Comparative efficacy between monoclonal antibodies and conventional drugs in postmenopausal women with osteoporosis: a network meta-analysis

Background: To evaluate the efficacy of different pharmacological interventions, with emphasis on monoclonal antibodies (McAbs) for the treatment of postmenopausal osteoporotic women. Methods: A search of PubMed, Google Scholar, Embase, and the Cochrane Library, as well as China National Knowledge Infrastructure (CNKI) was performed. Data were collected and pooled using Bayesian network meta-analysis (NMA), which conducts both direct and indirect comparisons. The primary outcome was the percentage change in bone mineral density (BMD) in the lumbar spine from baseline to 1 year of treatment. All drugs were ranked based on the surface under the cumulative ranking area (SUCRA). Furthermore, the heterogeneity, consistency, and publication bias of the enrolled literature were assessed. Results: There were 14 randomized controlled trials (RCTs) consisting of 4,881 participants included to compare 11 interventions. Compared with that of a placebo, all the 10 selected therapies showed significant efficacy through changes in BMD ranging from 6.0% to 19.0% (all P<0.01). As the SUCRA values indicated, the therapeutic performance of antibody drugs was better than that of the conventional chemical agents, and blosozumab was the best choice (SUCRA 99.2%) to improve lumbar spine BMD. Conclusions: Novel McAb treatments achieved better therapeutic effects in the treatment of postmenopausal osteoporosis (PMO), especially blosozumab. Further trials are needed to investigate and optimize the delivery strategy of McAbs.