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Denosumab safer than romosozumab in terms of cardiovascular outcomes

05 Dec 2019

Denosumab appears to have a neutral effect on the risk of composite and specific cardiovascular outcomes among patients with primary osteoporosis, whereas romosozumab may contribute to an increased risk of four-point major adverse cardiovascular event (4P MACE), according to the results of a meta-analysis.

Researchers searched multiple online databases for randomized clinical trials evaluating the effect of denosumab or romosozumab vs active comparators or placebo for at least 6 months in patients with primary osteoporosis or osteopaenia. Risk of bias was assessed in accordance with PRISMA guidelines.

The meta-analysis included 17 relevant studies, 11 of which were on denosumab (n=13,615 participants) and six were on romosozumab (n=12,219 participants). Pooled data showed no associations between denosumab therapy and risk of the following: a composite cardiovascular outcome (risk ratio [RR], 1.06, 95 percent confidence interval [CI], 0.88–1.28; p=0.54), three-point major adverse cardiovascular event (3P MACE; RR, 1.01, 95 percent CI, 0.83–1.23; p=0.93) and 4P MACE (RR, 0.99, 95 percent CI, 0.83–1.18;  p=0.89).

Romosozumab therapy, on the other hand, was associated with a heightened risk of 4P MACE (RR, 1.39, 95 percent CI, 1.01–1.90; p=0.04) among elderly men and postmenopausal woman with osteoporosis over a period of 12–36 months. Results were neutral for the risk of composite cardiovascular outcome (RR, 1.26, 95 percent CI, 0.95–1.68; p=0.11) and 3P MACE (RR, 1.41, 95 percent CI, 0.99–2.02; p=0.06).

Neither denosumab nor romosozumab exerted influence on specific cardiovascular outcomes, including cardiovascular death or any death, myocardial infarction, stroke, atrial fibrillation, heart failure, aortic and intracranial aneurysm, aortic dissection, aortic valve disease, and hypertension (p-all>0.05).

Sensitivity analysis modified the risk estimate for 4P MACE with romosozumab (RR, 1.36, 95 percent CI, 0.99–1.87; p=0.06).

Large observational studies with information on baseline cardiovascular disease risk and drug treatment and clear definitions of cardiovascular disease events are needed to fully understand the effects that denosumab or romosozumab therapies on cardiovascular disease outcomes, researchers said.

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Most Read Articles
Pearl Toh, 20 Nov 2019
The trade-off between the risk of ischaemic vs bleeding events may be different between Asian and non-Asian patients, which warrants careful consideration when deciding on the duration of antiplatelet therapy following a percutaneous coronary intervention (PCI), according to a presentation at ESC Asia Congress 2019.
4 days ago
Participating in a long-distance skiing event may help lower the risk of hypertension, with the number of completed races showing a weak association with the risk, a study has found.
06 Sep 2019
Hypertensive adults with lower plasma zinc concentration are at increased risk of haemorrhagic stroke, especially those with higher body mass index or lower plasma copper levels, a study has found.
06 Jan 2020
Target organ damage appears to be more noticeable in patients affected by primary aldosteronism than those affected by arterial hypertension without primary aldosteronism, suggests a study, adding that specific treatment can ease such condition.