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Bisphosphonates in multiple myeloma: a network meta-analysis

  1. Rahul Mhaskar1,
  2. Jasmina Redzepovic2,
  3. Keith Wheatley3,
  4. Otavio Augusto Camara Clark4,
  5. Branko Miladinovic1,
  6. Axel Glasmacher5,
  7. Ambuj Kumar1,*,
  8. Benjamin Djulbegovic6

Editorial Group: Cochrane Haematological Malignancies Group

Published Online: 16 MAY 2012

Assessed as up-to-date: 15 OCT 2011

DOI: 10.1002/14651858.CD003188.pub3


How to Cite

Mhaskar R, Redzepovic J, Wheatley K, Clark OAC, Miladinovic B, Glasmacher A, Kumar A, Djulbegovic B. Bisphosphonates in multiple myeloma: a network meta-analysis. Cochrane Database of Systematic Reviews 2012, Issue 5. Art. No.: CD003188. DOI: 10.1002/14651858.CD003188.pub3.

Author Information

  1. 1

    University of South Florida, Center for Evidence Based Medicine and Health Outcomes Research, Tampa, Florida, USA

  2. 2

    Bayer Schering Pharma AG, Berlin, Germany

  3. 3

    University of Birmingham, Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, Birmingham, UK

  4. 4

    Scientific Solutions in Healthcare, EVIDENCIAS, San Paolo, Brazil

  5. 5

    University of Bonn, Bonn, Germany

  6. 6

    Center for Evidence Based Medicine and Health Outcomes Research, University of South Florida, Professor of Medicine and Oncology, H. Lee Moffitt Cancer Center, Tampa, Florida, USA

*Ambuj Kumar, Center for Evidence Based Medicine and Health Outcomes Research, University of South Florida, Tampa, Florida, USA. akumar1@health.usf.edu. drambujkr@gmail.com.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 16 MAY 2012

SEARCH

[Figure 1]
Figure 1. Bisphosphonate chemical structures
[Figure 2]
Figure 2. Study flow chart. NRCT: Nonrandomized controlled trial.
[Figure 3]
Figure 3. Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
[Figure 4]
Figure 4. Bisphosphonate potency metaregression for overall survival. HR: Hazard ratio.
[Figure 5]
Figure 5. Randomized controlled trial (RCT) networks. OS: Overall survival; SREs: Skeletal-related events; PFS: Progression-free survival.
[Figure 6]
Figure 6. a: Ranking probabilities of competing bisphosphonates. The size of each bar corresponds to the probability of each treatment to be at a specific rank. OS: Overall survival; PFS: Progression-free survival; SRE: Skeletal-related events; Vert: Vertebral fractures; Non-Vert: Nonvertebral fractures; GI: Gastrointestinal symptoms; Hyper: Hypercalcemia.

b: Surface under the cumulative ranking curve (SUCRA) plots for each treatment. The outcomes are listed on the horizontal axis. SUCRA for each outcome are on the vertical axis.
[Analysis 1.1]
Analysis 1.1. Comparison 1 Bisphosphonates vs. control (efficacy), Outcome 1 Mortality.
[Analysis 1.2]
Analysis 1.2. Comparison 1 Bisphosphonates vs. control (efficacy), Outcome 2 Progression free survival.
[Analysis 1.3]
Analysis 1.3. Comparison 1 Bisphosphonates vs. control (efficacy), Outcome 3 Vertebral fractures.
[Analysis 1.4]
Analysis 1.4. Comparison 1 Bisphosphonates vs. control (efficacy), Outcome 4 Non-vertebral fractures.
[Analysis 1.5]
Analysis 1.5. Comparison 1 Bisphosphonates vs. control (efficacy), Outcome 5 Total skeletal related events.
[Analysis 1.6]
Analysis 1.6. Comparison 1 Bisphosphonates vs. control (efficacy), Outcome 6 Incidence of hypercalcemia.
[Analysis 1.7]
Analysis 1.7. Comparison 1 Bisphosphonates vs. control (efficacy), Outcome 7 Pain.
[Analysis 2.1]
Analysis 2.1. Comparison 2 Bisphosphonates vs. control (adverse effects), Outcome 1 Gastrointestinal toxicity (grade III/IV).
[Analysis 2.2]
Analysis 2.2. Comparison 2 Bisphosphonates vs. control (adverse effects), Outcome 2 Hypocalcaemia.
[Analysis 2.3]
Analysis 2.3. Comparison 2 Bisphosphonates vs. control (adverse effects), Outcome 3 Renal Dysfunction.
[Analysis 2.4]
Analysis 2.4. Comparison 2 Bisphosphonates vs. control (adverse effects), Outcome 4 Osteonecosis of jaw.
[Analysis 3.1]
Analysis 3.1. Comparison 3 Sensitivity analyses (assessment of bias: analysed outcome in brackets), Outcome 1 Allocation concealment (vertebral fractures).
[Analysis 3.2]
Analysis 3.2. Comparison 3 Sensitivity analyses (assessment of bias: analysed outcome in brackets), Outcome 2 Blinding (vertebral fractures).
[Analysis 3.3]
Analysis 3.3. Comparison 3 Sensitivity analyses (assessment of bias: analysed outcome in brackets), Outcome 3 Randomization method (vertebral fractures).
[Analysis 3.4]
Analysis 3.4. Comparison 3 Sensitivity analyses (assessment of bias: analysed outcome in brackets), Outcome 4 Type of data analysis (vertebral fractures).
[Analysis 3.5]
Analysis 3.5. Comparison 3 Sensitivity analyses (assessment of bias: analysed outcome in brackets), Outcome 5 Description of withdrawals and drop outs (vertebral fractures).
[Analysis 3.6]
Analysis 3.6. Comparison 3 Sensitivity analyses (assessment of bias: analysed outcome in brackets), Outcome 6 Alpha error (vertebral fractures).
[Analysis 3.7]
Analysis 3.7. Comparison 3 Sensitivity analyses (assessment of bias: analysed outcome in brackets), Outcome 7 Beta error (vertebral fractures).