Additional considerations are required when preparing a protocol for a systematic review with multiple interventions

Objectives: The number of systematic reviews that aim to compare multiple interventions using network meta-analysis is increasing. In this paper, we highlight aspects of a standard systematic review protocol that may need modification when multiple interventions are to be compared.
Study Design and setting: We take the protocol format suggested by Cochrane for a standard systematic review as our reference, and compare the considerations for a pairwise review with those required for a valid comparison of multiple interventions. We suggest new sections for protocols of systematic reviews including network meta-analyses with a focus on how to evaluate their
assumptions. We provide example text from published protocols to exemplify the considerations.

Results and Conclusion: Standard systematic review protocols for pairwise meta-analyses need extensions to accommodate the increased complexity of network meta-analysis. Our suggested modifications are widely applicable to both Cochrane and non-Cochrane systematic reviews involving network meta-analyses.