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metastatic/adv melanoma (mML), immune chekpoint inhibitors versus placebo, 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) 0.72 [0.58, 0.89]< 10%1 study (1/-)99.9 %NAnot evaluable crucial-
deaths (OS) (extension) 0.73 [0.64, 0.83]< 10%1 study (1/-)100.0 %NAnot evaluable important-
MFS 0.66 [0.46, 0.93]< 167%2 studies (2/-)99.1 %lownot evaluable highimportant-
MFS (extension) 0.76 [0.64, 0.90]< 10%1 study (1/-)99.9 %NAnot evaluable important-
RFS (extension) 0.65 [0.49, 0.87]< 181%2 studies (2/-)99.8 %lownot evaluable highimportant-
RFS/DFS 0.54 [0.37, 0.77]< 178%4 studies (4/-)100.0 %lownot evaluable highimportant-
DMFS 0.60 [0.49, 0.73]< 10%1 study (1/-)100.0 %NAnot evaluable non important-

safety endpoints 00

AE (any grade) 3.23 [0.67, 15.56]< 190%2 studies (2/-)7.3 %lownot evaluable highnon important-
AE (grade 3-4) 0.48 [0.03, 8.11]< 199%2 studies (2/-)69.1 %lownot evaluable highnon important-
AE leading to death (grade 5) 0.93 [0.06, 15.01]< 10%2 studies (2/-)52.1 %lownot evaluable highnon important-
AE leading to treatment discontinuation (any grade) 12.12 [1.15, 128.21]< 178%2 studies (2/-)2.0 %lownot evaluable highnon important-
AE leading to treatment discontinuation (grade 3-4) 17.04 [1.57, 184.53]< 161%2 studies (2/-)1.0 %lownot evaluable highnon important-
SAE (any grade) 2.40 [0.69, 8.40]< 179%2 studies (2/-)8.6 %lownot evaluable highnon important-
SAE (grade 3-4) 4.71 [1.39, 15.99]< 168%2 studies (2/-)0.7 %lownot evaluable highnon important-
STRAE (any grade) 14.61 [2.72, 78.57]< 158%2 studies (2/-)0.1 %lownot evaluable highnon important-
STRAE (grade 3-4) 42.30 [5.62, 318.55]< 10%2 studies (2/-)0.0 %lownot evaluable highnon important-
TRAE (any grade) 8.76 [4.52, 17.01]< 180%4 studies (4/-)0.0 %lownot evaluable highnon important-
TRAE (grade 3-4) 17.87 [8.78, 36.39]< 146%4 studies (4/-)0.0 %lownot evaluable highnon important-
TRAE leading to death (grade 5) 2.63 [0.47, 14.86]< 10%4 studies (4/-)13.8 %lownot evaluable highnon important-
TRAE leading to discontinuation (any grade) 22.32 [9.86, 50.54]< 123%3 studies (3/-)0.0 %lownot evaluable highnon important-
TRAE leading to discontinuation (grade 3-4) 34.42 [3.18, 372.75]< 127%2 studies (2/-)0.2 %lownot evaluable highnon important-

TRAE (grade 3-4) endpoints 00

Abdominal pain TRAE (grade 3-4) 0.92 [0.06, 14.87]< 10%2 studies (2/-)52.4 %lownot evaluable highnon important-
Acute kidney injury TRAE (grade 3-4) 1.37 [0.10, 18.13]< 10%2 studies (2/-)40.6 %lownot evaluable highnon important-
Adrenal insufficiency TRAE (grade 3-4) 1.57 [0.20, 12.24]< 10%3 studies (3/-)33.5 %lownot evaluable highnon important-
Alopecia TRAE (grade 3-4) 0.92 [0.06, 14.87]< 10%2 studies (2/-)52.4 %lownot evaluable highnon important-
Anaemia TRAE (grade 3-4) 1.37 [0.10, 18.13]< 10%2 studies (2/-)40.6 %lownot evaluable highnon important-
Arthralgia TRAE (grade 3-4) 3.26 [0.49, 21.69]< 10%3 studies (3/-)11.2 %lownot evaluable highnon important-
Blood and lymphatic system disorders TRAE (grade 3-4) 3.50 [0.36, 33.64]< 10%2 studies (2/-)14.0 %lownot evaluable highnon important-
Blood creatinine increased TRAE (grade 3-4) 0.92 [0.06, 14.87]< 10%2 studies (2/-)52.4 %lownot evaluable highnon important-
Chills TRAE (grade 3-4) 0.92 [0.06, 14.87]< 10%2 studies (2/-)52.4 %lownot evaluable highnon important-
Colitis TRAE (grade 3-4) 11.79 [3.23, 43.04]< 18%4 studies (4/-)0.0 %lownot evaluable highnon important-
Cough TRAE (grade 3-4) 0.92 [0.06, 14.87]< 10%2 studies (2/-)52.4 %lownot evaluable highnon important-
Decreased appetite TRAE (grade 3-4) 0.92 [0.06, 14.87]< 10%2 studies (2/-)52.4 %lownot evaluable highnon important-
Diabetes TRAE (grade 3-4) 3.28 [0.48, 22.60]< 10%3 studies (3/-)11.5 %lownot evaluable highnon important-
Diarrhoea TRAE (grade 3-4) 3.97 [0.63, 25.09]< 166%4 studies (4/-)7.2 %lownot evaluable highnon important-
Dizziness TRAE (grade 3-4) 0.92 [0.06, 14.87]< 10%2 studies (2/-)52.4 %lownot evaluable highnon important-
Dry skin TRAE (grade 3-4) 0.92 [0.06, 14.87]< 10%2 studies (2/-)52.4 %lownot evaluable highnon important-
Dysgeusia TRAE (grade 3-4) 0.92 [0.06, 14.87]< 10%2 studies (2/-)52.4 %lownot evaluable highnon important-
Dyspepsia TRAE (grade 3-4) 0.92 [0.06, 14.87]< 10%2 studies (2/-)52.4 %lownot evaluable highnon important-
Dyspnoea TRAE (grade 3-4) 1.25 [0.14, 10.76]< 10%3 studies (3/-)42.0 %lownot evaluable highnon important-
Ear and labyrinth disorders TRAE (grade 3-4) 0.93 [0.02, 47.58]< 10%1 study (1/-)51.5 %NAnot evaluable non important-
Endocrine disorders TRAE (grade 3-4) 16.68 [4.47, 62.16]< 10%4 studies (4/-)0.0 %lownot evaluable highnon important-
Eye disorders TRAE (grade 3-4) 1.37 [0.10, 18.13]< 10%2 studies (2/-)40.6 %lownot evaluable highnon important-
Fatigue TRAE (grade 3-4) 0.92 [0.06, 14.87]< 10%2 studies (2/-)52.4 %lownot evaluable highnon important-
Gastritis TRAE (grade 3-4) 2.19 [0.19, 25.33]< 10%2 studies (2/-)26.6 %lownot evaluable highnon important-
Gastrointestinal disorders TRAE (grade 3-4) 11.22 [4.04, 31.14]< 124%4 studies (4/-)0.0 %lownot evaluable highnon important-
General disorders and administration site conditions TRAE (grade 3-4) 2.19 [0.19, 25.33]< 10%2 studies (2/-)26.6 %lownot evaluable highnon important-
Headache TRAE (grade 3-4) 0.92 [0.06, 14.87]< 10%2 studies (2/-)52.4 %lownot evaluable highnon important-
Hepatitis TRAE (grade 3-4) 7.04 [1.58, 31.38]< 10%3 studies (3/-)0.5 %lownot evaluable highnon important-
Hepatobiliary disorders TRAE (grade 3-4) 26.18 [5.91, 115.97]< 15%3 studies (3/-)0.0 %lownot evaluable highnon important-
Hypertension TRAE (grade 3-4) 0.92 [0.06, 14.87]< 10%2 studies (2/-)52.4 %lownot evaluable highnon important-
Hyperthyroidism TRAE (grade 3-4) 2.57 [0.36, 18.21]< 10%3 studies (3/-)17.4 %lownot evaluable highnon important-
Hypophysitis TRAE (grade 3-4) 6.32 [1.18, 33.82]< 18%4 studies (4/-)1.6 %lownot evaluable highnon important-
Hypothyroidism TRAE (grade 3-4) 0.94 [0.10, 9.11]< 10%3 studies (3/-)52.1 %lownot evaluable highnon important-
Increase AST TRAE (grade 3-4) 10.16 [1.26, 81.81]< 10%2 studies (2/-)1.5 %lownot evaluable highnon important-
Increased ALT TRAE (grade 3-4) 14.02 [1.76, 111.54]< 10%2 studies (2/-)0.7 %lownot evaluable highnon important-
Increased lipase level TRAE (grade 3-4) 1.72 [0.60, 4.99]< 10%2 studies (2/-)15.8 %lownot evaluable highnon important-
Infusion-related reactions TRAE (grade 3-4) 0.92 [0.06, 14.87]< 10%2 studies (2/-)52.4 %lownot evaluable highnon important-
Leucopenia TRAE (grade 3-4) 0.92 [0.06, 14.87]< 10%2 studies (2/-)52.4 %lownot evaluable highnon important-
Maculopapular rash TRAE (grade 3-4) 1.37 [0.10, 18.13]< 10%2 studies (2/-)40.6 %lownot evaluable highnon important-
Metabolism and nutrition disorders TRAE (grade 3-4) 1.85 [0.17, 20.75]< 10%2 studies (2/-)31.0 %lownot evaluable highnon important-
Musculoskeletal and connective tissue disorders TRAE (grade 3-4) 2.92 [0.27, 32.01]< 10%2 studies (2/-)19.2 %lownot evaluable highnon important-
Myalgia TRAE (grade 3-4) 1.37 [0.10, 18.08]< 10%2 studies (2/-)40.7 %lownot evaluable highnon important-
Myocarditis TRAE (grade 3-4) 1.97 [0.07, 58.99]< 10%1 study (1/-)34.9 %NAnot evaluable non important-
Myositis TRAE (grade 3-4) 0.94 [0.10, 9.11]< 10%3 studies (3/-)52.1 %lownot evaluable highnon important-
Nausea TRAE (grade 3-4) 0.94 [0.10, 9.11]< 10%3 studies (3/-)52.1 %lownot evaluable highnon important-
Nephritis TRAE (grade 3-4) 3.96 [0.18, 87.96]< 10%1 study (1/-)19.5 %NAnot evaluable non important-
Nervous system disorders TRAE (grade 3-4) 5.81 [0.97, 34.87]< 10%3 studies (3/-)2.8 %lownot evaluable highnon important-
Neutropenia TRAE (grade 3-4) 0.92 [0.06, 14.87]< 10%2 studies (2/-)52.4 %lownot evaluable highnon important-
Palmar-plantar erythrodysaesthesia syndrome TRAE (grade 3-4) 0.92 [0.06, 14.87]< 10%2 studies (2/-)52.4 %lownot evaluable highnon important-
Pancreatitis TRAE (grade 3-4) 0.95 [0.13, 6.79]< 10%3 studies (3/-)52.0 %lownot evaluable highnon important-
Paraesthesia TRAE (grade 3-4) 0.92 [0.06, 14.87]< 10%2 studies (2/-)52.4 %lownot evaluable highnon important-
Peripheral neuropathy TRAE (grade 3-4) 1.37 [0.10, 18.13]< 10%2 studies (2/-)40.6 %lownot evaluable highnon important-
Pneumonitis TRAE (grade 3-4) 2.55 [0.34, 19.24]< 10%3 studies (3/-)18.4 %lownot evaluable highnon important-
Pruritus TRAE (grade 3-4) 0.94 [0.10, 9.11]< 10%3 studies (3/-)52.1 %lownot evaluable highnon important-
Pyrexia TRAE (grade 3-4) 2.19 [0.19, 25.33]< 10%2 studies (2/-)26.6 %lownot evaluable highnon important-
Rash TRAE (grade 3-4) 5.08 [0.56, 46.30]< 10%2 studies (2/-)7.6 %lownot evaluable highnon important-
Respiratory, thoracic and mediastinal disorders TRAE (grade 3-4) 2.55 [0.34, 19.24]< 10%3 studies (3/-)18.4 %lownot evaluable highnon important-
Sarcoidosis TRAE (grade 3-4) 0.94 [0.10, 9.11]< 10%3 studies (3/-)52.1 %lownot evaluable highnon important-
Severe skin reaction TRAE (grade 3-4) 5.95 [0.30, 119.02]< 10%1 study (1/-)12.5 %NAnot evaluable non important-
Skin and subcutaneous tissue disorders TRAE (grade 3-4) 6.71 [1.40, 32.05]< 10%4 studies (4/-)0.9 %lownot evaluable highnon important-
Stomatitis TRAE (grade 3-4) 0.92 [0.06, 14.87]< 10%2 studies (2/-)52.4 %lownot evaluable highnon important-
Thrombocytopenia TRAE (grade 3-4) 1.37 [0.10, 18.13]< 10%2 studies (2/-)40.6 %lownot evaluable highnon important-
Thyroiditis TRAE (grade 3-4) 0.94 [0.10, 9.11]< 10%3 studies (3/-)52.1 %lownot evaluable highnon important-
Uveitis TRAE (grade 3-4) 0.94 [0.10, 9.11]< 10%3 studies (3/-)52.1 %lownot evaluable highnon important-
Vitiligo TRAE (grade 3-4) 0.94 [0.10, 9.11]< 10%3 studies (3/-)52.1 %lownot evaluable highnon important-
Vomiting TRAE (grade 3-4) 0.92 [0.06, 14.87]< 10%2 studies (2/-)52.4 %lownot evaluable highnon important-
Weight decreased TRAE (grade 3-4) 0.92 [0.06, 14.87]< 10%2 studies (2/-)52.4 %lownot evaluable highnon important-

AE (grade 3-4) endpoints 00

Abdominal pain AE (grade 3-4) 0.04 [0.01, 0.17]< 10%1 study (1/-)100.0 %NAnot evaluable non important-
Colitis AE (grade 3-4) 6.26 [2.61, 15.03]< 10%1 study (1/-)0.0 %NAnot evaluable non important-
Cough AE (grade 3-4) 0.01 [0.00, 0.15]< 10%1 study (1/-)99.9 %NAnot evaluable non important-
Decreased appetite AE (grade 3-4) 0.06 [0.01, 0.46]< 10%1 study (1/-)99.6 %NAnot evaluable non important-
Diarrhoea AE (grade 3-4) 0.26 [0.18, 0.37]< 10%1 study (1/-)100.0 %NAnot evaluable non important-
Fatigue AE (grade 3-4) 0.05 [0.03, 0.10]< 10%1 study (1/-)100.0 %NAnot evaluable non important-
Headache AE (grade 3-4) 0.04 [0.01, 0.11]< 10%1 study (1/-)100.0 %NAnot evaluable non important-
Hypophysitis AE (grade 3-4) 11.01 [2.57, 47.24]< 10%1 study (1/-)0.1 %NAnot evaluable non important-
Hypothyroidism AE (grade 3-4) 0.14 [0.02, 1.16]< 10%1 study (1/-)96.5 %NAnot evaluable non important-
Increase AST AE (grade 3-4) 0.80 [0.45, 1.45]< 10%1 study (1/-)76.6 %NAnot evaluable non important-
Increased ALT AE (grade 3-4) 0.97 [0.55, 1.70]< 10%1 study (1/-)54.8 %NAnot evaluable non important-
Nausea AE (grade 3-4) 0.01 [0.00, 0.07]< 10%1 study (1/-)100.0 %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.