Abaloparatide for risk reduction of nonvertebral and vertebral fractures in postmenopausal women with osteoporosis: a network meta-analysis

• Published in: Osteoporosis international Vol. 30; no. 7; pp. 1465 - 1473
• Main Authors: Reginster, J. -Y., Bianic, F., Campbell, R., Martin, M., Williams, S. A., Fitzpatrick, L. A.
• Format: Journal Article Web Resource
• Language: English
• Published: London Springer London 01-07-2019; Springer Nature B.V
• Subjects: Abaloparatide; ACTIVE; Bone Density Conservation Agents - therapeutic use; Clinical trials; Endocrinology; Female; Fracture prevention; Fractures; General & internal medicine; Hip Fractures - prevention & control; Hormone replacement therapy; Human health sciences; Humans; Medicine; Medicine & Public Health; Meta-analysis; Médecine générale & interne; Network Meta-Analysis; Original; Original Article; Orthopedics; Osteoporosis; Osteoporosis, Postmenopausal - drug therapy; Osteoporotic Fractures - prevention & control; Parathyroid Hormone-Related Protein - therapeutic use; Post-menopause; Postmenopausal osteoporosis; Randomized Controlled Trials as Topic - methods; Rheumatology; Risk Reduction Behavior; Sciences de la santé humaine; Spinal Fractures - prevention & control; Teriparatide; Vertebrae; Wrist; Wrist Injuries - prevention & control; Abaloparatide; Network meta-analysis; ACTIVE; Postmenopausal osteoporosis; Fracture prevention; Teriparatide
• ISSN: 0937-941X; 1433-2965; 1433-2965
• DOI: 10.1007/s00198-019-04947-2

Summary
This network meta-analysis assessed the efficacy of abaloparatide versus other treatment options to reduce the risk of fractures in women with postmenopausal osteoporosis. The analysis indicates that abaloparatide reduces the risk of fractures in women with postmenopausal osteoporosis versus placebo and compared with other treatment options.
Introduction
This network meta-analysis (NMA) assessed the relative efficacy of abaloparatide versus other treatments to reduce the risk of fractures in women with postmenopausal osteoporosis (PMO).
Methods
PubMed®, Embase®, and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials published before December 20, 2017, that included women with PMO who were eligible to receive interventions for primary or secondary fracture prevention. The NMA was conducted by fracture site (vertebral [VF], nonvertebral [NVF], and wrist), with the relative risk (RR) of fracture versus placebo the main clinical endpoint. The NMA used fixed-effects and random-effects approaches.
Results
A total of 4978 articles were screened, of which 22 were included in the analysis. Compared with other treatments, abaloparatide demonstrated the greatest treatment effect relative to placebo in the VF network (RR = 0.13; 95% credible interval [CrI] 0.04–0.34), the NVF network (RR = 0.50; 95% CrI 0.28–0.85), and the wrist fracture network (RR = 0.39; CrI 0.15–0.90). Treatment ranking showed that abaloparatide had the highest estimated probability of preventing fractures in each of the networks (79% for VF, 70% for NVF, and 53% for wrist fracture) compared with other treatments. Individual networks demonstrated a good level of agreement with direct trial evidence and direct pair-wise comparisons.
Conclusions
This NMA indicates that abaloparatide reduces the RR of VF, NVF, and wrist fracture in women with PMO with or without prior fracture versus placebo, compared with other treatment options. Limitations include that adverse events and drug costs were not considered, and that generalizability is limited to the trial populations and endpoints included in the NMA.