Results of indirect and mixed treatment comparison of fracture efficacy for osteoporosis treatments: a meta-analysis.
Results of indirect and mixed treatment comparison of fracture efficacy for osteoporosis treatments: a meta-analysis.
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DOI：
10.1007/s00198-012-2068-9
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发表时间：
2013-01
影响因子：
4
通讯作者：
Roux, C.
中科院分区：
文献类型：
--
作者：
Freemantle, N.;Cooper, C.;Diez-Perez, A.;Gitlin, M.;Radcliffe, H.;Shepherd, S.;Roux, C.
本研究说明了网络荟萃分析技术（荟萃分析、调整的间接比较、混合治疗比较[MTC]）如何在缺乏全面头对头试验的情况下提供绝经后骨质疏松症治疗相对疗效的比较。在MEDLINE、EMBASE、科克伦对照试验中心注册库（CENTRAL）（通过Wiley Interscience）和护理和相关健康文献累积索引（CINAHL）中确定了2009年4月28日至2009年11月4日期间的源文章。两名评审员确定了报告上市骨质疏松药物按标签给药和骨折终点的随机对照试验（RCT）的英文文章。对试验设计、人群特征、干预和对照、骨折结局和不良事件进行了分析。主要分析包括来自具有骨折终点的RCT的数据。敏感性分析还包括通过不良事件报告报告骨折的研究。荟萃分析比较了药物治疗与安慰剂的骨折结局（固定和随机效应模型）;校正的间接比较和MTC评估了地舒单抗与其他药物治疗的绝经后女性的骨折风险。使用来自33项研究的数据，随机效应荟萃分析显示，与安慰剂相比，除依替膦酸盐外的所有药物均显著降低新发椎骨骨折的风险;地舒单抗、利塞膦酸盐和唑来膦酸显著降低非椎骨骨折和髋部骨折，而阿仑膦酸盐、雷奈酸锶和特立哌酮显著降低非椎骨骨折的风险。MTC显示地舒单抗在预防新发椎骨骨折方面比雷奈酸锶、雷洛昔芬、阿仑膦酸盐和利塞膦酸盐更有效。相对治疗疗效的条件估计表明，绝经后骨质疏松症的市售药物治疗在骨折风险降低方面存在重要差异。
This study illustrates how network meta-analysis techniques (meta-analysis, adjusted indirect comparison, mixed treatment comparison [MTC]) can provide comparisons of the relative efficacy of postmenopausal osteoporosis therapies in the absence of comprehensive head-to-head trials. Source articles were identified in MEDLINE; EMBASE; Cochrane Central Register of Controlled Trials (CENTRAL) via Wiley Interscience; and Cumulative Index to Nursing and Allied Health Literature (CINAHL) between April 28, 2009 and November 4, 2009. Two reviewers identified English-language articles reporting randomized controlled trials (RCTs) with on-label dosing of marketed osteoporosis agents and fracture endpoints. Trial design, population characteristics, intervention and comparator, fracture outcomes and adverse events were abstracted for analysis. Primary analyses included data from RCTs with fracture endpoints. Sensitivity analyses also included studies with fractures reported through adverse event reports. Meta-analysis compared fracture outcomes for pharmacologic therapies versus placebo (fixed and random effects models); adjusted indirect comparisons and MTC assessed fracture risk in postmenopausal women treated with denosumab versus other agents. Using data from 33 studies, random effects meta-analysis showed that all agents except etidronate significantly reduced risk of new vertebral fractures compared with placebo; denosumab, risedronate, and zoledronic acid significantly reduced non-vertebral and hip fracture while alendronate, strontium ranelate, and teriparatide significantly reduced risk for non-vertebral fractures. MTC showed denosumab as more effective than strontium ranelate, raloxifene, alendronate, and risedronate in preventing new vertebral fractures. The conditional estimates of relative treatment efficacy indicate that there are important differences in fracture risk reduction profiles for marketed pharmacologic therapies for postmenopausal osteoporosis.
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影响因子：
4.5
作者：
Jansen, Jeroen P.;Fleurence, Rachael;Cappelleri, Joseph C.
通讯作者：
Cappelleri, Joseph C.
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
影响因子：
4.4
作者：
Sutton, Alex;Ades, A. E.;Abrams, Keith
通讯作者：
Abrams, Keith
DOI：
10.1016/0197-2456(95)00134-4
发表时间：
1996-02-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
Jadad, AR;Moore, RA;McQuay, HJ
通讯作者：
McQuay, HJ
影响因子：
2.3
作者：
Jansen, Jeroen P.;Bergman, Gert J. D.;Olson, Melvin
通讯作者：
Olson, Melvin