The Comparative Efficacy of Drug Therapies Used for the Management of Corticosteroid-Induced Osteoporosis: A Meta-Regression
作者:Shreyasee Amin、Michael P. Lavalley、Robert W. Simms、David T. Felson
DOI:10.1359/jbmr.2002.17.8.1512
日期:——
We determined the comparative efficacy of vitamin D, calcitonin, fluoride, and bisphosphonates for the management of corticosteroid‐induced osteoporosis using meta‐regression models. A systematic search for trials was conducted using MEDLINE, bibliographic references, abstracts from national meetings, and contact with pharmaceutical companies and content experts. We included all randomized controlled trials, lasting at least 6 months, of adult patients on oral corticosteroids that evaluated treatment comparisons between vitamin D, calcitonin, bisphosphonates, or fluoride either with no therapy/calcium or with each other and that reported extractable results. The outcome measure of interest was change in lumbar spine bone mineral density (BMD). We identified 45 eligible trials, which provided 49 eligible treatment comparisons (some trials had three arms or more). Our results indicated that bisphosphonates were the most effective class (effect size 1.03; 95% CI: 0.85, 1.17); results were similar even when newer generations of nitrogen‐containing bisphosphonates were excluded from analysis. We found the efficacy of bisphosphonates was enhanced further when used in combination with vitamin D (effect size, 1.31; 95% CI: 1.07, 1.50). Vitamin D and calcitonin were more effective than no therapy/calcium (effect size, 0.46; 95% CI: 0.27, 0.62; and effect size, 0.51; 95% CI: 0.33, 0.67, respectively) and were of similar efficacy, but both were significantly less effective than bisphosphonates. Fluoride appeared effective, but there were too few studies (n = 5) to draw robust conclusions regarding its efficacy compared with the other three therapies. In summary, bisphosphonates are the most effective of evaluated agents for managing corticosteroid‐induced osteoporosis. The efficacy of bisphosphonates is enhanced further with concomitant use of vitamin D.
我们利用元回归模型确定了
维生素 D、
降钙素、
氟化物和
双膦酸盐在治疗皮质类
固醇引起的骨质疏松症方面的疗效比较。我们利用 MEDLINE、参考文献、全国性会议的摘要以及与制药公司和内容专家的联系,对试验进行了系统性检索。我们纳入了所有针对口服皮质类
固醇的成年患者进行的至少持续 6 个月的随机对照试验,这些试验评估了
维生素 D、
降钙素、双
磷酸盐或
氟化物与无疗法/
钙疗法或与其他疗法之间的治疗比较,并报告了可提取的结果。我们关注的结果指标是腰椎骨矿物质密度(BMD)的变化。我们确定了 45 项符合条件的试验,提供了 49 项符合条件的治疗对比(有些试验有三个或更多臂)。我们的结果表明,
双膦酸盐是最有效的一类药物(效应大小为 1.03;95% CI:0.85,1.17);即使将新一代含氮
双膦酸盐排除在分析之外,结果也是相似的。我们发现,如果与
维生素 D 联合使用,
双膦酸盐的疗效会进一步提高(效应大小为 1.31;95% CI:1.07, 1.50)。
维生素 D 和
降钙素比无疗法/
钙疗法更有效(效应大小分别为 0.46;95% CI:0.27,0.62;效应大小分别为 0.51;95% CI:0.33,0.67),两者的疗效相似,但都明显低于
双膦酸盐。
氟化物似乎有效,但研究数量太少(n = 5),无法就其疗效与其他三种疗法相比得出可靠的结论。总之,在已评估的治疗皮质类
固醇引起的骨质疏松症的药物中,
双膦酸盐最为有效。同时服用
维生素 D 可进一步提高
双膦酸盐的疗效。