Prevention of vertebral fractures in osteoporosis: mixed treatment comparison of bisphosphonate therapies
Prevention of vertebral fractures in osteoporosis: mixed treatment comparison of bisphosphonate therapies
复制标题
DOI：
10.1185/03007990903035281
复制
发表时间：
2009-08-01
影响因子：
2.3
通讯作者：
Olson, Melvin
中科院分区：
文献类型：
--
作者：
Jansen, Jeroen P.;Bergman, Gert J. D.;Olson, Melvin
目的：目的是比较双膦酸盐预防绝经后骨质疏松症妇女椎体骨折的疗效。方法：通过系统的文献检索，确定了7项随机安慰剂对照试验，研究了唑来膦酸（1项研究）、阿仑膦酸（3项研究）、伊班膦酸（1项研究）和利塞膦酸（2项研究）对骨折的影响，随访3年。研究的终点是椎体骨折。采用贝叶斯混合处理比较（MTC）同时分析所有试验的结果。使用MTC，可以在没有直接证据的情况下获得一种干预措施与另一种干预措施的相对治疗效果。当纳入的研究在改变基线患者和研究特征方面具有可比性时，MTC可以被认为是一种有效的方法。结果：与所有四种双膦酸盐相比，唑来膦酸有98%的可能性显示脊椎骨折的最大减少。唑来膦酸相对于安慰剂的OR为0.28(95%可信区间0.22;0.35)，相对于伊班膦酸的OR为0.57(0.36;0.92)，相对于阿仑膦酸的OR为0.54(0.39;0.75)，相对于利塞膦酸的OR为0.49（0.34;0.69）。阿仑膦酸盐、依邦膦酸盐和利塞膦酸盐的椎体骨折复位效果相当。使用保守随机效应模型的间接比较支持这些发现。结论：对安慰剂对照随机研究结果的间接比较表明，唑来膦酸比依邦膦酸、阿仑膦酸或利塞膦酸更能降低绝经后骨质疏松症妇女的椎体骨折风险。
Objective: The objective was to compare the efficacy of bisphosphonates regarding the prevention of vertebral fractures in postmenopausal women with osteoporosis.Methods: Seven randomized placebo controlled trials investigating the effects of zoledronic acid (one study), alendronate (three studies), ibandronate (one study), and risedronate (two studies) in terms of fractures with a follow-up of 3 years were identified with a systematic literature search. The endpoint of interest was vertebral fractures. Results of all trials were analyzed simultaneously with a Bayesian mixed treatment comparison (MTC). With MTC the relative treatment effect of one intervention to another can be obtained in the absence of head-to-head evidence. MTC can be considered a valid method when included studies are comparable regarding effect modifying baseline patient and study characteristics.Results: There is a 98% probability that zoledronic acid shows the greatest reduction in vertebral fractures of all four bisphophonates compared. Zoledronic acid showed an OR of 0.28 (95% Credible Interval 0.22; 0.35) relative to placebo, an OR of 0.57 (0.36; 0.92) relative to ibandronate, an OR of 0.54 (0.39; 0.75) relative to alendronate, and an OR of 0.49 (0.34; 0.69) relative to risedronate. Alendronate, ibandronate, and risedronate showed comparable vertebral fracture reductions. Indirect comparisons using a conservative random effects model supported these findings.Conclusion: An indirect comparison of findings from placebo controlled randomized studies indicates that zoledronic acid provides a greater vertebral fracture risk reduction in postmenopausal women with osteoporosis than ibandronate, alendronate, or risedronate.