is confirmed in a document signed by a legal representative of ITESM. The content of this data transmission is confidential and is intended to be delivered only to the addressees. Therefore, it shall not be distributed and/or disclosed through any means without the authorization of the original sender. If you are not the addressee, you are forbidden from using it, either totally or partially, for any purpose