Network Meta-Analysis of Pharmacological Agents for Osteoporosis Treatment and Fracture Prevention
Network Meta-Analysis of Pharmacological Agents for Osteoporosis Treatment and Fracture Prevention
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骨质疏松症治疗和骨折预防药物的网络荟萃分析
DOI：
10.1159/000453138
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发表时间：
2016-01-01
影响因子：
--
通讯作者：
Li, Yu-sheng
中科院分区：
文献类型：
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作者：
Yang, Xu-cheng;Deng, Zhen-han;Li, Yu-sheng
背景和目的：骨质疏松症困扰着世界上大量的人群，其特征是骨量和强度的全身性损害，这可能进一步引发脆性骨折风险的增加。该网络荟萃分析（NMA）旨在区分在疗效和安全性方面比其他疗法更可取的疗法。方法：系统检索相关文献。综合直接和间接证据来比较疗效，用比值比（OR）和95%可信区间（CrI）描述。此外，计算累积排序曲线下面积，以根据临床结局对概率进行排序。在该NMA中评价了新发非椎骨骨折、髋关节和腕关节骨折以及不良事件。结果如下：与安慰剂组相比，接受阿仑膦酸钠、地舒单抗、特立哌齐治疗的患者新发非椎骨骨折的风险降低。阿仑膦酸钠、地舒单抗和唑来膦酸预防髋部骨折的疗效较好。在预防手腕骨折方面，没有观察到显着差异。与安慰剂、阿仑膦酸盐、地舒单抗和雷洛昔芬相比，唑来膦酸显示出不良事件风险显著增加。根据SUCRA，特立哌酮在新发非椎骨骨折预防方面排名最高，依替膦酸盐和狄诺塞单抗平衡了安全性和有效性。结论：总之，特立帕鲁肽似乎是预防新发非椎骨骨折的最有效药物，而依替膦酸盐和狄诺塞单抗更适合平衡安全性和有效性。(C)2016作者（s）由S. Karger AG，巴塞尔
Background and Objective: Osteoporosis afflicts a large number of populations in the world and is featured by systemic impairment of bone mass and strength which may further trigger an increase in the risk of fragile fractures. This network meta-analysis (NMA) is designed to distinguish therapies more preferable than others with respect to efficacy and safety. Methods: We searched the medical literature for relevant studies systematically. Both direct and indirect evidence were synthesized to compare the efficacy, described by odds ratios (OR) and 95% credible intervals (CrI). Moreover, the surface under cumulative ranking curve was calculated to rank probabilities with respect to clinical outcomes. The new non-vertebral fractures, hip and wrist fractures, and adverse events were evaluated in this NMA. Results: Patients treated by alendronate, denosumab, teriparatide were associated with a reduced risk of new non-vertebral fractures compared to those treated by placebo. Alendronate, denosumab and zoledronic acid had better efficacy in preventing hip fractures. With respect to wrist fractures prevention, no significant difference was observed. Zoledronic acid exhibited significantly increased risk of adverse events than placebo, alendronate, denosumab, and raloxifene. According to SUCRA, teriparatide ranked highest in new non-vertebral fractures prevention, etidronate and denosumab balanced safety and efficacy well. Conclusion: In summary, teriparatide appeared to be the most efficacious drug for preventing new non vertebral fractures, while etidronate and denosumab were preferable for balancing safety and efficacy well. (C) 2016 The Author(s) Published by S. Karger AG, Basel