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Results of indirect and mixed treatment comparison of fracture efficacy for osteoporosis treatments: a meta-analysis

Results of indirect and mixed treatment comparison of fracture efficacy for osteoporosis treatments: a meta-analysis
Results of indirect and mixed treatment comparison of fracture efficacy for osteoporosis treatments: a meta-analysis
Summary
Network meta-analysis techniques (meta-analysis, adjusted indirect comparison, and mixed treatment comparison [MTC]) allow for treatment comparisons in the absence of head-to-head trials. In this study, conditional estimates of relative treatment efficacy derived through these techniques show important differences in the fracture risk reduction profiles of marketed pharmacologic therapies for postmenopausal osteoporosis.

Introduction
This study illustrates how network meta-analysis techniques (meta-analysis, adjusted indirect comparison, and MTC) can provide comparisons of the relative efficacy of postmenopausal osteoporosis therapies in the absence of comprehensive head-to-head trials.

Methods
Source articles were identified in MEDLINE; EMBASE; Cochrane Central Register of Controlled Trials (CENTRAL) via Wiley Interscience; and Cumulative Index to Nursing and Allied Health Literature (CINAHL) between April 28, 2009 and November 4, 2009. Two reviewers identified English-language articles reporting randomized controlled trials (RCTs) with on-label dosing of marketed osteoporosis agents and fracture endpoints. Trial design, population characteristics, intervention and comparator, fracture outcomes, and adverse events were abstracted for analysis. Primary analyses included data from RCTs with fracture endpoints. Sensitivity analyses also included studies with fractures reported through adverse event reports. Meta-analysis compared fracture outcomes for pharmacological therapies vs. placebo (fixed and random effects models); adjusted indirect comparisons and MTC assessed fracture risk in postmenopausal women treated with denosumab vs. other agents.

Results
Using data from 34 studies, random effects meta-analysis showed that all agents except etidronate significantly reduced the risk of new vertebral fractures compared with placebo; denosumab, risedronate, and zoledronic acid significantly reduced the risk for nonvertebral and hip fracture, while alendronate, strontium ranelate, and teriparatide significantly reduced the risk for nonvertebral fractures. MTC showed denosumab to be more effective than strontium ranelate, raloxifene, alendronate, and risedronate in preventing new vertebral fractures.

Conclusions
The conditional estimates of relative treatment efficacy indicate that there are important differences in fracture risk reduction profiles for marketed pharmacological therapies for postmenopausal osteoporosis.
0937-941X
209-217
Freemantle, N.
76c59b7f-991b-4b1b-9ecc-c1ba3e282fb5
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Diez Perez, A.
19f89c53-003a-469c-92ac-69b0b979f3ec
Gitlin, M.
56659348-ca04-4ceb-b4aa-5768172a4ef6
Radcliffe, H.
54a61bdf-66c6-494a-8171-b395316d989b
Shepherd, S.
dc74e030-85a8-45ab-91cc-23d74909a944
Roux, C.
fc926270-4149-405d-8cce-44d9305cc45d
Freemantle, N.
76c59b7f-991b-4b1b-9ecc-c1ba3e282fb5
Cooper, C.
e05f5612-b493-4273-9b71-9e0ce32bdad6
Diez Perez, A.
19f89c53-003a-469c-92ac-69b0b979f3ec
Gitlin, M.
56659348-ca04-4ceb-b4aa-5768172a4ef6
Radcliffe, H.
54a61bdf-66c6-494a-8171-b395316d989b
Shepherd, S.
dc74e030-85a8-45ab-91cc-23d74909a944
Roux, C.
fc926270-4149-405d-8cce-44d9305cc45d

Freemantle, N., Cooper, C., Diez Perez, A., Gitlin, M., Radcliffe, H., Shepherd, S. and Roux, C. (2013) Results of indirect and mixed treatment comparison of fracture efficacy for osteoporosis treatments: a meta-analysis. Osteoporosis International, 24 (1), 209-217. (doi:10.1007/s00198-012-2068-9.). (PMID:22832638)

Record type: Article

Abstract

Summary
Network meta-analysis techniques (meta-analysis, adjusted indirect comparison, and mixed treatment comparison [MTC]) allow for treatment comparisons in the absence of head-to-head trials. In this study, conditional estimates of relative treatment efficacy derived through these techniques show important differences in the fracture risk reduction profiles of marketed pharmacologic therapies for postmenopausal osteoporosis.

Introduction
This study illustrates how network meta-analysis techniques (meta-analysis, adjusted indirect comparison, and MTC) can provide comparisons of the relative efficacy of postmenopausal osteoporosis therapies in the absence of comprehensive head-to-head trials.

Methods
Source articles were identified in MEDLINE; EMBASE; Cochrane Central Register of Controlled Trials (CENTRAL) via Wiley Interscience; and Cumulative Index to Nursing and Allied Health Literature (CINAHL) between April 28, 2009 and November 4, 2009. Two reviewers identified English-language articles reporting randomized controlled trials (RCTs) with on-label dosing of marketed osteoporosis agents and fracture endpoints. Trial design, population characteristics, intervention and comparator, fracture outcomes, and adverse events were abstracted for analysis. Primary analyses included data from RCTs with fracture endpoints. Sensitivity analyses also included studies with fractures reported through adverse event reports. Meta-analysis compared fracture outcomes for pharmacological therapies vs. placebo (fixed and random effects models); adjusted indirect comparisons and MTC assessed fracture risk in postmenopausal women treated with denosumab vs. other agents.

Results
Using data from 34 studies, random effects meta-analysis showed that all agents except etidronate significantly reduced the risk of new vertebral fractures compared with placebo; denosumab, risedronate, and zoledronic acid significantly reduced the risk for nonvertebral and hip fracture, while alendronate, strontium ranelate, and teriparatide significantly reduced the risk for nonvertebral fractures. MTC showed denosumab to be more effective than strontium ranelate, raloxifene, alendronate, and risedronate in preventing new vertebral fractures.

Conclusions
The conditional estimates of relative treatment efficacy indicate that there are important differences in fracture risk reduction profiles for marketed pharmacological therapies for postmenopausal osteoporosis.

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More information

e-pub ahead of print date: 26 July 2012
Published date: January 2013
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 349351
URI: http://eprints.soton.ac.uk/id/eprint/349351
ISSN: 0937-941X
PURE UUID: b975cd00-0be4-4549-a976-8687d13bc9d3
ORCID for C. Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 01 Mar 2013 15:09
Last modified: 18 Mar 2024 02:45

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Contributors

Author: N. Freemantle
Author: C. Cooper ORCID iD
Author: A. Diez Perez
Author: M. Gitlin
Author: H. Radcliffe
Author: S. Shepherd
Author: C. Roux

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