Efficacy and Safety of First- and Second-Line Drugs to Prevent Glucocorticoid-Induced Fractures: A Network Meta-Analysis.
J Clin Endocrinol Metab. 2019 Sep 12;: Authors: Ding L, Hu J, Wang D, Liu Q, Mo Y, Tan X, Wen F
CONTEXT: The evidence about benefits and harms of drugs for glucocorticoid-induced osteoporosis (GIOP) is limited, and the comparative efficacy and safety of first-line and second-line agents to prevent glucocorticoid-induced (GI) fractures remains unclear. OBJECTIVE: To assess the comparative clinical efficacy, safety and tolerability of first-line and second-line agents in preventing GI fractures. DATA SOURCES: We searched three different databases through March 5, 2019. STUDY SELECTION: We included randomized controlled trials (RCTs) enrolling patients receiving long-term glucocorticoids (GCs), and comparing a first-line or second-line agent with another one or with placebo. DATA EXTRACTION: Two reviewers independently extracted study and participant characteristics, and outcome data. DATA SYNTHESIS: We performed multivariate random-effects network meta-analyses including base, 3 subgroup, and 12 sensitivity analyses. We included 22 papers from 19 unique trials involving 4328 patients receiving GCs. Teriparatide (RR 0.11, 95% CI 0.03-0.47), denosumab (RR 0.21, 95% CI 0.09-0.49), and risedronate (RR 0.33, 95% CI 0.19-0.58) reduced the risk of GI vertebral fractures, and the former two were the most efficacious according to violin plots including the SUCRA values calculated by base and sensitivity analyses. Oral alendronate (RR 0.33, 95% CI 0.12-0.93) reduced this risk in patients receiving GCs with at least 7.5 mg/day, while intravenous ibandronate (RR 0.25, 95% CI 0.06-0.99) was efficacious for the primary prevention of GIOP. Six drugs were similar in terms of the five other outcomes. CONCLUSIONS: In terms of clinical efficacy and safety, second-line teriparatide and denosumab pose a challenge to first-line oral bisphosphonates for prevention of GI fractures. PMID: 31513250 [PubMed - as supplied by publisher]