药物干预治疗糖皮质激素性骨质疏松症:伞式评价。
Pharmacological Interventions for Glucocorticoid-Induced Osteoporosis: An Umbrella Review.
机构信息
The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou, China.
出版信息
Horm Metab Res. 2023 Aug;55(8):511-519. doi: 10.1055/a-2112-1596. Epub 2023 Jun 19.
There is still a lack of high-quality evidence-based studies on the efficacy of drug treatment for glucocorticoid-induced osteoporosis (GIOP). The purpose of this umbrella review is to comprehensively evaluate the existing evidence to determine the efficacy and safety of pharmacological interventions for GIOP. We searched PubMed, Embase, and the Cochrane Library for systematic reviews and/or meta-analyses (SRs) of randomized controlled trials (RCTs) aimed at evaluating drug therapy for GIOP. Both the methodological quality and the strength of recommendation of the endpoints included in the SRs were evaluated by using the AMSTAR-2 tool and GRADE system, respectively. Six SRs involving 7225 GIOP patients in 59 RCTs were included in this umbrella review. The results of the methodological quality evaluation showed that 2 high-quality, 2 low-quality and 2 critically low-quality SRs were included. The GRADE evaluation results showed that the quality of evidence and the strength of recommendation of 46 outcome indicators were evaluated in the umbrella review; there were 3 with high-level evidence, 20 with moderate-level evidence, 15 with low-level evidence, and 8 with very low-level evidence. Moderate- to high-level evidence suggests that teriparatide, bisphosphonates, and denosumab can improve the bone mineral density in patients with GIOP. The findings of this umbrella review can enable patients and clinical healthcare professionals to choose the best drug prescription.
目前,糖皮质激素性骨质疏松症(GIOP)药物治疗疗效的高质量证据仍较为缺乏。本汇总分析旨在全面评估现有证据,以确定药物干预治疗 GIOP 的疗效和安全性。我们检索了 PubMed、Embase 和 Cochrane Library 中评价 GIOP 药物治疗的系统评价和/或荟萃分析(SR)。采用 AMSTAR-2 工具和 GRADE 系统分别评估了纳入 SR 中终点的方法学质量和推荐强度。本汇总分析纳入了 6 项纳入 59 项随机对照试验(RCT)的 GIOP 患者 7225 例的 SR。方法学质量评估结果显示,纳入了 2 项高质量、2 项低质量和 2 项极低质量的 SR。GRADE 评估结果显示,本汇总分析共评估了 46 个结局指标的证据质量和推荐强度;其中 3 项为高级别证据,20 项为中级别证据,15 项为低级别证据,8 项为极低级别证据。中高级别证据表明特立帕肽、双膦酸盐和地舒单抗可改善 GIOP 患者的骨密度。本汇总分析的结果可以帮助患者和临床医护人员选择最佳药物处方。