用于减少早期和局部晚期乳腺癌妇女的骨损失的骨修饰剂:一个网络元分析
Anne Adams1, Tina Jakob2, Alessandra Huth2
1Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
The Cochrane database of systematic reviews
|July 9, 2024
概括
像双酸盐和RANKL抑制剂这样的骨修饰剂可以增加骨矿物质密度,并减少乳腺癌妇女的骨折. 然而,这些治疗可能会增加骨缩和功能障碍的风险,需要仔细考虑疗效和安全性.
科学领域:
- 在瘤学瘤学.
- 药理学 药理学是指药理学的学科.
- 骨的新陈代谢 骨的新陈代谢
背景情况:
- 骨修饰剂,包括双酸盐和RANKL抑制剂,用于管理乳腺癌没有骨转移的女性的骨损失.
- 这些治疗旨在减轻骨密度降低和骨折风险,双酸盐显示出潜在的生存益处,特别是在绝经后的妇女中.
研究的目的:
- 为了比较各种骨修饰剂在减少乳腺癌患者骨质密度损失和骨质疏松性骨折的有效性,而没有骨转移.
- 使用网络元分析 (NMA) 来生成治疗排名,以指导临床决策.
主要方法:
- 在CENTRAL,MEDLINE和Embase数据库中进行系统的电子搜索,直到2023年1月.
- 包括随机对照试验,将不同的双酸盐和RANKL抑制剂相互比较或安慰剂.
- 网络元分析 (NMA) 进行了评估结果,包括骨矿物质密度,生活质量,骨折,存活率和不良事件.
主要成果:
- 与安慰剂 (中等确定性) 相比,伊班德罗纳酸和佐尔德罗尼酸可能会增加骨矿物质密度.
- 克洛德罗纳特和伊班德罗纳特显著降低了骨折率 (高确定性),而德诺苏马布和佐莱德龙酸显示可能略有下降 (中等确定性).
- 某些药物,特别是登苏马布,伊班德罗纳特和龙酸,与骨瘤的风险增加有关,对于伊班德罗纳特,功能障碍.
结论:
- 双酸盐 (不包括阿伦德罗酸盐和帕米德罗酸盐) 和德诺苏马布在改善骨矿物质密度和减少骨折方面似乎有效.
- 益处必须与潜在的不良事件进行权衡,例如下巴骨髓缩和功能障碍.
- 需要进行进一步的对比试验,特别是比较denosumab与双酸盐,以完善治疗建议.
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