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urothelial cancer (UC) - bladder cancer (BC), anti-PD-(L)1 versus chemotherapy, meta-analysis of study results

Outcome Relative effect 95%CI LoD Trt. better when I2 k (RCT/OBS) Bayesian probability Overall ROB Publication bias Degree of certainty Endpoint importance Published MA

efficacy endpoints 00

deaths (OS) 0.88 [0.82, 0.95]< 121%7 studies (7/-)99.9 %some concernnot evaluable moderatecrucial-
deaths (OS) (extension) 0.77 [0.66, 0.90]< 138%2 studies (2/-)100.0 %some concernnot evaluable moderateimportant-
PFS (extension) 0.96 [0.79, 1.16]< 10%1 study (1/-)66.1 %NAnot evaluable important-
progression or deaths (PFS) 0.92 [0.76, 1.12]< 178%6 studies (6/-)79.5 %some concernnot evaluable moderateimportant-
CRR 1.96 [1.21, 3.17]> 10%1 study (1/-)99.7 %NAnot evaluable non important-
DOR 0.50 [0.20, 1.24]< 191%5 studies (5/-)93.3 %some concernnot evaluable moderatenon important-
objective responses (ORR) 0.82 [0.50, 1.33]> 193%7 studies (7/-)20.8 %some concernnot evaluable moderatenon important-
objective responses (ORR) (extension) 2.16 [1.34, 3.48]> 10%1 study (1/-)99.9 %NAnot evaluable non important-

safety endpoints 00

AE (any grade) 0.36 [0.15, 0.88]< 162%4 studies (4/-)98.7 %some concernnot evaluable moderatenon important-
AE (grade 3-4) 0.46 [0.23, 0.92]< 195%5 studies (5/-)98.6 %some concernnot evaluable moderatenon important-
AE (grade 3-5) 0.76 [0.19, 3.00]< 196%2 studies (2/-)65.4 %some concernnot evaluable moderatenon important-
AE leading to death (grade 5) 1.78 [1.15, 2.77]< 158%6 studies (6/-)0.5 %some concernnot evaluable moderatenon important-
AE leading to treatment discontinuation (any grade) 0.63 [0.34, 1.17]< 194%7 studies (7/-)92.7 %some concernnot evaluable moderatenon important-
AE leading to treatment discontinuation (grade 3-4) 0.85 [0.44, 1.65]< 10%1 study (1/-)68.1 %NAnot evaluable non important-
SAE (any grade) 0.95 [0.82, 1.10]< 18%4 studies (4/-)75.2 %some concernnot evaluable moderatenon important-
STRAE (any grade) 0.65 [0.41, 1.02]< 189%6 studies (6/-)97.1 %some concernserious moderatenon important-
TRAE (any grade) 0.18 [0.09, 0.35]< 191%6 studies (6/-)100.0 %some concernnot evaluable moderatenon important-
TRAE (grade 3-4) 0.22 [0.09, 0.57]< 198%7 studies (7/-)99.9 %some concernnot evaluable moderatenon important-
TRAE leading to death (grade 5) 0.96 [0.55, 1.71]< 10%7 studies (7/-)54.9 %some concernnot evaluable moderatenon important-
TRAE leading to discontinuation (any grade) 0.36 [0.22, 0.60]< 156%3 studies (3/-)100.0 %some concernnot evaluable moderatenon important-

TRAE (grade 3-4) endpoints 00

Abdominal pain TRAE (grade 3-4) 3.64 [0.16, 81.12]< 10%1 study (1/-)21.0 %NAnot evaluable non important-
Acute kidney injury TRAE (grade 3-4) 0.45 [0.02, 13.55]< 10%1 study (1/-)67.4 %NAnot evaluable non important-
Adrenal insufficiency TRAE (grade 3-4) 1.47 [0.24, 9.04]< 10%4 studies (4/-)34.0 %some concernnot evaluable moderatenon important-
Alopecia TRAE (grade 3-4) 0.60 [0.06, 5.94]< 10%2 studies (2/-)66.8 %some concernnot evaluable moderatenon important-
Anaemia TRAE (grade 3-4) 0.17 [0.06, 0.49]< 193%7 studies (7/-)99.9 %some concernserious moderatenon important-
Arthralgia TRAE (grade 3-4) 0.91 [0.02, 45.86]< 10%1 study (1/-)51.9 %NAnot evaluable non important-
Arthritis TRAE (grade 3-4) 0.91 [0.02, 45.86]< 10%1 study (1/-)51.9 %NAnot evaluable non important-
Asthenia TRAE (grade 3-4) 0.55 [0.27, 1.11]< 157%7 studies (7/-)95.3 %some concernserious moderatenon important-
Blood creatinine increased TRAE (grade 3-4) 0.45 [0.02, 13.55]< 10%1 study (1/-)67.4 %NAnot evaluable non important-
Colitis TRAE (grade 3-4) 3.06 [0.80, 11.68]< 10%4 studies (4/-)5.2 %some concernnot evaluable moderatenon important-
Constipation TRAE (grade 3-4) 0.21 [0.04, 1.05]< 138%5 studies (5/-)97.1 %some concernnot evaluable moderatenon important-
Decreased appetite TRAE (grade 3-4) 0.70 [0.29, 1.68]< 10%6 studies (6/-)78.6 %some concernnot evaluable moderatenon important-
Diabetes TRAE (grade 3-4) 1.68 [0.22, 13.01]< 10%3 studies (3/-)31.2 %some concernnot evaluable moderatenon important-
Diarrhoea TRAE (grade 3-4) 0.96 [0.47, 1.95]< 10%4 studies (4/-)54.5 %some concernnot evaluable moderatenon important-
Dyspnoea TRAE (grade 3-4) 3.64 [0.16, 81.12]< 10%1 study (1/-)21.0 %NAnot evaluable non important-
Fatigue TRAE (grade 3-4) 0.55 [0.29, 1.05]< 145%7 studies (7/-)96.5 %some concernnot evaluable moderatenon important-
Febrile neutropenia TRAE (grade 3-4) 0.06 [0.01, 0.30]< 10%2 studies (2/-)100.0 %some concernnot evaluable moderatenon important-
Gastritis TRAE (grade 3-4) 0.91 [0.02, 45.86]< 10%1 study (1/-)51.9 %NAnot evaluable non important-
Guillain-Barré syndrome TRAE (grade 3-4) 1.82 [0.06, 54.35]< 10%1 study (1/-)36.7 %NAnot evaluable non important-
Hepatitis TRAE (grade 3-4) 3.07 [0.47, 19.99]< 10%3 studies (3/-)12.2 %some concernnot evaluable moderatenon important-
Hypersensitivity TRAE (grade 3-4) 0.45 [0.02, 13.55]< 10%1 study (1/-)67.4 %NAnot evaluable non important-
Hyperthyroidism TRAE (grade 3-4) 1.23 [0.19, 8.07]< 10%4 studies (4/-)41.6 %some concernnot evaluable moderatenon important-
Hypophysitis TRAE (grade 3-4) 2.72 [0.39, 19.09]< 10%3 studies (3/-)15.9 %some concernnot evaluable moderatenon important-
Hypothyroidism TRAE (grade 3-4) 2.25 [0.31, 16.26]< 10%3 studies (3/-)21.2 %some concernnot evaluable moderatenon important-
Increase AST TRAE (grade 3-4) 0.91 [0.13, 6.48]< 10%1 study (1/-)53.9 %NAnot evaluable non important-
Increased ALT TRAE (grade 3-4) 2.74 [0.28, 26.45]< 10%1 study (1/-)19.4 %NAnot evaluable non important-
Increased lipase level TRAE (grade 3-4) 6.46 [0.79, 52.82]< 10%1 study (1/-)4.2 %NAnot evaluable non important-
Infusion-related reactions TRAE (grade 3-4) 0.93 [0.06, 14.94]< 10%2 studies (2/-)52.0 %some concernnot evaluable moderatenon important-
Leucopenia TRAE (grade 3-4) 0.07 [0.00, 1.54]< 184%3 studies (3/-)95.2 %some concernnot evaluable moderatenon important-
Myocarditis TRAE (grade 3-4) 2.19 [0.30, 15.87]< 10%3 studies (3/-)21.9 %some concernnot evaluable moderatenon important-
Myositis TRAE (grade 3-4) 0.98 [0.16, 6.04]< 10%4 studies (4/-)50.8 %some concernnot evaluable moderatenon important-
Nausea TRAE (grade 3-4) 0.50 [0.22, 1.14]< 122%6 studies (6/-)95.0 %some concernnot evaluable moderatenon important-
Nephritis TRAE (grade 3-4) 2.89 [0.57, 14.59]< 10%4 studies (4/-)10.1 %some concernnot evaluable moderatenon important-
Neutropenia TRAE (grade 3-4) 0.08 [0.02, 0.34]< 191%7 studies (7/-)100.0 %some concernserious moderatenon important-
Pancreatitis TRAE (grade 3-4) 2.93 [0.43, 19.90]< 10%3 studies (3/-)13.7 %some concernnot evaluable moderatenon important-
Pancytopenia TRAE (grade 3-4) 0.11 [0.01, 2.13]< 10%1 study (1/-)92.5 %NAnot evaluable non important-
Peripheral neuropathy TRAE (grade 3-4) 0.15 [0.03, 0.83]< 10%2 studies (2/-)98.5 %some concernnot evaluable moderatenon important-
Pneumonitis TRAE (grade 3-4) 4.44 [1.25, 15.74]< 10%4 studies (4/-)1.1 %some concernnot evaluable moderatenon important-
Pruritic rash TRAE (grade 3-4) 0.91 [0.02, 45.86]< 10%1 study (1/-)51.9 %NAnot evaluable non important-
Pruritus TRAE (grade 3-4) 1.64 [0.40, 6.73]< 10%6 studies (6/-)24.7 %some concernnot evaluable moderatenon important-
Pyrexia TRAE (grade 3-4) 0.23 [0.01, 5.02]< 10%1 study (1/-)82.3 %NAnot evaluable non important-
Rash TRAE (grade 3-4) 2.48 [0.66, 9.36]< 10%5 studies (5/-)9.1 %some concernnot evaluable moderatenon important-
Sarcoidosis TRAE (grade 3-4) 1.05 [0.07, 16.88]< 10%2 studies (2/-)48.5 %some concernnot evaluable moderatenon important-
Sepsis TRAE (grade 3-4) 0.91 [0.06, 14.56]< 10%1 study (1/-)52.7 %NAnot evaluable non important-
Severe skin reaction TRAE (grade 3-4) 1.36 [0.32, 5.68]< 141%3 studies (3/-)33.8 %some concernnot evaluable moderatenon important-
Stevens-Johnson syndrome TRAE (grade 3-4) 1.82 [0.06, 54.35]< 10%1 study (1/-)36.7 %NAnot evaluable non important-
Stomatitis TRAE (grade 3-4) 0.91 [0.02, 45.86]< 10%1 study (1/-)51.9 %NAnot evaluable non important-
Thrombocytopenia TRAE (grade 3-4) 0.20 [0.05, 0.71]< 185%5 studies (5/-)99.4 %some concernserious moderatenon important-
Thyroiditis TRAE (grade 3-4) 1.24 [0.19, 8.17]< 10%4 studies (4/-)41.2 %some concernnot evaluable moderatenon important-
Vomiting TRAE (grade 3-4) 0.34 [0.06, 1.92]< 160%3 studies (3/-)88.9 %some concernnot evaluable moderatenon important-

AE (grade 3-4) endpoints 00

Abdominal pain AE (grade 3-4) 0.40 [0.10, 1.58]< 10%1 study (1/-)90.3 %NAnot evaluable non important-
Acute kidney injury AE (grade 3-4) 2.27 [0.58, 8.88]< 10%1 study (1/-)12.0 %NAnot evaluable non important-
Alopecia AE (grade 3-4) 0.16 [0.01, 3.17]< 10%1 study (1/-)88.3 %NAnot evaluable non important-
Anaemia AE (grade 3-4) 0.38 [0.08, 1.85]< 197%3 studies (3/-)88.3 %some concernnot evaluable moderatenon important-
Arthralgia AE (grade 3-4) 0.16 [0.01, 3.17]< 10%1 study (1/-)88.3 %NAnot evaluable non important-
Asthenia AE (grade 3-4) 0.56 [0.18, 1.73]< 181%3 studies (3/-)84.4 %some concernnot evaluable moderatenon important-
Back pain AE (grade 3-4) 1.92 [0.17, 21.35]< 10%1 study (1/-)29.8 %NAnot evaluable non important-
Blood and lymphatic system disorders AE (grade 3-4) 0.24 [0.15, 0.40]< 10%1 study (1/-)100.0 %NAnot evaluable non important-
Blood creatinine increased AE (grade 3-4) 1.92 [0.17, 21.35]< 10%1 study (1/-)29.8 %NAnot evaluable non important-
Cardiac disorders AE (grade 3-4) 0.72 [0.16, 3.23]< 10%1 study (1/-)66.8 %NAnot evaluable non important-
Constipation AE (grade 3-4) 0.35 [0.09, 1.34]< 10%1 study (1/-)93.6 %NAnot evaluable non important-
Cough AE (grade 3-4) 1.92 [0.06, 57.51]< 10%1 study (1/-)35.5 %NAnot evaluable non important-
Decreased appetite AE (grade 3-4) 3.28 [0.89, 12.06]< 10%1 study (1/-)3.7 %NAnot evaluable non important-
Diarrhoea AE (grade 3-4) 0.96 [0.24, 3.87]< 10%1 study (1/-)52.4 %NAnot evaluable non important-
Dizziness AE (grade 3-4) 0.48 [0.02, 14.32]< 10%1 study (1/-)66.2 %NAnot evaluable non important-
Dry skin AE (grade 3-4) 0.96 [0.02, 48.49]< 10%1 study (1/-)50.8 %NAnot evaluable non important-
Dysgeusia AE (grade 3-4) 0.96 [0.02, 48.49]< 10%1 study (1/-)50.8 %NAnot evaluable non important-
Dyspnoea AE (grade 3-4) 1.61 [0.38, 6.80]< 10%1 study (1/-)25.9 %NAnot evaluable non important-
Endocrine disorders AE (grade 3-4) 5.81 [0.29, 116.49]< 10%1 study (1/-)12.8 %NAnot evaluable non important-
Eye disorders AE (grade 3-4) 3.86 [0.17, 85.92]< 10%1 study (1/-)20.0 %NAnot evaluable non important-
Fatigue AE (grade 3-4) 0.48 [0.25, 0.91]< 153%3 studies (3/-)98.8 %some concernnot evaluable moderatenon important-
Febrile neutropenia AE (grade 3-4) 0.16 [0.01, 3.75]< 185%3 studies (3/-)86.8 %some concernnot evaluable moderatenon important-
Gastrointestinal disorders AE (grade 3-4) 0.42 [0.24, 0.75]< 10%1 study (1/-)99.9 %NAnot evaluable non important-
General disorders and administration site conditions AE (grade 3-4) 0.49 [0.28, 0.86]< 10%1 study (1/-)99.4 %NAnot evaluable non important-
Headache AE (grade 3-4) 1.92 [0.06, 57.51]< 10%1 study (1/-)35.5 %NAnot evaluable non important-
Hypertension AE (grade 3-4) 1.16 [0.29, 4.59]< 177%2 studies (2/-)41.4 %some concernnot evaluable moderatenon important-
Hypothyroidism AE (grade 3-4) 0.96 [0.02, 48.49]< 10%1 study (1/-)50.8 %NAnot evaluable non important-
Increase AST AE (grade 3-4) 11.75 [0.65, 211.40]< 10%1 study (1/-)4.9 %NAnot evaluable non important-

LoD: level of statistical demonstration: Statistically conclusive: statistically significant with a strict control of overall risk of type 1 error (statistically demonstrated), does not take into account the risk of bias; suggested: nominally statistically significant but without a strict control of overall risk of type 1 error; inconclusive: not nominally statistically significant; safety concerns;
Bayesian probability: Bayesian posterior probability of treatment effect (computed with a noninformative prior); ROB: risk of bias; k: number of studies; published MA: number of published meta-analysis on the same topic; degree of certainty adapted from GRADE. Trt. better when: indicates when the relative treatment effect shows that the studied treatment is better than control.