雙膦酸鹽類藥物治療多發性骨髓瘤的系統評價_《中國循證醫學雜志》

作者：

姚小健 ,  劉春霞

蘭州大學第一醫院（蘭州 730000）;

關鍵詞：

雙膦酸鹽類多發性骨髓瘤系統評價隨機對照試驗

DOI：

10.7507/1672-2531.20100568

視頻：

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目的　系統評價雙膦酸鹽類藥物治療多發性骨髓瘤的效果和安全性。
方法　采用Cochrane系統評價方法，檢索Cochrane Library、PubMed、EMbase、中國生物醫學文獻數據庫、中國期刊全文數據庫等數據庫，由兩名評價者共同納入符合標準的研究，采用Cochrane 系統評價手冊4.2.7中RCT的質量評價標準評價研究的方法學質量后，對同質研究進行Meta分析。
結果　共納入11個RCT，研究地點均在國外，研究質量均較高，各試驗間具有基線可比性。Meta分析結果顯示：雙膦酸鹽類藥物有助于預防病理性脊柱骨折［OR=0.59，95%CI（0.45，0.78），P=0.000 2］和緩解疼痛［OR=0.59，95%CI（0.46，0.76），P=0.000 05］，但在緩解疼痛方面，由于數據臨床異質性較大，需謹慎對待這一結論。同時，在病死率［OR =0.98，95%CI（0.82，1.18），P=0.85］及高鈣血癥［OR=0.76，95%CI（0.56，1.03），P=0.07］方面與安慰劑組無差異。
結論　在治療多發性骨髓瘤中加入雙膦酸鹽類藥物可降低病理性脊柱骨折和疼痛，但無益于病死率及高鈣血癥的改善。

引用本文： 姚小健,劉春霞. 雙膦酸鹽類藥物治療多發性骨髓瘤的系統評價. 中國循證醫學雜志, 2010, 10(10): 1188-1193. doi: 10.7507/1672-2531.20100568 復制

1.	Alexanian R, Dimopulos M. The treatment of multiple myeloma. N Eng J Med, 1994, 330: 484-489.
2.	Raje N, Anderson KC. Introduction: the evolving role of bisphosphonate therapy in multiple myeloma. Blood, 2000, 96(2): 381-383.
3.	Berenson JR, Lichtenstein A, Porter L, et al. Long-term pamidronate treatment of advanced multiple myeloma patients reduces skeletal events. J Clin Oncol, 1998, 16(2): 593-602.
4.	Aparicio A, Gardner A, Tu Y, et al. In vitro cytoreductive effects on multiple myeloma cells induced by bisphosphonates. Leukemia, 1998, 12(2): 220-229.
5.	Shipman CM, Rogers MJ, Apperley JF. Bisphosphonates induce apoptosis in human myeloma cells: a novel anti-tumour activiy. Br J Haematol, 1997, 98(3): 665-672.
6.	Cohen J. A coemcient of agreement for nominal scales. Educ Psychol Meas, 1960, 20(42): 37-46.
7.	Belch AR, Bergsagel DE, Wilson K, et al. Effect of daily etidronate on the osteolysis of multiple myeloma. J Clin Oncol, 1991, 9(8): 1397-1402.
8.	Berenson JR, Lichtenstein A, Porter L, et al. Long-term pamidronate treatment of advanced multiple myeloma patients reduces skeletal events. J Clin Oncol, 1998, 16(2): 593-602.
9.	Brincker H, Westin J, Abildgaard N, et al. Failure of oral pamidronate to reduce skeletal morbidity in multiple myeloma: a double-blind placebo controlled trial. Br J Haematol, 1998, 101(2): 280-286.
10.	Daragon A, Humez C, Michot C, et al. Treatment of multiple myeloma with etidronate results of a multicentre double-blind study.Eur J Med, 1993, 2(8): 449-452.
11.	Delmas PD, Charhon S, Chapuy MC, et al. Long-term effects of dichloromethylene diphosphonate (CI2MDP) on skeletal lesions in multiple myeloma. Metab Bone Dis Relat Res, 1982, 4(3): 163-168.
12.	Heim ME, Clemens MR, Queiber W, et al. Prospective randomized trial of dichloromethilene bisphosphonate (clodronate) in patients with multiple myeloma. Onkologie, 1995, 18: 439-444.
13.	Lahtinen R, Laakso M, Palva I, et al. Randomized,placebo-controlled multicentre trial of clodronate in multiple myeloma. Lancet, 1992, 340(8827): 1049-1052.
14.	McCloskey EV, Dunn JA, Kanis JA, et al. Long-term follow-up of a prospective,double-blind,placebo-controlled randomized trial of clodronate in multiple myeloma. Br J Haematol, 2001, 113(4): 1035-1043.
15.	Fontana A, Herrmann Z, Menssen HD, et al. Effects of intravenous ibandronate therapy on skeletal related events (SRE)and survival in patients with advanced multiple myeloma. Blood, 1998, 92(Suppl1): 106a.
16.	Terpos E, Palermos J, Tsionos K, et al. Effect of pamidronate administration on markers of bone turnover and disease activity in multiple myeloma. Eur J Haematol, 2000, 65(5): 331-336.
17.	Kraj M, Poglod R, Pawlikowsky J, et al. The effect of pamidronate treatment on skeletal morbidity in advanced multiple myeloma. Acta Haematologica Polonica, 2000, 31: 379-389.
18.	Rosen LS, Gordon D, Kaminski M, et al. Zoledronic acid versus pamidronate in the treatment of skeletal metastases in patients with breast cancer or osteolytic lesions of multiple myeloma: a phase Ⅲ, double - blind,comparative trial. Cancer J, 2001, 7(5): 377-387.
19.	Ali SM, Esteva FJ, Hortobagyi G, et al. Safety and efficacy of bisphosphonates beyond 24 months in cancer patients. J Clin Oncol, 2001, 19(14): 3434-3437.
20.	Croucher PI, Shipman CM, Lippitt J, et al. Osteoprotegerin inhibits the development of osteolytic bone disease in multiple myeloma.Blood, 2001, 98(13): 3534-3540.
21.	Mundy G, Garrett R, Harris S, et al. Stimulation of bone formation in vitro and in rodents by statins. Science, 1999, 286(5446): 1946-1949.

1. Alexanian R, Dimopulos M. The treatment of multiple myeloma. N Eng J Med, 1994, 330: 484-489.
2. Raje N, Anderson KC. Introduction: the evolving role of bisphosphonate therapy in multiple myeloma. Blood, 2000, 96(2): 381-383.
3. Berenson JR, Lichtenstein A, Porter L, et al. Long-term pamidronate treatment of advanced multiple myeloma patients reduces skeletal events. J Clin Oncol, 1998, 16(2): 593-602.
4. Aparicio A, Gardner A, Tu Y, et al. In vitro cytoreductive effects on multiple myeloma cells induced by bisphosphonates. Leukemia, 1998, 12(2): 220-229.
5. Shipman CM, Rogers MJ, Apperley JF. Bisphosphonates induce apoptosis in human myeloma cells: a novel anti-tumour activiy. Br J Haematol, 1997, 98(3): 665-672.
6. Cohen J. A coemcient of agreement for nominal scales. Educ Psychol Meas, 1960, 20(42): 37-46.
7. Belch AR, Bergsagel DE, Wilson K, et al. Effect of daily etidronate on the osteolysis of multiple myeloma. J Clin Oncol, 1991, 9(8): 1397-1402.
8. Berenson JR, Lichtenstein A, Porter L, et al. Long-term pamidronate treatment of advanced multiple myeloma patients reduces skeletal events. J Clin Oncol, 1998, 16(2): 593-602.
9. Brincker H, Westin J, Abildgaard N, et al. Failure of oral pamidronate to reduce skeletal morbidity in multiple myeloma: a double-blind placebo controlled trial. Br J Haematol, 1998, 101(2): 280-286.
10. Daragon A, Humez C, Michot C, et al. Treatment of multiple myeloma with etidronate results of a multicentre double-blind study.Eur J Med, 1993, 2(8): 449-452.
11. Delmas PD, Charhon S, Chapuy MC, et al. Long-term effects of dichloromethylene diphosphonate (CI2MDP) on skeletal lesions in multiple myeloma. Metab Bone Dis Relat Res, 1982, 4(3): 163-168.
12. Heim ME, Clemens MR, Queiber W, et al. Prospective randomized trial of dichloromethilene bisphosphonate (clodronate) in patients with multiple myeloma. Onkologie, 1995, 18: 439-444.
13. Lahtinen R, Laakso M, Palva I, et al. Randomized,placebo-controlled multicentre trial of clodronate in multiple myeloma. Lancet, 1992, 340(8827): 1049-1052.
14. McCloskey EV, Dunn JA, Kanis JA, et al. Long-term follow-up of a prospective,double-blind,placebo-controlled randomized trial of clodronate in multiple myeloma. Br J Haematol, 2001, 113(4): 1035-1043.
15. Fontana A, Herrmann Z, Menssen HD, et al. Effects of intravenous ibandronate therapy on skeletal related events (SRE)and survival in patients with advanced multiple myeloma. Blood, 1998, 92(Suppl1): 106a.
16. Terpos E, Palermos J, Tsionos K, et al. Effect of pamidronate administration on markers of bone turnover and disease activity in multiple myeloma. Eur J Haematol, 2000, 65(5): 331-336.
17. Kraj M, Poglod R, Pawlikowsky J, et al. The effect of pamidronate treatment on skeletal morbidity in advanced multiple myeloma. Acta Haematologica Polonica, 2000, 31: 379-389.
18. Rosen LS, Gordon D, Kaminski M, et al. Zoledronic acid versus pamidronate in the treatment of skeletal metastases in patients with breast cancer or osteolytic lesions of multiple myeloma: a phase Ⅲ, double - blind,comparative trial. Cancer J, 2001, 7(5): 377-387.
19. Ali SM, Esteva FJ, Hortobagyi G, et al. Safety and efficacy of bisphosphonates beyond 24 months in cancer patients. J Clin Oncol, 2001, 19(14): 3434-3437.
20. Croucher PI, Shipman CM, Lippitt J, et al. Osteoprotegerin inhibits the development of osteolytic bone disease in multiple myeloma.Blood, 2001, 98(13): 3534-3540.
21. Mundy G, Garrett R, Harris S, et al. Stimulation of bone formation in vitro and in rodents by statins. Science, 1999, 286(5446): 1946-1949.

《中國循證醫學雜志》

雙膦酸鹽類藥物治療多發性骨髓瘤的系統評價

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《中國循證醫學雜志》

雙膦酸鹽類藥物治療多發性骨髓瘤的系統評價

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