Rapid health technology assessment of calcitonin in the treatment of postmenopausal osteoporosis

ZHENG Zihui; GAO Feng; ZHANG Yatong; ZHAO Zinan; PAN Huijie; JI Liwei; HU Xin; JIN Pengfei

doi:10.6039/j.issn.1001-0408.2022.21.17

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Rapid health technology assessment of calcitonin in the treatment of postmenopausal osteoporosis

更新时间：2023-02-22

- Rapid health technology assessment of calcitonin in the treatment of postmenopausal osteoporosis
- ZHONGGUO YAOFANG Vol. 33, Issue 21, Pages: 2654-2659(2022)
- 作者机构：
  
  1.北京医院药学部/北京市药物临床风险与个体化应用评价重点实验室（北京医院），北京;100730
  2.国家老年医学中心/中国医学科学院老年医学研究院，北京　100730
  3.中央军委联合参谋部警卫局卫生保健处，北京　100017
  4.北京医院检验科，北京　100730
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2022.21.17
  CLC： R977.1
- Published：15 November 2022，
  
  Received：21 March 2022，
  
  Revised：30 September 2022，
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郑子恢,高峰,张亚同等.降钙素治疗绝经后骨质疏松症的快速卫生技术评估 ^Δ[J].中国药房,2022,33(21):2654-2659.

ZHENG Zihui,GAO Feng,ZHANG Yatong,et al.Rapid health technology assessment of calcitonin in the treatment of postmenopausal osteoporosis[J].ZHONGGUO YAOFANG,2022,33(21):2654-2659.
郑子恢,高峰,张亚同等.降钙素治疗绝经后骨质疏松症的快速卫生技术评估 ^Δ[J].中国药房,2022,33(21):2654-2659. DOI： 10.6039/j.issn.1001-0408.2022.21.17.

ZHENG Zihui,GAO Feng,ZHANG Yatong,et al.Rapid health technology assessment of calcitonin in the treatment of postmenopausal osteoporosis[J].ZHONGGUO YAOFANG,2022,33(21):2654-2659. DOI： 10.6039/j.issn.1001-0408.2022.21.17.

摘要

目的

评价降钙素治疗绝经后骨质疏松症（PMOP）的有效性、安全性和经济性，为临床用药决策提供循证医学证据。

方法

计算机检索the Cochrane Library、PubMed、Embase、中国知网、万方数据库、中国生物医学文献服务系统和卫生技术评估（HTA）机构官方网站，收集降钙素治疗PMOP的系统评价（SR）/Meta分析、药物经济学研究和HTA报告，检索时限均为建库至2022年9月30日。由2位研究者独立进行文献筛选、数据提取及质量评价，并对数据结果进行描述性分析。

结果

共纳入18项研究，包括12项SR/Meta分析和6项药物经济学研究，未检索到HTA报告。在有效性方面，所纳入的研究结果基本一致：降钙素在降低椎体骨折发生率方面除对比单独使用钙剂和拉索昔芬可能有一定优势外，相比其他阳性药物均未体现出临床优势；在降低非椎体骨折发生率方面，降钙素除对比单独使用钙剂和雷洛昔芬可能有一定优势外，相比其他阳性药物均未体现出临床优势；在提高椎体骨密度（BMD）方面，仅有2项研究表明降钙素相比钙剂有一定优势，和其他阳性药物相比未见临床优势；在提高非椎体BMD方面，仅有1项研究表明降钙素与钙剂合用相比单独使用钙剂对提高股骨BMD有一定优势，和其他阳性药物相比未见临床优势；在降低骨痛评分方面，所纳入的2项研究均表明鼻用降钙素对减轻椎骨骨折患者的急性疼痛具有短期益处，对慢性疼痛患者无效。在安全性方面，所纳入的3项研究均表明降钙素相比其他阳性药物的不良反应更轻微，但长期使用有增加恶性肿瘤的风险。在经济性方面，只有1项研究表明使用鼻用降钙素治疗PMOP相比不治疗或使用依替膦酸盐治疗更具有经济学优势。

结论

降钙素对减轻PMOP椎体骨折患者的急性疼痛有一定作用，安全性有待进一步考察，未见明显经济学优势。

Abstract

OBJECTIVE

According to the rapid Health Technology Assessment （HTA） for postmenopausal osteoporosis （PMOP）， To evaluate the efficacy， safety and economy of calcitonin in the treatment of PMOP， and provide evidence-based medical evidence for clinical drug decision.

METHODS

Retrieved from the Cochrane Library， PubMed， Embase， CNKI， Wanfang database， CBM and HTA official website， systematic review/meta-analysis， pharmacoeconomics research and HTA reports about calcitonin in the treatment of PMOP were retrieved from the inception to Sept. 30th， 2022. Two researchers independently carried out screening， data extraction and quality evaluation， and analyzed the data results descriptively.

RESULTS

A total of 18 studies were included， including 12 SR/meta-analysis and 6 economic studies， and no HTA report was retrieved. In terms of effectiveness， the results of the included studies were basically consistent： calcitonin had a certain advantage in reducing the incidence of vertebral fracture compared with calcium and lasoxifene alone， but did not show clinical advantage compared with other positive drugs. In terms of reducing the incidence of non-vertebral fractures， calcitonin had some advantages， compared with calcium alone and raloxifene， but did not show clinical advantage compared with other positive drugs. In terms of improving bone mineral density （BMD）， only 2 studies showed that calcitonin had a certain advantage over calcium but no advantage was observed compared with other positive drugs. In terms of improving non-vertebral BMD， only 1 study showed that calcitonin combined with calcium had certain advantages compared with calcium alone in improving femoral BMD， but there was no advantage compared with other positive drugs. In terms of lowering bone pain scores， both included studies demonstrated short-term benefit of nasal calcitonin in reducing acute pain was found in patients with vertebral fractures， but not in patients with chronic pain. In terms of safety， the three included studies showed that calcitonin caused mild adverse reactions compared with other positive drugs， but there was a risk of malignant tumors after long-term use. In terms of economy， only 1 study showed the use of nasal calcitonin in the treatment of PMOP had more economic advantages than no treatment or etidronate.

CONCLUSIONS

Calcitonin has a certain effect on reducing acute pain in patients with PMOP vertebral fracture， and its safety needs further investigation. No obvious economic advantage has been found.

关键词

降钙素绝经后骨质疏松症卫生经济学快速卫生技术评估

Keywords

postmenopausal osteoporosishealth economicsrapid health technology assessment

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