Ranking antireabsorptive agents to prevent vertebral fractures in postmenopausal
osteoporosis by mixed treatment comparison meta-analysis.
Author(s): Migliore A(1), Broccoli S, Massafra U, Cassol M, Frediani B.
Affiliation(s): Author information:
(1)S. Pietro Fatebenefratelli Hospital, Rome, Italy. albertomigliore@terra.es
Publication date & source: 2013, Eur Rev Med Pharmacol Sci. , 17(5):658-67
INTRODUCTION: Bisphosphonates are considered as a first-line therapy for the
prevention and treatment of osteoporosis, showing in double-blind, randomized,
controlled trials a significant reduction of incidence of new vertebral fractures
compared to placebo. Recently also, Denosumab has been shown to reduce the
appearance of new vertebral fractures by blocking RANK. There are not head to
head comparative studies between the above mentioned drugs. Mixed treatment
comparison, an extension of traditional meta-analysis, is able to compare
simultaneously several drugs across a range producing a synthetic evidence of
efficacy and a range of probability as to the best treatment.
OBJECTIVES: The aim of this study is to simultaneously compare alendronate,
risedronate, ibandronate, zolendronate and denosumab in the prevention of OP
vertebral fractures in a Bayesian meta-analysis for assessing indirect
comparisons.
MATERIALS AND METHODS: A search for randomized controlled trials involving
alendronate, risedronate, ibandronate, zolendronate and denosumab was conducted
using several databases. Randomized controlled trials (RCTs) with a double blind
treatment period of at least 3 years were included. Men and Glucorticoid Induced
osteoporosis, RCTs having as primary or secondary endpoints continuous values as
body mineral density (BMD) and studies comparing different dosing regimens of the
same agent, which are not used in clinical practice, were excluded. Only fully
published reports were considered.
RESULTS: A total of 9 RCTs were identiļ¬ed providing data on 31,393 participants.
Zolendronate had the highest probability (52%) of being the most effective
treatment towards placebo, followed by denosumab (46% probability), ibandronate
and then alendronate and risedronate against placebo.
CONCLUSIONS: Although the mixed treatment comparisons among alendronate,
risedronate, ibandronate, zolendronate and denosumab did not show a statistically
significant difference, this analysis suggests that zolendronate, compared to
placebo, is expected to provide the highest rate of reduction in vertebral
fractures affecting osteoporosis affected patients.
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