{"doi":"10.1093/ije/dyz241","title":"Most recommended medical interventions reach P < 0.005 for their primary outcomes in meta-analyses","abstract":"Background
It has been proposed that the threshold of statistical significance should shift from P-value < 0.05 to P-value < 0.005, but there is concern that this move may dismiss effective, useful interventions. We aimed to assess how often medical interventions are recommended although their evidence in meta-analyses of randomized trials lies between P-value = 0.05 and P-value = 0.005.Methods
We included Cochrane systematic reviews (SRs) published from 1 January 2013 to 30 June 2014 that had at least one meta-analysis with GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessment and at least one primary outcome having favourable results for efficacy at P-value < 0.05. Only comparisons of randomized trials between active versus no treatment/placebo were included. We then assessed the respective UpToDate recommendations for clinical practice from 22 May 2018 to 5 October 2018 and recorded how many treatments were recommended and what were the P-values in their meta-analysis evidence. The primary analysis was based on the first-listed outcomes.Results
Of 608 screened SRs with GRADE assessment, 113 SRs were eligible, including 143 comparisons of which 128 comparisons had first-listed primary outcomes with UpToDate coverage. Altogether, 60% (58/97) of interventions with P-values < 0.005 for their evidence were recommended versus 32% (10/31) of those with P-value 0.005-0.05. Therefore, most (58/68, 85.2%) of the recommended interventions had P-values < 0.005 for the first-listed primary outcome. Of the 10 exceptions, 4 had other primary outcomes with P-values < 0.005 and another 4 had additional extensive evidence for similar indications that would allow extrapolation for practice recommendations.Conclusions
Few interventions are recommended without their evidence from meta-analyses of randomized trials reaching P-value < 0.005.","journal":"International Journal of Epidemiology","year":2019,"id":4118,"datarank":0.6811088165428759,"base_score":2.772588722239781,"endowment":2.772588722239781,"self_citation_contribution":0.41588830833596724,"citation_network_contribution":0.2652205082069087,"self_endowment_contribution":0.41588830833596724,"citer_contribution":0.2652205082069087,"corpus_percentile":null,"corpus_rank":null,"citation_count":15,"citer_count":6,"citers_with_citation_signal":5,"citers_with_endowment":5,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.0465,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2019-11-25","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":679,"name":"Marco Solmi","orcid":"0000-0003-4877-7233","position":1,"is_corresponding":false},{"id":40868,"name":"Nikolaos Pandis","orcid":"0000-0003-0258-468X","position":2,"is_corresponding":false},{"id":40869,"name":"Padhraig S. Fleming","orcid":"0000-0002-5327-2849","position":3,"is_corresponding":false},{"id":20809,"name":"Christoph U. Correll","orcid":"0000-0002-7254-5646","position":4,"is_corresponding":false},{"id":148,"name":"John P. A. Ioannidis","orcid":"0000-0003-3118-6859","position":5,"is_corresponding":false},{"id":40867,"name":"Despina Koletsi","orcid":"0000-0001-6280-9372","position":0,"is_corresponding":true}],"reference_count":49,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-03-01T18:20:47.508186Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}