骨癌用药急需临床指南
2012-05-19 12:12:35 来源：
丁香园 作者： 评论：0 点击：
Although bisphosphonate drugs can reduce pain and bone fractures in individuals with multiple myeloma, no one drug is superior, according to a systematic review of the current evidence of these drugs. The review is published in The Cochrane Library.
虽然双磷酸盐药物可以降低多发性骨髓瘤导致的骨折引起的疼痛，但对这些药物进行系统性的回顾分析，目前没有证据表明哪一种药物疗效更好，这项综述发表在The Cochrane Library。
Multiple myeloma is a type of cancer that grows in and on bones. The disease can cause fractures in the spine and long bones. Bisphosphonate drugs are used to prevent or reduce the occurrence of bone fractures and pain in these patients and work by inhibiting the activities of osteoclasts (bone cells).
多发性骨髓瘤是一种生长在骨骼上的癌症。这种病会导致脊柱和长骨骨折。双磷酸盐药物通过抑制破骨细胞（骨细胞）的活动来预防和减轻这些患者骨折的发生和疼痛，
The team examined data on 6,692 myeloma patients from 20 trials who took bisphosphonate drugs in addition to their myeloma treatments. The bisphosphonate drugs included:
该小组研究了6692名多发性骨髓瘤患者的数据，这项数据来自20个服用双磷酸盐药物治疗多发性骨髓瘤的试验组。
clodronate氯磷酸二钠
etidronate依替磷酸钠
zoledronate唑来磷酸
ibandronate伊班磷酸钠
pamidronate帕米磷酸
The researchers found that patients who took bisphosphnoates had reduced occurrence of pain and fractures. For all types of fractures, between 6 and 15 patients would require treatment in order to prevent fractures in 1 patient,， according to their estimates, while 5 to 13 patients would need to be treated to reduce pain in 1.
研究人员发现服用双磷酸盐能使患者减少骨折和疼痛的发生。根据他们的估计，对于所有类型的骨折，进行这种治疗的6到15名患者，有一人减少了骨折的发生，而5到13名患者有一人减轻了疼痛。
4 of the 20 trials suggested that zoledronate was more effective than etidronate at reducing fractures. However, when the team made indirect comparisons by interrogating the data from the 20 trials (direct comparisons between different drugs; drug vs. placebo; and drug vs. no treatment), they found no drug to be superior.
20个试验小组中的4个表明唑来磷酸比依替磷酸钠更能有效减少骨折的发生，然而当该小组通过询问20个试验小组的数据进行比较（在不同药物之间进行对比；药物对比安慰剂；药物对比没有治疗的），他们发现没有服药效果更好。
Lead researcher of the study, Ambuj Kumar of the Center for Evidence Based Medicine and Health Outcomes Research at the University of South Florida, Tampa, Florida, explained:
来自Tampa, Florida，南佛罗里达大学询证医学和卫生研究中心的Ambuj Kumar，该研究的负责人解释说：
"Whether zoledronate is superior to any other bisphosphonate drug remains an open question. In light of the inconsistencies we see in the data, it is difficult to recommend any drug as a preferential treatment for clinical practice."
唑来磷酸是否比其它双磷酸盐更优越仍是个未解决的问题。由于我们发现数据不一致，所以很难为临床推荐任何优先选择的药物。
Although side effects of these drugs seem to be rare, one potential complication is osteonecrosis of the jaw. However, the researchers found that it is not more prevalent in patients taking bisphosphonate drugs than patients receiving placebo or no treatment.
虽然这些药物很少有副作用，但是一种潜在的并发症是颚骨坏死。然而研究人员发现服用双磷酸盐并不比服用兴奋剂和未接受治疗的更普遍。
Kumar concluded:
Kumar 得出结论：
"We didn't identify any significant adverse effects, but this work does highlight the need for larger head-to-head trials, which are needed to better compare the safety and effectiveness of the different drugs available."
尽管我们没有发现任何严重的副作用，但这项研究很需要更大规模的对比试验，需要更好的对比可能存在的不同药物的安全性和有效性。
虽然双磷酸盐药物可以降低多发性骨髓瘤导致的骨折引起的疼痛，但对这些药物进行系统性的回顾分析，目前没有证据表明哪一种药物疗效更好，这项综述发表在The Cochrane Library。
Multiple myeloma is a type of cancer that grows in and on bones. The disease can cause fractures in the spine and long bones. Bisphosphonate drugs are used to prevent or reduce the occurrence of bone fractures and pain in these patients and work by inhibiting the activities of osteoclasts (bone cells).
多发性骨髓瘤是一种生长在骨骼上的癌症。这种病会导致脊柱和长骨骨折。双磷酸盐药物通过抑制破骨细胞（骨细胞）的活动来预防和减轻这些患者骨折的发生和疼痛，
The team examined data on 6,692 myeloma patients from 20 trials who took bisphosphonate drugs in addition to their myeloma treatments. The bisphosphonate drugs included:
该小组研究了6692名多发性骨髓瘤患者的数据，这项数据来自20个服用双磷酸盐药物治疗多发性骨髓瘤的试验组。
clodronate氯磷酸二钠
etidronate依替磷酸钠
zoledronate唑来磷酸
ibandronate伊班磷酸钠
pamidronate帕米磷酸
The researchers found that patients who took bisphosphnoates had reduced occurrence of pain and fractures. For all types of fractures, between 6 and 15 patients would require treatment in order to prevent fractures in 1 patient,， according to their estimates, while 5 to 13 patients would need to be treated to reduce pain in 1.
研究人员发现服用双磷酸盐能使患者减少骨折和疼痛的发生。根据他们的估计，对于所有类型的骨折，进行这种治疗的6到15名患者，有一人减少了骨折的发生，而5到13名患者有一人减轻了疼痛。
4 of the 20 trials suggested that zoledronate was more effective than etidronate at reducing fractures. However, when the team made indirect comparisons by interrogating the data from the 20 trials (direct comparisons between different drugs; drug vs. placebo; and drug vs. no treatment), they found no drug to be superior.
20个试验小组中的4个表明唑来磷酸比依替磷酸钠更能有效减少骨折的发生，然而当该小组通过询问20个试验小组的数据进行比较（在不同药物之间进行对比；药物对比安慰剂；药物对比没有治疗的），他们发现没有服药效果更好。
Lead researcher of the study, Ambuj Kumar of the Center for Evidence Based Medicine and Health Outcomes Research at the University of South Florida, Tampa, Florida, explained:
来自Tampa, Florida，南佛罗里达大学询证医学和卫生研究中心的Ambuj Kumar，该研究的负责人解释说：
"Whether zoledronate is superior to any other bisphosphonate drug remains an open question. In light of the inconsistencies we see in the data, it is difficult to recommend any drug as a preferential treatment for clinical practice."
唑来磷酸是否比其它双磷酸盐更优越仍是个未解决的问题。由于我们发现数据不一致，所以很难为临床推荐任何优先选择的药物。
Although side effects of these drugs seem to be rare, one potential complication is osteonecrosis of the jaw. However, the researchers found that it is not more prevalent in patients taking bisphosphonate drugs than patients receiving placebo or no treatment.
虽然这些药物很少有副作用，但是一种潜在的并发症是颚骨坏死。然而研究人员发现服用双磷酸盐并不比服用兴奋剂和未接受治疗的更普遍。
Kumar concluded:
Kumar 得出结论：
"We didn't identify any significant adverse effects, but this work does highlight the need for larger head-to-head trials, which are needed to better compare the safety and effectiveness of the different drugs available."
尽管我们没有发现任何严重的副作用，但这项研究很需要更大规模的对比试验，需要更好的对比可能存在的不同药物的安全性和有效性。
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