抗骨质疏松药物治疗原发性骨质疏松症有效性的网状Meta分析

Efficacy of anti-osteoporosis agents for primary osteoporosis:network Meta-analysis

目的:采用网状Meta分析方法系统评价不同抗骨质疏松药物治疗原发性骨质疏松症的临床疗效,为临床用药提供循证依据。方法:计算机检索PubMed、Embase、Cochrane Library、中国知网和万方数据库,搜集关于不同抗骨质疏松药物治疗原发性骨质疏松症患者的随机对照试验(randomized controlled trials,RCTs),检索时限均为建库至2023年2月。由2名研究者对文献进行筛选、提取数据和质量评价,采用Stata16.0软件进行网状Meta分析。结果:该研究共纳入62篇RCTs,涉及10种干预措施,包括50704名患者。网状Meta分析结果显示,在增加腰椎骨密度(bone mineral density,BMD)方面,SUCRA概率排序依次是罗莫单抗>阿巴洛肽>特立帕肽>雷奈酸锶>地舒单抗>唑来膦酸>阿仑膦酸>伊班膦酸>利塞磷酸>雷洛昔芬>安慰剂;在增加髋骨骨密度方面,SUCRA概率排序依次是罗莫单抗>地舒单抗>雷奈酸锶>阿巴洛肽>唑来膦酸>阿仑膦酸>伊班膦酸>雷洛昔芬>利塞磷酸>特立帕肽>安慰剂;在增加股骨颈骨密度方面,SUCRA概率排序依次是罗莫单抗>唑来膦酸>雷奈酸锶>地舒单抗>阿巴洛肽>阿仑膦酸>伊班膦酸>特立帕肽>利塞磷酸>雷洛昔芬>安慰剂。结论:罗莫单抗在改善腰椎、髋骨和股骨颈骨密度方面的疗效是上述药物中最好的,可认为是改善骨密度的首选药物。

OBJECTIVE To systematically evaluate the clinical efficacy of different anti-osteoporosis agents in the treatment of primary osteoporosis through reticular Meta-analysis to provide evidence-based rationales for clinical rational medication.METHODS The databases of PubMed,Embase,Cochrane Library,China National Knowledge Infrastructure(CNKI)and Wanfang were searched for collecting the randomized controlled trials(RCTs)on treating primary osteoporosis with different anti-osteoporosis agents.The retrieval time period started from inceptions to February 2023.Two researchers independently screened the literature,extracted the data and evaluated the quality of literature.Stata 16.0 software was utilized for network Meta-analysis.RESULTS A total of 62 RCTs involving 10 interventions were selected,including 50,704 patients.The results of network Meta-analysis indicated that,regarding rising bone mineral density(BMD)at lumbar spine,the order of SUCRA probability was romomumab>abaloparatide>teriparatide>strontium ranelate>denosumab>zoledronate>alendronate>ibandronate>risedronate>raloxifene>placebo.The SUCRA probability of rising total hip BMD was romomumab>denosumab>strontium ranelate>abaloparatide>zoledronate>alendronate>ibandronate>raloxifene>risedronate>teriparatide>placebo.The SUCRA probability of rising femoral neck BMD was romomumab>zoledronate>strontium ranelate>denosumab>abaloparatide>alendronate>ibandronate>teriparatide>risedronate>raloxifene>placebo.CONCLUSION In these drugs,romomumab offers the best efficacy in improving BMD of lumbar spine,total hip and femoral neck.It is recommended as a first option for improving BMD.