Meta-analysis vs. Pivotal Trial

Which is better – a meta-analysis of all good quality evidence, or the results of the most precise trial contributing to that meta-analysis? Of course there can’t be a definitive answer to that question if there is no gold standard. However, a single large trial does produce the more pessimistic evidence on treatment effect on average, according to Berlin and Golub.[1] Given a premise that bias tends towards ‘optimistic’ results, then the large “definitive” trial is the less biased on average.

— Richard Lilford, CLAHRC WM Director


  1. Berlin JA, Golub RM. Meta-analysis as Evidence. Building a Better Pyramid. JAMA. 2014; 312(6): 603-5.

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