Reply

The misconception that rapid reviews (RRs) are less valid in comparison to systematic reviews (SRs) has been fully addressed by the World Health Organization (WHO) [1] and the Cochrane Rapid Review Methods Group (CRRMG) [2]. The WHO has recognized barriers to the use of RRs such as ‘the belief that the results of RRs are not useful or valid, a lack of understanding of how to identify and access relevant RRs, and a lack of skills to assess or interpret RRs’ [1]. More recently, CRRMG stated, ‘evidence synthesis type alone is insufficient to judge its reliability and quality’ [2]. We caution against the acceptance or rejection of RR or SR findings, without careful consideration of their methods and ensuing findings. SR and RR methodologies are often not mutually exclusive. Furthermore, we recognize SRs and RRs as distinct evidence-synthesis strategies and do not argue for the replacement of SRs with RRs. Our RR was guided by the WHO methodology to streamline the SR process yet produce a rigorous, reproducible, timely and transparently reported summary of the evidence using key principles of knowledge synthesis [1]. Our rationale for using RR methodology aligns with CRRMG guidance on determining when to conduct a RR instead of a SR [2]. Primarily, to provide timely evidence to support decision-makers facing uncertainty in the absence of an existing SR, to identify evidence gaps and guide future research priorities [2]. We welcome the SR by Huntley et al. [3] as our search period ended in April 2022. While a full critical appraisal is outside the scope of this response, we provide a comparative analysis of the primary results of both reviews (Table 1). Comparative analysis of reviews Comparative analysis of reviews The comparison confirms our findings and alleviates concerns regarding missed studies resulting from two database searches. Both reviews included 12 observational studies; 7 were identical and 5 differed due to varying eligibility criteria. Both RR (six studies) and SR (five studies) observed that silica is the most researched occupational exposure associated with sarcoidosis development and reported increased risk estimates. Finally, both reviews recognize sarcoidosis is likely not a disease due to a single etiologic agent but may be a syndrome caused by many agents in predisposed individuals and acknowledge the need for additional research. Decisions to exclude World Trade Center (WTC) studies or to limit to case–control and cohort studies were not necessitated by the choice of review approach or to restrict the scope. Our RR excluded WTC studies to focus on evidence that is most relevant and generalizable to the routine exposure circumstances of workers. Huntley et al. reviewed one study of WTC dust with an odds ratio (OR) < 1 [4]. While we agree with investigative approaches that include other observational and experimental study designs, and mechanistic evidence, to better understand disease processes, biological mechanisms, and exposure characterizations [5], these were not the objectives of our review. Huntley et al. also only included cohort and case–control studies in their analysis informing causal inferences. Cohort and case–control studies relate individual exposures to disease occurrence and provide estimates of risk [5]. The authors received no external funding for the conduct of this study. All authors are full-time Senior Scientists/Policy Analysts at the Workplace Safety and Insurance Board (Ontario, Canada). The authors were solely responsible for the conduct of this study, writing of the report and decision to submit the manuscript for publication. Additional support for the search strategy and retrieval of journal articles was provided by WSIB library staff. All inferences, opinions and conclusions drawn in this report are those of the authors and do not in any way reflect or imply endorsement of the content by the WSIB.

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