Comparison of Teriparatide and Denosumab in Patients Switching From Long-Term Bisphosphonate Use
Comparison of Teriparatide and Denosumab in Patients Switching From Long-Term Bisphosphonate Use
复制标题
特立帕肽和狄诺塞麦在长期使用双膦酸盐治疗转用的患者中的比较
DOI：
10.1210/jc.2019-00924
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发表时间：
2019-11-01
影响因子：
5.8
通讯作者：
Solomon, Daniel H.
中科院分区：
文献类型：
--
作者：
Lyu, Houchen;Zhao, Sizheng S.;Solomon, Daniel H.
内容：特立帕鲁肽和地舒单抗是治疗骨质疏松症的有效药物，通常在患者使用双膦酸盐后作为二线选择。然而，有限的头对头比较有效性数据之间存在特立帕鲁肽和denosumab.Objective：我们比较了骨矿物质密度（BMD）的变化与特立帕鲁肽或denosumab治疗组之间使用双膦酸盐后，侧重于在BMD的变化，而对任何药物超过2 years.Design：观察性队列研究，使用电子病历从两个学术医疗中心在美国。参与者：研究人群包括年龄>45岁的骨质疏松患者，他们在转换为特立帕肽或狄诺塞麦前接受双膦酸盐治疗>1年。结果测量：腰椎、全髋关节和股骨颈的BMD从基线的年变化。平均（SD）年龄为70（10）岁，使用双膦酸盐的中位持续时间（四分位距）为7.0（5.6 - 9.7）年。与地舒单抗使用者相比，特立哌酮使用者脊柱的年BMD变化高1.3%（95% CI 0.02，2.7%），但全髋关节低-2.2%（95% CI -2.9至-1.5%），股骨颈低-1.1%（95% CI -2.1至-0.1%）。那些谁切换到teriparbidine有一个短暂的损失，髋关节BMD的第一年，在总髋关节BMD超过2 years.Conclusions：在长期使用双膦酸盐的患者中，切换到teriparbidine的决定应谨慎，特别是对髋部骨折的高风险患者。
Context: Teriparatide and denosumab are effective treatments for osteoporosis and typically reserved as second-line options after patients have used bisphosphonates. However, limited head-to-head comparative effectiveness data exist between teriparatide and denosumab.Objective: We compared changes in bone mineral density (BMD) between groups treated with teriparatide or denosumab after using bisphosphonates, focusing on the change in BMD while on either drug over 2 years.Design: Observational cohort study using electronic medical records from two academic medical centers in the United States.Participants: The study population included osteoporotic patients >45 years who received bisphosphonates >1 year before switching to teriparatide or denosumab.Outcome Measures: Annualized BMD change from baseline at the lumbar spine, total hip, and femoral neck.Results: Patients treated with teriparatide (n = 110) were compared with those treated with denosumab (n = 105); the mean (SD) age was 70 (10) years and median duration (interquartile range) of bisphosphonate use was 7.0 (5.6 to 9.7) years. Compared with denosumab users, teriparatide users had higher annualized BMD change at the spine by 1.3% (95% CI 0.02, 2.7%) but lower at the total hip by -2.2% (95% CI -2.9 to -1.5%) and the femoral neck by -1.1% (95% CI -2.1 to -0.1 %). Those who switched to teriparatide had a transient loss of hip BMD for the first year, with no overall increase in the total hip BMD over 2 years.Conclusions: Among patients who use long-term bisphosphonates, the decision of switching to teriparatide should be made with caution, especially for patients at high risk of hip fracture.