Purpose-This study illustrates how network meta-analysis techniques (meta-analysis, adjusted indirect comparison, mixed treatment comparison [MTC]) can provide comparisons of the relative efficacy of postmenopausal osteoporosis therapies in the absence of comprehensive head-to-head trials.Methods-Source articles were identified in MEDLINE; EMBASE; Cochrane Central Register of Controlled Trials (CENTRAL) via Wiley Interscience; and Cumulative Index to Nursing and Allied Health Literature (CINAHL) between April 28, 2009 and November 4, 2009. Two reviewers identified English-language articles reporting randomized controlled trials (RCTs) with on-label dosing of marketed osteoporosis agents and fracture endpoints. Trial design, population characteristics, intervention and comparator, fracture outcomes and adverse events were abstracted for analysis. Primary analyses included data from RCTs with fracture endpoints. Sensitivity analyses also included studies with fractures reported through adverse event reports. Meta-analysis compared fracture outcomes for pharmacologic therapies versus placebo (fixed and random effects models); adjusted indirect comparisons and MTC assessed fracture risk in postmenopausal women treated with denosumab versus other agents. NF has received research grants from Amgen, Inc. and has served as a consultant for Amgen, Inc., Sanofi-Aventis, Pfizer, Wyeth, and Eli Lilly. CC has received consulting and lecture fees from Amgen, Inc., GSK, Eli Lilly, Novartis, Servier, and Alliance for Bone Health. AD-P has received honoraria or consulted for Amgen, Inc., Novartis, Eli Lilly and MSD; and received research grants from the Alliance of Bone Health, and Amgen, Inc. CR has received research grants, and/or honoraria from Amgen, MSD, Servier, Novartis, and Lilly. tter Bone Health, Shire, Wyeth, and Pfizer. MG, HR and SS are employees of and have stock ownership in Amgen, Inc. Conclusions-The conditional estimates of relative treatment efficacy indicate that there are important differences in fracture risk reduction profiles for marketed pharmacologic therapies for postmenopausal osteoporosis.
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