In a letter to the editor by Meuwese et al regarding our recent paper, they mentioned two important known biases of observational studies, that is, confounding and survival biases. Because of those and other biases, the results of any meta-analysis of observational studies need cautious interpretation. The meta-analyses of randomized trials have been considered to provide robust and, at times, contradictory results in comparison with the meta-analyses of observational studies. However, in the absence of randomized trials to address the question being asked, meta-analyses of observational studies have been long performed, understanding that there may be limitations. At times, the meta-analyses of observational studies provide crucial answers to the questions being asked, as the randomized trials may have restrictive inclusion/exclusion criteria and a limited duration of follow-up. They also provide real-world data.