Cochrane · systematic review · CD003188
Bisphosphonates in multiple myeloma: an updated network meta‐analysis
Mhaskar, R, Kumar, A, Miladinovic, B, et al. · Cochrane Database of Systematic Reviews · 2017 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
7
current version
GRADE rated
7
No studies
0
Included studies
NR
No studies 0 · 0%Ungraded 0 · 0%Very low 1 · 14.3%Low 2 · 28.6%Moderate 4 · 57.1%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlySummary of findings (direct comparisons)
Population: patients with multiple myeloma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall survival## | HR 0.9 [0.76, 1.07] | 14 studies · 2706 participants | Moderate Downgraded: risk of bias, inconsistency |
Progression‐free survival### | HR 0.75 [0.57, 1] | 7 studies · 908 participants | Low Downgraded: risk of bias, publication bias |
Vertebral fractures | RR 0.74 [0.62, 0.89] | 7 studies · 1116 participants | Moderate Downgraded: risk of bias, publication bias |
Non‐vertebral fractures | RR 1.03 [0.68, 1.56] | 6 studies · 1389 participants | Moderate Downgraded: risk of bias, publication bias |
Skeletal‐related events | RR 0.74 [0.63, 0.88] | 10 studies · 2141 participants | Moderate Downgraded: risk of bias, publication bias |
Pain | RR 0.75 [0.6, 0.95] | 8 studies · 1281 participants | Very low |
Osteonecrosis of jaw | RR 4.61 [0.99, 21.35] | 6 studies · 1284 participants | Low Downgraded: risk of bias, imprecision, inconsistency, publication bias |
Summary of findings (benefits)
Population: patients with prevention of skeletal‐related events in multiple myeloma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall mortality 2292 patients | HR 0.96 [0.82, 1.13] | 12 studies · 2292 participants | Low Downgraded: risk of bias, inconsistency |
Progression‐free survival 364 Patients | HR 0.7 [0.41, 1.19] | 4 studies · 364 participants | Very low Downgraded: risk of bias |
Vertebral fractures 1116 Patients | RR 0.74 [0.62, 0.89] | 7 studies · 1116 participants | Moderate Downgraded: risk of bias |
Nonvertebral fractures 1389 patients | RR 1.03 [0.68, 1.56] | 6 studies · 1389 participants | Moderate Downgraded: risk of bias |
Skeletal‐related events 1497 patients | RR 0.8 [0.72, 0.89] | 7 studies · 1497 participants | Moderate Downgraded: risk of bias |
Pain 1281 patients | RR 0.75 [0.6, 0.95] | 8 studies · 1281 participants | Very low Downgraded: risk of bias |
Hypercalcemia 1934 patients | RR 0.79 [0.56, 1.11] | 8 studies · 1934 participants | Moderate Downgraded: risk of bias |
Summary of findings (harms)
Population: patients with prevention of skeletal‐related events in multiple myeloma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Gastrointestinal toxicity 1689 patients | RR 1.23 [0.95, 1.6] | 6 studies · 1689 participants | Low |
Hypocalcemia 1002 patients | RR 2.19 [0.49, 9.74] | 3 studies · 1002 participants | Very low |
Osteonecrosis of jaw 913 patients | RR 3.99 [0.44, 35.84] | 3 studies · 913 participants | Low |
Renal dysfunction 414 patients | no estimate extracted | 2 studies · 414 participants | Low |
Summary of findings (benefits)
Population: patients with prevention of skeletal related events in multiple myeloma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Overall mortality 2221 patients | HR 0.93 [0.79, 1.09] | 11 studies · 2221 participants | Low Downgraded: risk of bias, inconsistency |
Progression free survival 364 Patients | HR 0.7 [0.41, 1.19] | 4 studies · 364 participants | Very low Downgraded: risk of bias |
Vertebral fractures 1116 Patients | RR 0.74 [0.62, 0.89] | 7 studies · 1116 participants | Moderate Downgraded: risk of bias |
Non vertebral fractures 1389 patients | RR 1.03 [0.68, 1.56] | 6 studies · 1389 participants | Moderate Downgraded: risk of bias |
Skeletal related events 1497 patients | RR 0.81 [0.72, 0.92] | 7 studies · 1497 participants | Moderate Downgraded: risk of bias |
Pain 1281 patients | RR 0.75 [0.6, 0.95] | 8 studies · 1281 participants | Very low Downgraded: risk of bias |
Hypercalcemia 1934 patients | RR 0.87 [0.61, 1.24] | 8 studies · 1934 participants | Moderate Downgraded: risk of bias |
Summary of findings (harms)
Population: patients with prevention of skeletal related events in multiple myeloma
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Gastro intestinal toxicity 1689 patients | RR 1.23 [0.95, 1.6] | 6 studies · 1689 participants | Low |
Hypocalcemia 913 patients | RR 2.19 [0.49, 9.74] | 3 studies · 913 participants | Very low |
Osteonecrosis of jaw ( | no estimate extracted | 7 participants | Very low |