Abstract: TH-PO924

Efficacy and Safety of Different Bisphosphonates for Bone Loss Prevention in Kidney Transplant Patients: A Systematic Review and Network Meta-Analysis

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Yang, Yan, Kidney Research Institute, Division of Nephrology, West China Hospital, Sichuan University, Chengdu, China
  • Qiu, Shi, Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, P.R. China, Chengdu, China
  • Tang, Xi, west china hospital, sichuan university, Chengdu, SICHUAN, China
  • Fu, Ping, West China Hospital of Sichuan University, Chengdu, China
Background

Because the preferred bisphosphonate regimen for kidney transplantation (KT) patients is still controversial, we aimed to compare different bisphosphonate treatments.

Methods

We searched PubMed, Embase, CENTRAL and reference lists of relevant articles up to April 1, 2017. We included RCTs comparing bisphosphonates in adult KT patients. The primary outcome was BMD change at the lumber spine and femoral neck. We performed pairwise meta-analyses by random effect model and network meta-analysis (NMA) by Bayesian model. We used the GRADE framework to assess the quality of evidence.

Results

A total of 21 RCTs involving 1332 patients with 6 bisphosphonate regimens were included in the NMA. At the lumber spine (Figure 1A), calcium alone showed significantly lower percent change in BMD compared to combination with vitamin D analogs or other bisphosphonates except clodronate. Pamidronate with calcium and vitamin D analogs showed improvemed BMD in comparison to clodronate with calcium. The combination of calcium and vitamin D analogs had a significantly lower influence than adding pamidronate or alendronate. Considering absolute terms (Figure 1B), zoledronic acid and calcium outperformed calcium alone. In terms of percent change in BMD at femoral neck (Figure 1C), both pamidronate and ibandronate combined with calcium revealed a remarkable gain compared with calcium. In absolue terms (Figure 1D), alendronate with or without vitamin D analogs, displayed a significant increase compared to calcium alone. Ibandronate with calcium demonstrated advantages than any other treatments.

Conclusion

New generation bisphosphonates were more favorable in KT patients to improve BMD. Bisphosphonate therapy was well-tolerated without increasing the frequency of adverse events and graft loss.

Summary MD and 95%CrI from NMA of BMD change. The results are read from top to bottom and left to right. Significant results are in bold. A. Percent change at lumber spine; B. Absolute change at lumber spine; C. Percent change at femoral neck; D. Absolute change at femoral neck.

Funding

  • Government Support - Non-U.S.