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metastatic/adv melanoma (mML), immune chekpoint inhibitors versus immune chekpoint inhibitors, 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) 0.75 [0.65, 0.86]< 162%10 studies (10/-)100.0 %lowlow highcrucial-
deaths (OS) (extension) 0.66 [0.57, 0.77]< 158%5 studies (5/-)100.0 %lownot evaluable highimportant-
MFS 0.73 [0.56, 0.96]< 10%1 study (1/-)98.8 %NAnot evaluable important-
PFS (extension) 0.55 [0.45, 0.67]< 180%6 studies (6/-)100.0 %lownot evaluable highimportant-
progression or deaths (PFS) 0.64 [0.51, 0.80]< 182%8 studies (8/-)100.0 %lownot evaluable highimportant-
RFS (extension) 0.71 [0.59, 0.85]< 10%1 study (1/-)100.0 %NAnot evaluable important-
RFS/DFS 0.57 [0.37, 0.87]< 141%2 studies (2/-)99.5 %lownot evaluable highimportant-
DCR 1.06 [0.82, 1.37]> 110%2 studies (2/-)67.5 %lownot evaluable highnon important-
objective responses (ORR) 2.49 [1.39, 4.46]> 193%9 studies (9/-)99.9 %lownot evaluable highnon important-
objective responses (ORR) (extension) 5.60 [3.83, 8.17]> 165%4 studies (4/-)100.0 %lownot evaluable highnon important-

safety endpoints 00

AE (any grade) 2.25 [0.33, 15.15]< 187%3 studies (3/-)20.4 %lownot evaluable highnon important-
AE (grade 3-4) 1.03 [0.21, 5.01]< 198%3 studies (3/-)48.6 %lownot evaluable highnon important-
AE leading to death (grade 5) 1.35 [0.44, 4.13]< 10%2 studies (2/-)29.8 %some concernnot evaluable moderatenon important-
AE leading to treatment discontinuation (any grade) 1.25 [0.02, 89.58]< 199%2 studies (2/-)46.0 %lownot evaluable highnon important-
AE leading to treatment discontinuation (grade 3-4) 1.09 [0.01, 103.30]< 198%2 studies (2/-)48.6 %lownot evaluable highnon important-
SAE (any grade) 3.69 [1.68, 8.08]< 10%1 study (1/-)0.1 %NAnot evaluable non important-
SAE (grade 3-4) 3.48 [1.58, 7.66]< 10%1 study (1/-)0.1 %NAnot evaluable non important-
STRAE (any grade) 1.26 [0.42, 3.80]< 191%3 studies (3/-)34.1 %some concernnot evaluable moderatenon important-
STRAE (grade 3-4) 4.03 [1.73, 9.38]< 10%3 studies (3/-)0.1 %lownot evaluable highnon important-
TRAE (any grade) 1.55 [0.94, 2.54]< 188%10 studies (10/-)4.2 %lowlow highnon important-
TRAE (grade 3-4) 1.61 [0.76, 3.40]< 197%10 studies (10/-)10.6 %lowlow highnon important-
TRAE leading to death (grade 5) 1.18 [0.40, 3.47]< 10%8 studies (8/-)38.2 %lownot evaluable highnon important-
TRAE leading to discontinuation (any grade) 1.69 [0.68, 4.23]< 197%9 studies (9/-)13.1 %lownot evaluable highnon important-
TRAE leading to discontinuation (grade 3-4) 1.66 [0.58, 4.75]< 196%9 studies (9/-)17.3 %lownot evaluable highnon important-

TRAE (grade 3-4) endpoints 00

Abdominal pain TRAE (grade 3-4) 0.58 [0.18, 1.87]< 10%8 studies (8/-)81.9 %lownot evaluable highnon important-
Acute kidney injury TRAE (grade 3-4) 2.06 [0.07, 62.55]< 10%1 study (1/-)34.2 %NAnot evaluable non important-
Adrenal insufficiency TRAE (grade 3-4) 1.48 [0.67, 3.29]< 10%8 studies (8/-)16.7 %lownot evaluable highnon important-
Alopecia TRAE (grade 3-4) 0.95 [0.10, 9.21]< 10%3 studies (3/-)51.6 %some concernnot evaluable moderatenon important-
Anaemia TRAE (grade 3-4) 1.34 [0.24, 7.35]< 10%3 studies (3/-)36.9 %some concernnot evaluable moderatenon important-
Arthralgia TRAE (grade 3-4) 1.00 [0.34, 3.00]< 10%8 studies (8/-)49.7 %lownot evaluable highnon important-
Asthenia TRAE (grade 3-4) 0.43 [0.16, 1.15]< 10%7 studies (7/-)95.3 %lownot evaluable highnon important-
Blood and lymphatic system disorders TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Chills TRAE (grade 3-4) 0.81 [0.11, 5.75]< 10%4 studies (4/-)58.5 %some concernnot evaluable moderatenon important-
Colitis TRAE (grade 3-4) 0.94 [0.41, 2.18]< 183%9 studies (9/-)55.7 %lownot evaluable highnon important-
Constipation TRAE (grade 3-4) 0.94 [0.11, 8.13]< 10%3 studies (3/-)52.1 %some concernnot evaluable moderatenon important-
Cough TRAE (grade 3-4) 0.98 [0.23, 4.22]< 10%6 studies (6/-)51.2 %lownot evaluable highnon important-
Decreased appetite TRAE (grade 3-4) 1.85 [0.55, 6.30]< 10%7 studies (7/-)16.2 %lowserious highnon important-
Diabetes TRAE (grade 3-4) 1.24 [0.17, 8.83]< 10%3 studies (3/-)41.6 %lownot evaluable highnon important-
Diarrhoea TRAE (grade 3-4) 0.88 [0.47, 1.65]< 179%10 studies (10/-)65.4 %lowlow highnon important-
Dizziness TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Dry skin TRAE (grade 3-4) 1.29 [0.63, 2.67]< 10%6 studies (6/-)24.3 %lowserious highnon important-
Dysgeusia TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Dyspepsia TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Dyspnoea TRAE (grade 3-4) 1.94 [0.63, 6.00]< 10%7 studies (7/-)12.6 %lownot evaluable highnon important-
Ear and labyrinth disorders TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Endocrine disorders TRAE (grade 3-4) 1.31 [0.39, 4.40]< 166%4 studies (4/-)33.3 %lownot evaluable highnon important-
Eye disorders TRAE (grade 3-4) 1.01 [0.09, 11.20]< 10%2 studies (2/-)49.8 %lownot evaluable highnon important-
Fatigue TRAE (grade 3-4) 1.59 [0.74, 3.42]< 132%8 studies (8/-)11.8 %lownot evaluable highnon important-
Febrile neutropenia TRAE (grade 3-4) 3.99 [0.18, 88.89]< 10%1 study (1/-)19.4 %NAnot evaluable non important-
Gastritis TRAE (grade 3-4) 4.19 [0.18, 95.03]< 10%1 study (1/-)18.7 %NAnot evaluable non important-
Gastrointestinal disorders TRAE (grade 3-4) 1.06 [0.28, 4.07]< 193%5 studies (5/-)46.4 %lownot evaluable highnon important-
General disorders and administration site conditions TRAE (grade 3-4) 4.19 [0.18, 95.03]< 10%1 study (1/-)18.7 %NAnot evaluable non important-
Guillain-Barré syndrome TRAE (grade 3-4) 3.99 [0.18, 88.89]< 10%1 study (1/-)19.4 %NAnot evaluable non important-
Headache TRAE (grade 3-4) 0.82 [0.28, 2.36]< 10%8 studies (8/-)64.6 %lownot evaluable highnon important-
Hepatitis TRAE (grade 3-4) 3.26 [1.50, 7.12]< 10%9 studies (9/-)0.1 %lownot evaluable highnon important-
Hepatobiliary disorders TRAE (grade 3-4) 2.30 [0.16, 33.53]< 189%4 studies (4/-)27.4 %lownot evaluable highnon important-
Hypersensitivity TRAE (grade 3-4) 3.72 [0.39, 35.19]< 10%2 studies (2/-)12.8 %lownot evaluable highnon important-
Hypertension TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Hyperthyroidism TRAE (grade 3-4) 1.74 [0.55, 5.45]< 10%8 studies (8/-)17.2 %lownot evaluable highnon important-
Hypophysitis TRAE (grade 3-4) 0.65 [0.34, 1.23]< 121%10 studies (10/-)90.7 %lowlow highnon important-
Hypothyroidism TRAE (grade 3-4) 1.03 [0.35, 3.03]< 10%10 studies (10/-)47.5 %lowlow highnon important-
Increase AST TRAE (grade 3-4) 1.80 [0.59, 5.47]< 171%10 studies (10/-)15.0 %lowlow highnon important-
Increased ALT TRAE (grade 3-4) 1.92 [0.65, 5.63]< 180%10 studies (10/-)11.8 %lowlow highnon important-
Increased lipase level TRAE (grade 3-4) 2.32 [1.59, 3.39]< 10%6 studies (6/-)0.0 %lownot evaluable highnon important-
Infusion-related reactions TRAE (grade 3-4) 2.37 [0.21, 27.07]< 10%2 studies (2/-)24.6 %lownot evaluable highnon important-
Leucopenia TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Maculopapular rash TRAE (grade 3-4) 1.68 [0.70, 4.02]< 15%9 studies (9/-)12.2 %lownot evaluable highnon important-
Metabolism and nutrition disorders TRAE (grade 3-4) 1.02 [0.06, 16.70]< 10%1 study (1/-)49.5 %NAnot evaluable non important-
Musculoskeletal and connective tissue disorders TRAE (grade 3-4) 0.16 [0.01, 3.31]< 10%1 study (1/-)87.9 %NAnot evaluable non important-
Myalgia TRAE (grade 3-4) 0.91 [0.27, 3.09]< 10%7 studies (7/-)56.0 %lownot evaluable highnon important-
Myositis TRAE (grade 3-4) 0.95 [0.10, 9.21]< 10%3 studies (3/-)51.6 %some concernnot evaluable moderatenon important-
Nausea TRAE (grade 3-4) 1.86 [0.70, 4.97]< 10%8 studies (8/-)10.9 %lownot evaluable highnon important-
Nephritis TRAE (grade 3-4) 0.46 [0.04, 5.09]< 10%2 studies (2/-)73.5 %some concernnot evaluable moderatenon important-
Nervous system disorders TRAE (grade 3-4) 1.76 [0.12, 26.45]< 151%2 studies (2/-)34.3 %lownot evaluable highnon important-
Neutropenia TRAE (grade 3-4) 0.95 [0.10, 9.21]< 10%3 studies (3/-)51.6 %some concernnot evaluable moderatenon important-
Palmar-plantar erythrodysaesthesia syndrome TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Pancreatitis TRAE (grade 3-4) 1.50 [0.11, 19.59]< 10%2 studies (2/-)38.0 %lownot evaluable highnon important-
Pancytopenia TRAE (grade 3-4) 1.99 [0.07, 59.56]< 10%1 study (1/-)34.8 %NAnot evaluable non important-
Paraesthesia TRAE (grade 3-4) 0.57 [0.07, 4.44]< 10%3 studies (3/-)70.3 %some concernnot evaluable moderatenon important-
Pericarditis TRAE (grade 3-4) 1.99 [0.07, 59.56]< 10%1 study (1/-)34.8 %NAnot evaluable non important-
Peripheral neuropathy TRAE (grade 3-4) 2.96 [0.30, 29.40]< 10%2 studies (2/-)17.9 %lownot evaluable highnon important-
Pneumonitis TRAE (grade 3-4) 1.72 [0.66, 4.49]< 10%8 studies (8/-)13.5 %lownot evaluable highnon important-
Polymyalgia Rheumatica TRAE (grade 3-4) 0.50 [0.02, 14.85]< 10%1 study (1/-)65.5 %NAnot evaluable non important-
Pruritic rash TRAE (grade 3-4) 0.78 [0.18, 3.32]< 10%7 studies (7/-)63.1 %lownot evaluable highnon important-
Pruritus TRAE (grade 3-4) 1.44 [0.60, 3.45]< 10%10 studies (10/-)20.5 %lowlow highnon important-
Pyrexia TRAE (grade 3-4) 1.48 [0.49, 4.49]< 10%8 studies (8/-)24.6 %lownot evaluable highnon important-
Rash TRAE (grade 3-4) 1.35 [0.56, 3.28]< 147%9 studies (9/-)25.1 %lownot evaluable highnon important-
Renal and urinary disorders TRAE (grade 3-4) 0.99 [0.08, 12.98]< 10%2 studies (2/-)50.3 %lownot evaluable highnon important-
Respiratory, thoracic and mediastinal disorders TRAE (grade 3-4) 1.15 [0.22, 6.12]< 123%4 studies (4/-)43.4 %lownot evaluable highnon important-
Sarcoidosis TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Skin and subcutaneous tissue disorders TRAE (grade 3-4) 1.23 [0.32, 4.75]< 174%5 studies (5/-)38.4 %lowserious highnon important-
Stomatitis TRAE (grade 3-4) 1.02 [0.02, 52.25]< 10%1 study (1/-)49.6 %NAnot evaluable non important-
Thrombocytopenia TRAE (grade 3-4) 2.06 [0.07, 62.55]< 10%1 study (1/-)34.2 %NAnot evaluable non important-
Thyroiditis TRAE (grade 3-4) 1.59 [0.32, 7.89]< 10%5 studies (5/-)28.6 %lowserious highnon important-
Uveitis TRAE (grade 3-4) 0.78 [0.12, 5.14]< 10%4 studies (4/-)60.2 %lownot evaluable highnon important-
Vitiligo TRAE (grade 3-4) 0.77 [0.17, 3.50]< 10%6 studies (6/-)63.4 %lownot evaluable highnon 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.