■对于绝经后骨质疏松症(PMO)的女性,序贯的抗骨质疏松治疗很重要,但是使用不同类型药物的顺序令人困惑和有争议。因此,我们进行了一项网络荟萃分析,比较了现有序贯治疗的疗效和安全性,以探索最有效的骨质疏松症长期治疗策略.
■在此网络荟萃分析中,我们搜索了PubMed,EMBASE,WebofScience,Cochrane图书馆,和ClinicalTrials.gov从开始到2023年9月19日,以确定比较PMO女性序贯治疗的随机对照试验。通过阅读标题和摘要筛选确定的试验,仅纳入了涉及序贯抗骨质疏松治疗和报告的PMO相关结局的随机临床试验。主要结果包括椎体骨折风险,不同身体部位骨密度(BMD)的百分比变化,以及切换治疗后阶段的所有安全指标。使用多变量随机效应方法进行了频率网络荟萃分析,并使用累积排名曲线(SUCRA)下的表面进行了评估。使用网络荟萃分析(CINeMA)框架中的信心评估证据的确定性。本研究在PROSPERO注册:CRD42022360236。
■本研究共纳入19项试验,包括18,416名参与者。调查了五种不同的序贯治疗作为主要干预措施,并与相应的对照组进行比较。本研究中的干预组包括以下治疗转换方案:从合成代谢剂(AB)转换为抗吸收剂(AR)(ABtAR),从一个AR过渡到另一个AR(ARTAAR),从AR转换为AB(ARtAB),从AB切换到AB和AR的联合治疗(ABtC),并从AR过渡到联合治疗(ARtC)。在ARtC中观察到椎骨骨折的发生率显着降低,第二阶段的ABtAR和ARtAB,ARtC的发生率最低,为81.5%SUCRA。ARtAAR和ABtAR是预防骨折和改善身体其他部位BMD的两种有效策略。尤其是,ARtAAR可以改善总髋部BMD,SUCRA最高为96.1%,ABtAR可以降低总骨折的风险,SUCRA最高为94.3%。在其他比较中,安全性结果几乎没有差异。
■我们的研究结果表明,ARtAAR和ABtAR策略是预防骨折和改善PMO骨密度的有效和安全的序贯治疗方法。ARtC在预防椎骨骨折方面更有效。
■国家自然科学基金(82170900,81970762),湖南省中医药管理局,和湖南省高层次卫生人才“225”项目。
UNASSIGNED: The
sequential anti-osteoporotic treatment for women with postmenopausal osteoporosis (PMO) is important, but the order in which different types of drugs are used is confusing and controversial. Therefore, we performed a network meta-analysis to compare the efficacy and safety of available
sequential treatments to explore the most efficacious strategy for long-term management of osteoporosis.
UNASSIGNED: In this network meta-analysis, we searched the PubMed, EMBASE, Web of Science, the Cochrane Library, and ClinicalTrials.gov from inception to September 19, 2023 to identify randomised controlled trials comparing sequential treatments for women with PMO. The identified trials were screened by reading the title and abstract, and only randomised clinical trials involving
sequential anti-osteoporotic treatments and reported relevant outcomes for PMO were included. The main outcomes included vertebral fracture risk, the percentage change in bone mineral density (BMD) in different body parts, and all safety indicators in the stage after switching treatment. A frequentist network meta-analysis was performed using the multivariate random effects method and evaluated using the surface under the cumulative ranking curve (SUCRA). Certainty of evidence was assessed using the Confidence in the Network Meta-Analysis (CINeMA) framework. This study is registered with PROSPERO: CRD42022360236.
UNASSIGNED: A total of 19 trials comprising 18,416 participants were included in the study. Five different
sequential treatments were investigated as the main interventions and compared to the corresponding control groups. The intervention groups in this study comprised the following treatment switch protocols: switching from an anabolic agent (AB) to an anti-resorptive agent (AR) (ABtAR), transitioning from one AR to another AR (ARtAAR), shifting from an AR to an AB (ARtAB), switching from an AB to a combined treatment of AB and AR (ABtC), and transitioning from an AR to a combined treatment (ARtC). A significant reduction in the incidence of vertebral fractures was observed in ARtC, ABtAR and ARtAB in the second stage, and ARtC had the lowest incidence with 81.5% SUCRA. ARtAAR and ABtAR were two effective strategies for preventing fractures and improving BMD in other body parts. Especially, ARtAAR could improve total hip BMD with the highest 96.1% SUCRA, and ABtAR could decrease the risk of total fractures with the highest 94.3% SUCRA. Almost no difference was observed in safety outcomes in other comparisons.
UNASSIGNED: Our findings suggested that the ARtAAR and ABtAR strategy are the effective and safe
sequential treatment for preventing fracture and improving BMD for PMO. ARtC is more effective in preventing vertebral fractures.
UNASSIGNED: The National Natural Science Foundation of China (82170900, 81970762), the Hunan Administration of Traditional Chinese Medicine, and the Hunan Province High-level Health Talents \"225\" Project.