The I1 values were 0% for the comparison of GEM/capecitabine versus GEM alone and GEM/cis platin versus GEM alone. In pairwise comparisons, the combination of GEM/capecitabine, GEM/oxaliplatin, PEFG, GEM plus NAB paclitaxel, GEM/erloti nib bevacizumab and FOLFIRINOX were associated with statistically significant hazard ratios for OS over GEM alone. Results from the network meta analysis of the primary outcome The effect estimates from both the fixed and random effects models were comparable and matched closely to the estimates derived from the pairwise comparisons in both direction and magnitude. Figure 3 illustrates the hazard ratios for OS and 95% credible intervals obtained from the indirect comparisons of the included regimens. Following Figure 3 from left to right, FOLFIRINOX. PEFG.
GEM/NAB P. GEM/erloti nib/bevacizumab. GEM/erlotinib. GEM/capecitabine and GEM/oxaliplatin were found to have significantly im proved survival estimates in comparison to GEM alone. FOLFIRINOX was associated with statistically significant hazard ratios for OS relative to fifteen different treatments including GEM alone and the combinations of GEM with oxaliplatin. capecitabine. cisplatin. 5 fluorouacil folinic acid. pemetrexed. irinotecan. exatecan. axinitib. tipifarnib. marimastat and sorafenib. FOLFINOX had a calculated OS gain of 4. 2 months over GEM alone and a median survival advantage of 4 months over the other treatments included in the ana lysis. FOLFIRINOX had a 64. 9% probability of being best for OS. Using the mean rank scale, FOLFIRINOX was ranked first with a mean rank of 1.
5 out of 20 treatments. FOLFIRI NOX was not associated with statistically significant hazard ratios for OS compared to GEM/NAB P, PEFG, nor the combination of GEM/erlotinib/bevicizumab. GEM/NAB P was amongst the top ranked for OS. It was associ ated with a statistically significant benefit in survival over GEM alone . GEM/cisplatin . GEM/5FU/FA . GEM/pemetrexed . GEM/exatecan . GEM/cetuximab and GEM/ sorafenib. GEM/ NAB P had a median increase of OS time of 2. 2 months over GEM alone. PEFG had improved OS with median survival gain of 3 months over GEM alone. It was associated with statistically superior HR over GEM/cetuximab, GEM/irinotecan, GEM/5FU/FA, and GEM/sorafenib. The combination of GEM/erlotinib/bevacizumab was associatedm with improved survival over GEM alone, as well as GEM/irinotecan, GEM/sorafenib, GEM/5FU/FA and GEM/cetuximab.
It was ranked fourth for OS, with a mean rank of 4. 3. GEM/erlotinib was associated with improved survival over GEM alone and over GEM/cetuximab. GEM/capecitabine had statistically longer survival than GEM alone, GEM/sorafenib, GEM/5FU/FA, and GEM/ cetuximab. Drug_discovery It was associated with statistically worse OS compared to FOLFIRINOX. No other significant differences were observed for the remaining combination chemotherapy treatments pre sented in Figure 3.