| アブストラクト | PURPOSE: This paper aims to compare the clinical effectiveness of oral anti-osteoporosis drugs based on the observed risk of fracture while on treatment in primary care actual practice. MATERIALS AND METHODS: We investigated two primary care records databases covering UK National Health Service (Clinical Practice Research Datalink, CPRD) and Catalan healthcare (Information System for Research in Primary Care, SIDIAP) patients during 1995-2014 and 2006-2014, respectivey. Treatment-naive incident users of anti-osteoporosis drugs were included and followed until treatment cessation, switching, death, transfer out, or study completion. We considered hip fracture while on treatment as main outcome and major osteoporotic fractures (hip, clinical spine, wrist, and proximal humerus) as secondary outcome. Users of alendronate (reference group) were compared to those of (1) OBP, (2) strontium ranelate (SR), and (3) selective estrogen receptor modulators (SERMs), after matching on baseline characteristics using propensity scores. Multiple imputation was used to handle missing data on confounders and competing risk modelling for the calculation of relative risk according to therapy. Country-specific data were analyzed separately and meta-analyzed. RESULTS: A total of 163,950 UK and 145,236 Catalan patients were identified. Hip (sub-hazard ratio [SHR] [95% CI] 1.04 [0.77-1.40]) and major osteoporotic (SHR [95% CI] 1 [0.78-1.27]) fracture risks were similar among OBP compared to alendronate users. Both hip (SHR [95% CI] 1.26 [1.14-1.39]) and major osteoporotic (SHR [95% CI] 1.06 [1.02-1.12]) fracture risk were higher in SR compared to alendronate users. SERM users had a reduced hip (SHR [95% CI] 0.75 [0.60-0.94]) and major osteoporotic (SHR [95% CI] 0.77 [0.72-0.83]) fracture risk compared to alendronate users. CONCLUSION: We found a 26% excess hip fracture risk among SR compared to matched alendronate users, in line with placebo-controlled RCT findings. Conversely, in a lower risk population, SERM users had a 25% reduced hip fracture risk compared to alendronate users. Head-to-head RCTs are needed to confirm these findings. |
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| 投稿者 | Khalid, Sara; Calderon-Larranaga, Sara; Hawley, Samuel; Ali, M Sanni; Judge, Andrew; Arden, Nigel; van Staa, Tjeerd; Cooper, Cyrus; Javaid, Muhammad Kassim; Prieto-Alhambra, Daniel |
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| 組織名 | Centre for Statistics in Medicine, Nuffield Department of Orthopaedics,;Rheumatology, and Musculoskeletal Sciences.;Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, United;Kingdom, daniel.prietoalhambra@ndorms.ox.ac.uk.;Family and Community Medicine Teaching Unit of Granada. Cartuja University Health;Centre. Andalusian Health Service (SAS), Granada, Spain.;London School of Hygiene and Tropical Medicine, London, United Kingdom.;Bristol NIHR Biomedical Research Centre, Musculoskeletal Research Unit, Southmead;Hospital, University of Bristol, Bristol, United Kingdom.;Arthritis Research UK Centre for Sport, Exercise, and Osteoarthritis, University;of Oxford, Oxford, United Kingdom.;Farr Institute, University of Manchester, Manchester, United Kingdom.;Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the;Netherlands.;Medical Research Council Lifecourse Epidemiology Unit, University of Southampton,;Southampton, United Kingdom.;NIHR Southampton Biomedical Research Centre, University of Southampton and;University Hospital Southampton NHS Foundation Trust, Southampton, United;Kingdom.;GREMPAL (Grup de Recerca en Malalties Prevalents de l'Aparell Locomotor) Research;Group, Idiap Jordi Gol Primary Care Research Institute, Universitat Autonoma de;Barcelona, Barcelona, Spain, daniel.prietoalhambra@ndorms.ox.ac.uk. |
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