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Anti-reabsorptive agents in women with osteoporosis: determining statistical equivalence according to evidence-based methods

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Abstract

Background

In the present study, we undertook an equivalence analysis on the effectiveness of the main anti-reabsorptive agents indicated for women with osteoporosis.

Methods

Our methodology was a combination of meta-analysis (both pair-wise meta-analysis and network meta-analysis) and equivalence testing. The end-point was the incidence on new vertebral fractures. The anti-reabsorptive agents examined included alendronate, zoledronate, ibandronate, risedronate, and denosumab.

Results

Our analysis involved nine randomized trials. Ten head-to-head indirect comparisons were examined through network meta-analysis and the respective values of RR were estimated. The 95 % confidence intervals for RR remained within the interval of a relative ±40 % variation for all comparisons that involved alendronate, risedronate, ibandronate, and denosumab. In contrast, the comparisons involving zoledronate satisfied a post hoc margin up to ±67 %.

Conclusion

Our results confirm that most of these anti-reabsorptive drugs (namely, alendronate, risedronate, ibandronate, and denosumab) are equivalent according to reasonable equivalence margins.

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References

  1. Ahn S, Park SH, Lee KH (2013) How to demonstrate similarity by using noninferiority and equivalence statistical testing in radiology research. Radiology 267(2):328–338

    Article  PubMed  Google Scholar 

  2. Messori A, Fadda V, Maratea D, Trippoli S (2014) The Italian way to evidence-based demonstration of equivalence as a prerequisite for conducting procurement tendering within the NHS (Rapid Response), thebmj. http://www.bmj.com/content/347/bmj.f4951/rr/759376. Accessed 1 July 2014

  3. Migliore A, Broccoli S, Massafra U, Cassol M, Frediani B (2013) Ranking antireabsorptive agents to prevent vertebral fractures in postmenopausal osteoporosis by mixed treatment comparison meta-analysis. Eur Rev Med Pharmacol Sci 17(5):658–667

    CAS  PubMed  Google Scholar 

  4. Norman G, Monteiro S, Salama S (2012) Sample size calculations: should the emperor’s clothes be off the peg or made to measure? BMJ 23(345):e5278. doi:10.1136/bmj.e5278

    Article  Google Scholar 

  5. Jones PW, Beeh KM, Chapman KR, Decramer M, Mahler DA, Wedzicha JA (2014) Minimal clinically important differences in pharmacological trials. Am J Respir Crit Care Med 189(3):250–255

    Article  PubMed  Google Scholar 

  6. Fadda V, Maratea D, Trippoli S, Messori A (2011) Network meta-analysis. Results can be summarised in a simple figure. BMJ 23(342):d1555

    Article  Google Scholar 

  7. Messori A (2014) Comment, PubMed Commons. Available at http://www.ncbi.nlm.nih.gov/pubmed/23543450/#comments. Accessed 5 Apr 2014

  8. Arruda MA (2013) No evidence of efficacy or evidence of no efficacy. JAMA Pediatr 167(3):300–302

    Article  PubMed  Google Scholar 

  9. Messori A, Fadda V, Maratea D, Trippoli S (2013) Erythropoiesis-stimulating agents in heart failure: no proof of effectiveness or proof of no effectiveness? Eur J Heart Fail 15(8):944–945

    Article  PubMed  Google Scholar 

  10. Freemantle N, Cooper C, Diez-Perez A, Gitlin M, Radcliffe H, Shepherd S, Roux C (2013) Results of indirect and mixed treatment comparison of fracture efficacy for osteoporosis treatments: a meta-analysis. Osteoporos Int 24(1):209–217

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Correspondence to Andrea Messori.

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Messori, A., Fadda, V., Maratea, D. et al. Anti-reabsorptive agents in women with osteoporosis: determining statistical equivalence according to evidence-based methods. J Endocrinol Invest 37, 769–773 (2014). https://doi.org/10.1007/s40618-014-0124-3

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  • DOI: https://doi.org/10.1007/s40618-014-0124-3

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