Background: Metastatic bone disease (MBD) presents significant challenges in patient management, leading to skeletal-related events (SREs), compromised health-related quality of life, and heightened pain experiences. Denosumab (Dmab) and zoledronic acid (ZA) are bone-modifying agents (BMAs) commonly employed to mitigate the sequelae of MBD. Previous meta-analyses have assessed primary outcomes such as overall survival, pathological fractures, radiation to bone, and the time to SREs within studies. However, a single comprehensive analysis comparing their efficacy across multiple primary and secondary outcomes, as well as cost-effectiveness in specific cancer types, has not yet been conducted.Methods: A literature search identified relevant randomized controlled trials (RCTs), and the primary outcomes included overall survival, pathologic fractures, radiation to bone, and the time to SREs within studies. Secondary outcomes included adverse events, pain, analgesia usage, quality of life, and cost.Results: Meta-analysis revealed that Dmab effectively reduced the need for bone-targeted radiation therapy and was superior to ZA in delaying the time to SREs, except in multiple myeloma. Dmab also reduced pathological fracture incidences in breast cancer patients by 39%.Conclusions: Our analysis suggests that while both agents similarly impact overall survival and disease progression, Dmab offers advantages in SRE reduction and improved HRQoL and pain outcomes with lower rates of opioid usage, albeit with higher risks of hypocalcemia and osteonecrosis in some subgroups. The consensus on cost-effectiveness is mixed and varies based on the cancer type and healthcare system, with some studies favoring Dmab’s superior efficacy and safety, while others find ZA more cost-effective due to its lower cost. This study underscores the potential of Dmab as a preferred BMA for MBD management, especially for high-risk skeletal complications, while highlighting cancer-specific safety considerations. Further research is warranted to refine cancer-specific BMA use and optimize MBD management strategies.
背景：转移性骨病（MBD）给患者管理带来重大挑战，常导致骨骼相关事件（SREs）、健康相关生活质量下降及疼痛加剧。地舒单抗（Dmab）与唑来膦酸（ZA）是临床常用的骨改良剂（BMAs），用于缓解MBD引发的继发性损害。既往荟萃分析主要评估了总生存期、病理性骨折、骨放疗需求及SREs发生时间等主要结局指标，但尚未有研究系统比较这两种药物在多种主要与次要结局指标上的疗效差异，亦缺乏针对特定癌症类型成本效益的综合分析。 方法：通过文献检索筛选相关随机对照试验（RCTs），主要结局指标包括总生存期、病理性骨折发生率、骨放疗需求及SREs发生时间。次要结局指标涵盖不良事件、疼痛程度、镇痛药物使用、生活质量及治疗成本。 结果：荟萃分析显示，除多发性骨髓瘤外，Dmab能有效降低骨靶向放疗需求，且在延缓SREs发生方面优于ZA。在乳腺癌患者中，Dmab使病理性骨折发生率降低39%。 结论：本研究表明，虽然两种药物对总生存期和疾病进展的影响相似，但Dmab在减少SREs、改善健康相关生活质量和疼痛控制方面更具优势，且阿片类药物使用率更低，但部分亚组患者低钙血症和骨坏死风险较高。成本效益评估结果存在分歧，其结论因癌症类型和医疗体系而异：部分研究肯定Dmab更优的疗效与安全性，另一些研究则因ZA成本更低而认为其更具经济性。本研究提示Dmab可作为MBD管理的优选骨改良剂，尤其适用于高风险骨骼并发症患者，同时强调需关注癌症特异性的安全性问题。未来需进一步开展研究以完善癌症特异性骨改良剂的应用策略，优化MBD管理方案。
肿瘤(癌症)患者之家