Effect of odanacatib on BMD and fractures: estimates from Bayesian univariate and bivariate meta-analyses
Olga Gajic-Veljanoski1, George Tomlinson, Jeevitha Srighanthan
1Osteoporosis Program (O.G.-V., J.S., A.M.C.), University Health Network/Mt Sinai Hospital, Toronto, ON M5G 2C4, Canada; Institute of Health Policy, Management and Evaluation (G.T., A.M.C.), and Department of Medicine (G.T., R.J., A.M.C.), University of Toronto, Toronto, ON M5T 3M6, Canada; St Joseph's Healthcare and McMaster University (J.D.A.), Hamilton, ON L8N 1Y2, Canada; St Michael's Hospital (R.J.), Toronto, ON M5C 2T2, Canada; and Centre Hospitalier Universitaire de Québec Research Centre and Laval University (J.P.B.), Quebec, QC G1V 4G2, Canada.
Context:
Odanacatib (ODN), a selective cathepsin-K inhibitor, was found to increase bone mineral density (BMD); the effect on fractures is based on adverse event reports.
Objective:
To estimate current effects and predict future effects of ODN on BMD and fractures.
Data Sources:
Electronic databases (Medline, EMBASE, Cochrane Library), conference proceedings, and bibliographies.
Study Selection:
Trials that compared ODN 50 mg/wk to placebo for at least 1 year and reported changes in BMD or fractures. Meta-analysis: Two bone outcomes were pooled as independent and as joint outcomes in Bayesian univariate and bivariate random-effects models.
Data Synthesis:
Of 32 potentially eligible articles, six citations describing four trials (993 patients) were included. ODN for 3 years increased mean BMD at the lumbar spine by 5.0% (95% credible interval [CrI], 2.7, 7.5), total hip by 3.6% (95% CrI, 1.6, 5.9), and femoral neck (FN) by 3.6% (95% CrI, 1.6, 5.7). In a future trial of 3-year duration, the predicted mean increase in BMD, adjusted for the effect on fractures, was 4.9% for lumbar spine (95% CrI, 2.5, 7.4), 3.4% for total hip (95% CrI, 1.7, 5.2), and 3.5% for FN (95% CrI, 1.8, 5.3). After accounting for the effect on FN BMD, ODN for 3 years was associated with a population odds ratio of 0.38 (95% CrI, 0.1, 0.8). In a future trial, the odds ratio was 0.41 (95% CrI, 0.1, 1.1). The probability of benefit on fractures was 96-99%. The estimates remained robust in sensitivity analyses.
Conclusions:
Our analyses suggest that ODN will increase BMD and decrease all fractures in the fracture outcome trial; however, direct demonstration of this antifracture efficacy is needed.
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