Title: Monitoring Living Evidence for Research Synthesis

Abstract: A living systematic review (LSR) is an innovative approach that continuously updates and synthesizes evidence in real time. Trial sequential analysis (TSA) is a key tool in LSRs, crucial for evaluating the conclusiveness of evidence. It employs sequential monitoring boundaries to assess intervention effectiveness and futility boundaries to determine whether an intervention shows a significant difference from or a similar effect to the control. Although TSA is becoming increasingly popular, its reproducibility is often compromised by a lack of detailed information on underlying assumptions. Moreover, existing TSA methods are challenged by their heavy reliance on interim analyses from randomized controlled trials, which typically involve more homogeneous participant groups than those found in meta-analyses. In this presentation, we will introduce novel methods aimed at preventing the premature termination of LSRs, thereby strengthening the robustness of evidence synthesis. Our numerical studies indicate that these new methods provide greater reliability compared to existing approaches.