地舒单抗对比唑来膦酸用于乳腺癌护骨治疗的快速卫生技术评估
Rapid health technology assessment of denosumab versus zoledronic acid for bone care in breast cancer
王慧芳 1宋志颖 2董馨蔚 1左瑶瑶 1顾海娟1
作者信息
- 1. 南通大学附属肿瘤医院药剂科,江苏南通 226300
- 2. 南通大学附属肿瘤医院肿瘤内科,江苏南通 226300
- 折叠
摘要
目的:评估地舒单抗vs.唑来膦酸(zoledronic acid,ZA)在乳腺癌护骨治疗中的获益与风险,为临床决策提供循证依据.方法:系统检索卫生技术评估(health technology assessment,HTA)相关网站、PubMed、万方数据、Cochrane Library、中国知网数据库,纳入地舒单抗与ZA用于乳腺癌骨改良治疗的系统评价/Meta分析、HTA报告以及药物经济学研究,由2名研究员依据纳入排除标准独立筛选文献、提取数据并评价质量后,对结果进行综合性定性分析与比较.结果:纳入6篇系统评价/Meta分析和5篇经济学研究.在乳腺癌骨转移人群中,与ZA相比,地舒单抗在延缓骨相关事件(skeletal-related events,SREs)首次发生时间和复发时间、降低SREs发生率方面更加有效.地舒单抗可降低接受芳香化酶抑制剂治疗的绝经后乳腺癌人群的骨折发生率,而ZA无此优势.与ZA相比,地舒单抗的发热、骨痛、水肿和肾功能衰竭的不良反应更轻微,但可能增加颌骨坏死发生率.在国内外医疗环境下,地舒单抗相比ZA可能更具成本效用优势.结论:与ZA相比,地舒单抗在乳腺癌护骨治疗中更具安全性、有效性与经济性.
Abstract
OBJECTIVE To evaluate the advantages and hazards of denosumab vs.zoledronic acid(ZA)in bone protection for breast cancer and provide evidence-based proof for clinical decision-making.METHODS Health technology assessment(HTA)related websites,including PubMed,WanFang,Cochrane Library and CNKI,were systematically searched.The sys-tematic review/Meta-analysis and pharmacoeconomic evaluation on denosumab and ZA for modified bone therapy in breast cancer were included.According to the inclusion and exclusion criteria,two reviewers independently identified the literature,extracted the data and assessed the quality of the included studies,and then performed qualitative description and comparison of the results.RESULTS Six systematic review/Meta and five pharmacoeconomic evaluation were included.Compared with ZA,denosumab was more effective in delaying the time of first occurrence and recurrence of skeletal-related events(SREs),reducing the inci-dence of SREs,and preventing pain in breast cancer with bone metastases.Denosumab reduced the fracture rates in postmeno-pausal breast cancer treated with aromatase inhibitors,while ZA did not show the effect.Compared with ZA,the adverse effects of denosumab were less severe inedema,pyrexia,renal failure and bone pain.However,denosumab may promote the occurrence of osteonecrosis of jaw.Denosumab may have more cost-effectiveness advantages than ZA in domestic and international medical settings.CONCLUSION Compared with ZA,denosumab is safer,more effective and more economical in bone care of breast cancer.
关键词
地舒单抗/唑来膦酸/骨折/乳腺癌/快速卫生技术评估Key words
denosumab/zoledronic acid/fracture/breast cancer/rapid health technology assessment引用本文复制引用
基金项目
江苏省研究型医院学会精益化用药石药专项科研项目(JY202233)
南通市科技计划(MSZ2022147)
南通市药学会常州四药医院药学科研项目(ntyx2208)
出版年
2024
NETL
NSTL
万方数据