海南医科大学学报2025，Vol.31Issue(5)：373-386,14.DOI:10.13210/j.cnki.jhmu.20241226.002
不同骨改良药物治疗实体瘤骨转移或多发性骨髓瘤患者的安全性的网状Meta分析
Network meta-analysis of the safety of different bone-modifying agents for the treatment of patients with bone metastases from solid tumors or multiple myeloma
摘要
Abstract
Objective:To compare the incidence of adverse reactions[including total adverse reactions,osteonecrosis of the jaw(ONJ),renal impairment,and hypocalcemia]among patients with solid tumors bone metastasis or multiple myeloma treated with different bone-modifying agents,based on a network meta-analysis.Methods:Two researchers independently searched PubMed,Cochrane Library,Embase,Clinical Trials,Web of Science,CNKI,Wanfang,and Wipu for randomized controlled tri-als(RCTs)of bone-modifying agents for the treatment of patients with solid tumors with bone-metastatic cancers or multiple my-eloma in accordance with the search strategy.Randomized controlled trials of patients with solid tumors bone metastatic cancer or multiple myeloma were searched from the establishment of the databases to November 2024,and different dosing frequencies(standardized)were examined.Adverse event outcomes were analyzed in subgroups with different dosing frequencies(standard dosing group and long interval dosing group).Bayesian mesh meta-analysis was performed using R 4.3.3 software and STATA 17.0.Results:A total of 48 RCTs comprising 25 489 patients and involving 11 interventions were included.Regarding the inci-dence of total adverse reactions,the highest incidence of adverse effects was shown in the standard clodronate administration group,as surface under the cumulative ranking probabilities(SUCRA).Regarding the incidence of ONJ,SUCRA showed that the incidence of adverse reactions was highest in the standard dosing group of denosumab biosimilar,but the difference was not sta-tistically significant compared to that of the original drug(P>0.05).Regarding the incidence of renal impairment,SUCRA showed the highest incidence of adverse reactions in the zoledronic acid standard dosing group.Regarding the incidence of hypocal-cemia,SUCRA showed the highest incidence of adverse reactions in the risedronic acid standard dosing group,but the difference was not statistically significant compared to the second-ranked standard dosing group of the denosumab prodrug(P>0.05).Sub-group analysis showed a significantly higher incidence of renal impairment in the standard dosing group compared with the long in-terval dosing group(P<0.05).Conclusion:Current evidence suggests that different bone-modifying drugs have their own specific adverse effects.Among them,due to the small number of studies included in subgroup analysis,there are problems such as patient health status,drug combination,and individual differences.Therefore,prolonging the frequency of BMAs administration may re-duce the incidence of renal impairment in some cases,but more RCT trials are needed to confirm this.关键词
骨改良药物/实体瘤骨转移/多发性骨髓瘤/网状Meta分析Key words
Bone-modifying agents/Solid tumors bone metastasis/Multiple myeloma/Networkmeta-analysis分类
临床医学引用本文复制引用
胡玉婷,严颖,祁力文,王惠君,王新春..不同骨改良药物治疗实体瘤骨转移或多发性骨髓瘤患者的安全性的网状Meta分析[J].海南医科大学学报,2025,31(5):373-386,14.基金项目
This study was supported by the First Affiliated Hospital of Shihezi University School of Medicine Hospital-level Clinical and Basic Research Project(LJ202202) 石河子大学医学院第一附属医院院级课题临床-基础研究项目(LJ202202) （LJ202202）
