Abstract:
BACKGROUND:Bisphosphonates are specific inhibitors of osteoclastic activity and are currently used as supportive therapy for multiple myeloma (MM). However, the exact clinical role of bisphosphonates in MM remains unclear. OBJECTIVES:This update of the first review published in 2002. We have also analyzed observational studies targeting osteonecrosis of jaw (ONJ). SEARCH STRATEGY:We searched the literature using the methods outlined in the previous review. We also searched observational studies or case reports examining ONJ. SELECTION CRITERIA:We selected RCTs with a parallel design related to the use of bisphosphonate in myeloma. We also selected observational studies or case reports examining bisphosphonates related to ONJ. DATA COLLECTION AND ANALYSIS:We have reported pooled data using either hazard ratio or risk ratio and, when appropriate, as absolute risk reduction and the number needed to treat to prevent or to cause a pathological event. We have assessed statistical heterogeneity and reported I(2) statistic. MAIN RESULTS:This review includes 17 trials with 1520 patients analyzed in bisphosphonates groups, and 1490 analyzed in control groups. In comparison with placebo/no treatment, the pooled analysis demonstrated the beneficial effect of bisphosphonates on prevention of pathological vertebral fractures (RR= 0.74 (95% CI: 0.62 to 0.89), P = 0.001), total skeletal related events (SREs) (RR= 0.80 (95% CI: 0.72 to 0.89), P < 0.0001) and on amelioration of pain (RR = 0.75 (95% CI: 0.60 to 0.95), P = 0.01). We found no significant effect of bisphosphonates on overall survival (OS), progression-free survival (PFS), hypercalcemia or on the reduction of non-vertebral fractures. The indirect meta-analyses did not find the superiority of any particular type of bisphosphonate over others. Only two RCTs reported ONJ. The identified observational studies suggested that ONJ may be a common event (range: 0% to 51%). AUTHORS' CONCLUSIONS:Adding bisphosphonates to the treatment of MM reduces pathological vertebral fractures, SREs and pain but not mortality. Assuming the baseline risk of 20% to 50% for vertebral fracture without treatment, we estimate that between eight and 20 MM patients should be treated to prevent vertebral fracture(s) in one patient. Assuming the baseline risk of 31% to 76% for pain amelioration without treatment, we estimate that between five to 13 MM patients should be treated to reduce pain in one patient. Also, with the baseline risk of 35% to 86% for SREs without treatment, we estimate that between six and 15 MM patients should be treated to prevent SRE(s) in one patient. No bisphoshphonate appears to be superior to others.
journal_name
Cochrane Database Syst Revjournal_title
The Cochrane database of systematic reviewsauthors
Mhaskar R,Redzepovic J,Wheatley K,Clark OA,Miladinovic B,Glasmacher A,Kumar A,Djulbegovic Bdoi
10.1002/14651858.CD003188.pub2subject
Has Abstractpub_date
2010-03-17 00:00:00pages
CD003188issue
3issn
1469-493Xpub_type
杂志文章,评审abstract:BACKGROUND:The results from controlled clinical trials investigating the efficacy of azathioprine and 6-mercaptopurine for the treatment of active Crohn's disease were conflicting and controversial. A meta-analysis was performed to assess the effectiveness of these drugs for the induction of remission in active Crohn's...
journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD000545.pub2
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,评审
doi:10.1002/14651858.CD002035
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doi:10.1002/14651858.CD003196.pub2
更新日期:2013-10-17 00:00:00
abstract:BACKGROUND:Uterine fibroids cause heavy prolonged bleeding, pain, pressure symptoms and subfertility. The traditional method of treatment has been surgery as medical therapies have not proven effective. Uterine artery embolization has been reported to be an effective and safe alternative to treat fibroids in women not ...
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pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD011640.pub2
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pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD003178.pub3
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journal_title:The Cochrane database of systematic reviews
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doi:10.1002/14651858.CD002253.pub4
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更新日期:2013-06-05 00:00:00
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pub_type: 杂志文章,meta分析,评审
doi:10.1002/14651858.CD012763
更新日期:2017-08-14 00:00:00
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journal_title:The Cochrane database of systematic reviews
pub_type: 杂志文章,meta分析,评审
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