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Research and evaluation

Cochrane launches 'urgent' investigation of HPV vaccine review

Critics have said that a Cochrane human papilloma virus vaccine review did not include all the relevant trials and ignored possible sources of bias, prompting the editor-in-chief to initiate an urgent update.

An ‘urgent’ investigation is being launched by Cochrane into its review of human papilloma virus (HPV) vaccine safety after criticisms from researchers about its findings.

According to BMJ Evidence Based Medicine, a Cochrane HPV vaccine review, published in May 2017, which had given the all-clear to vaccines designed to prevent cervical cancer, did not include all the relevant trials and ignored possible sources of bias. Critics said the review “failed to meet the needs of citizens or healthcare providers who rely on Cochrane reviews”.

The review based its conclusions on 26 studies involving 73,428 women. But it could have included as many as 46 trials involving more than 120,000 women, according to researchers Lars Jørgensen and Peter Gøtzsche from the Nordic Cochrane Centre in Copenhagen, and Tom Jefferson of the Centre for Evidence Based Medicine in Oxford.

The Cochrane research concluded that the vaccines are effective against precancerous changes that lead to cervical cancer and that the risk of side effects is no greater in the vaccinated than in the control groups.

Writing in BMJ Evidence Based Medicine on 9 August 2018, the three critics said that the HPV vaccine review fell short of Cochrane standards because it was influenced by reporting bias and biased trial designs, and “failed to meet the needs of citizens or healthcare providers who rely on Cochrane reviews”.

David Tovey, editor-in-chief of the Cochrane Library, told BMJ Evidence Based Medicine there was “no reason to believe that the main conclusions of the review relating to benefit and serious adverse effects are unsafe”.

“However, we intend to initiate an urgent update of the review that will incorporate information provided in the BMJ Evidence Based Medicine study,” he added.

Tovey said work was “ongoing on a second review that will tackle matters of comparative benefit and harms from the different forms of HPV vaccine”.

The government announced in July 2018 that boys aged 12–13 years in England will be offered the HPV vaccine, in an extension of the vaccination programme for girls.

The announcement follows advice from the Joint Committee on Vaccination and Immunisation, which recommended that boys should also be vaccinated. The Scottish and Welsh governments will also be extending their HPV vaccination programmes to include boys.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2018.20205314

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