Meta-analysis · binary outcome

Funnel plot example: magnesium trials and ISIS-4

Funnel plot of 16 trials of intravenous magnesium after heart attack, with Egger’s regression line: small trials showed a benefit that the ISIS-4 mega-trial did not confirm.

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0.11100.00.51.01.52.0Standard errorOdds ratio (log scale)StudiesSummary estimatePseudo 95% confidence limitsEgger’s regression lineEgger’s test: bias = -1.60, t = -5.78, df = 14, P < 0.001Begg’s test: Kendall’s tau = 0.150, P = 0.450
Mortality odds ratios of 16 magnesium trials with pseudo 95% limits and Egger’s regression line.

About this example

An early meta-analysis of small trials suggested that intravenous magnesium halved mortality after myocardial infarction. The ISIS-4 trial, with over 58,000 patients, then found no benefit. Egger, Davey Smith and Altman (2001) used these 16 trials to show how a funnel plot reveals the discrepancy: the small trials sit far to the left of the large one.

Here the fixed-effect summary is drawn with pseudo 95% confidence limits and Egger’s regression line. The line runs from the precise ISIS-4 estimate towards the imprecise small trials, and Egger’s test is highly significant. Bertschat 1989 has a zero cell and gets the usual 0.5 continuity correction, as in metafor.

The data

StudyEvents TTotal TEvents CTotal C
Morton 1984140236
Rasmussen 1986913523135
Smith 198622007200
Abraham 1987148146
Feldstedt 1988101508148
Shechter 1989159956
Ceremuzynski 1989125323
Bertschat 1989022121
Singh 19906761175
Pereira 1990127727
Shechter 19912891280
Golf 19915231333
Thogersen 199141308122
LIMIT-2 19929011591181157
Shechter 1995410717108

…and 1 more row. Open the example to see all of them.

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