1
|
Lai ECC, Lin TC, Lange JL, Chen L, Wong ICK, Sing CW, Cheung CL, Shao SC, Yang YHK. Effectiveness of denosumab for fracture prevention in real-world postmenopausal women with osteoporosis: a retrospective cohort study. Osteoporos Int 2022; 33:1155-1164. [PMID: 35032187 PMCID: PMC9007768 DOI: 10.1007/s00198-021-06291-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 12/27/2021] [Indexed: 12/26/2022]
Abstract
To determine denosumab's effectiveness for fracture prevention among postmenopausal women with osteoporosis in East Asia, the risk of fracture was compared between patients continuing denosumab therapy versus patients discontinuing denosumab after one dose. The real-world effectiveness was observed to be consistent with the efficacy demonstrated in the phase III trial. INTRODUCTION After therapeutic efficacy is demonstrated for subjects in global clinical trials, real-world evidence may provide complementary knowledge of therapeutic effectiveness in a heterogeneous mix of patients seen in clinical practice. This retrospective cohort study was conducted to compare the fracture risk in real-world clinical care received in Taiwan and Hong Kong between a treatment cohort (patients receiving denosumab 60 mg subcutaneously every 6 months) versus an off-treatment cohort (patients discontinuing after 1 dose of denosumab, which has no known clinical benefit) among real-world postmenopausal women. METHODS This study included 38,906 and 2,835 postmenopausal women receiving denosumab in Taiwan and Hong Kong, respectively. The primary endpoint was hip fracture, and secondary endpoints were clinical vertebral and nonvertebral fractures. Propensity-score-matched analysis, adjusting for known covariates, was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). The robustness of findings was evaluated with a series of sensitivity and quantitative bias analyses. RESULTS In this study, 554 hip fractures were included in the primary Taiwan population analysis. The crude incidence rate was 0.9 per 100 person-years in the treatment cohort (n = 25,059) and 1.7 per 100 person-years in the off-treatment cohort (n = 13,847). After adjusting for prognostic differences between cohorts, denosumab reduced the risk of hip fractures by 38% (HR = 0.62, CI:0.52-0.75). Risk reductions of similar magnitude were observed for the secondary endpoints and for the analysis of the smaller Hong Kong population. CONCLUSION The effectiveness of denosumab for fracture reduction among real-world postmenopausal women with osteoporosis was consistent with the efficacy demonstrated in a global clinical trial. REGISTRATION EnCePP registration number: EUPAS26372; registration date: 12/11/2018.
Collapse
Affiliation(s)
- E C-C Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, 1, University Road, Tainan, 701, Taiwan
| | - T-C Lin
- Amgen Inc, Thousand Oaks, CA, USA
| | | | - L Chen
- Amgen Inc, Thousand Oaks, CA, USA
| | - I C K Wong
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - C-W Sing
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - C-L Cheung
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - S-C Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Y-H Kao Yang
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, 1, University Road, Tainan, 701, Taiwan.
| |
Collapse
|
2
|
Sing CW, Cheng VKF, Ho DKC, Kung AWC, Cheung BMY, Wong ICK, Tan KCB, Salas-Salvadó J, Becerra-Tomas N, Cheung CL. Serum calcium and incident diabetes: an observational study and meta-analysis. Osteoporos Int 2016; 27:1747-54. [PMID: 26659066 DOI: 10.1007/s00198-015-3444-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/26/2015] [Indexed: 01/11/2023]
Abstract
UNLABELLED The study aimed to prospectively evaluate if serum calcium is related to diabetes incidence in Hong Kong Chinese. The results showed that serum calcium has a significant association with increased risk of diabetes. The result of meta-analysis reinforced our findings. INTRODUCTION This study aimed to evaluate the association of serum calcium, including serum total calcium and albumin-corrected calcium, with incident diabetes in Hong Kong Chinese. METHODS We conducted a retrospective cohort study in 6096 participants aged 20 or above and free of diabetes at baseline. Serum calcium was measured at baseline. Incident diabetes was determined from several electronic databases. We also searched relevant databases for studies on serum calcium and incident diabetes and conducted a meta-analysis using fixed-effect modeling. RESULTS During 59,130.9 person-years of follow-up, 631 participants developed diabetes. Serum total calcium and albumin-corrected calcium were associated with incident diabetes in the unadjusted model. After adjusting for demographic and clinical variables, the association remained significant only for serum total calcium (hazard ratio (HR), 1.32 (95 % confidence interval (CI), 1.02-1.70), highest vs. lowest quartile). In a meta-analysis of four studies including the current study, both serum total calcium (pooled risk ratio (RR), 1.38 (95 % CI, 1.15-1.65); I (2) = 5 %, comparing extreme quantiles) and albumin-corrected calcium (pooled RR, 1.29 (95 % CI, 1.03-1.61); I (2) = 0 %, comparing extreme quantiles) were associated with incident diabetes. Penalized regression splines showed that the association of incident diabetes with serum total calcium and albumin-correlated calcium was non-linear and linear, respectively. CONCLUSIONS Elevated serum calcium concentration is associated with incident diabetes. The mechanism underlying this association warrants further investigation.
Collapse
Affiliation(s)
- C W Sing
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - V K F Cheng
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - D K C Ho
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - A W C Kung
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - B M Y Cheung
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
- Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
- The State Key Laboratory of Pharmaceutical Biotechnology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - I C K Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
- The State Key Laboratory of Pharmaceutical Biotechnology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - K C B Tan
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
- Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China
| | - J Salas-Salvadó
- Human Nutrition Unit, Faculty of Medicine and Health Sciences, Institut d'Investigacio Sanitaria Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - N Becerra-Tomas
- Human Nutrition Unit, Faculty of Medicine and Health Sciences, Institut d'Investigacio Sanitaria Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Institute of Health Carlos III, Madrid, Spain
| | - C L Cheung
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China.
- Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China.
- Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China.
- The State Key Laboratory of Pharmaceutical Biotechnology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, People's Republic of China.
| |
Collapse
|
3
|
Cheung CL, Sing CW, Tang CSM, Cheng VKF, Pirmohamed M, Choi CH, Hung CS, Lau EYF, Lee KF, Mak MWH, Leung JYY, Wong TW, Ho AYY, Chan KW, Hung VHF, Tam V, Siu SC, Pang HK, Wat WZM, Lee HHY, Chung CT, Hue RSM, Sham PC, Cheung BMY, Wong ICK, Tan KCB, Kung AWC. HLA-B*38:02:01predicts carbimazole/methimazole-induced agranulocytosis. Clin Pharmacol Ther 2016; 99:555-61. [PMID: 26599303 DOI: 10.1002/cpt.309] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/17/2015] [Indexed: 12/30/2022]
Affiliation(s)
- C-L Cheung
- Pharmacogenomics and Precision Therapeutics Laboratory, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong China
- The State Key Laboratory of Pharmaceutical Biotechnology, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong China
- Department of Medicine, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong China
- Centre for Genomic Sciences, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong China
| | - C-W Sing
- Pharmacogenomics and Precision Therapeutics Laboratory, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong China
| | - CSM Tang
- Centre for Genomic Sciences, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong China
- Department of Psychiatry, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong China
| | - VKF Cheng
- Pharmacogenomics and Precision Therapeutics Laboratory, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong China
| | - M Pirmohamed
- Department of Molecular and Clinical Pharmacology; The University of Liverpool; United Kingdom
- Royal Liverpool and Broadgreen University Hospital NHS Trust; Liverpool United Kingdom
| | - C-H Choi
- Department of Medicine; Queen Elizabeth Hospital; Hong Kong China
| | - C-S Hung
- Department of Medicine and Geriatrics; United Christian Hospital; Hong Kong China
| | - EY-F Lau
- Department of Medicine; Pamela Youde Nethersole Eastern Hospital; Hong Kong China
| | - KF Lee
- Department of Medicine and Geriatrics; Kwong Wah Hospital; Hong Kong China
| | - MW-H Mak
- Department of Medicine and Geriatrics; Kwong Wah Hospital; Hong Kong China
| | - JYY Leung
- Department of Medicine and Geriatrics; Ruttonjee & Tang Shiu Kin Hospitals; Hong Kong China
| | - T-W Wong
- Department of Medicine and Geriatrics; Ruttonjee & Tang Shiu Kin Hospitals; Hong Kong China
| | - AYY Ho
- Department of Medicine and Geriatrics; Tuen Mun Hospital; Hong Kong China
| | - K-W Chan
- Department of Medicine and Geriatrics; Princess Margaret Hospital; Hong Kong China
| | - VHF Hung
- Department of Medicine and Geriatrics; Princess Margaret Hospital; Hong Kong China
| | - V Tam
- F.H.K.A.M, Department of Medicine; Caritas Medical Centre; Hong Kong China
| | - S-C Siu
- Department of Medicine; Tung Wah Eastern Hospital; Hong Kong China
| | - H-K Pang
- Department of Medicine; Pamela Youde Nethersole Eastern Hospital; Hong Kong China
| | - WZ-M Wat
- Department of Medicine; Pamela Youde Nethersole Eastern Hospital; Hong Kong China
| | - HH-Y Lee
- Department of Medicine; Pamela Youde Nethersole Eastern Hospital; Hong Kong China
| | - C-T Chung
- Department of Medicine; Pamela Youde Nethersole Eastern Hospital; Hong Kong China
| | - RS-M Hue
- Department of Medicine; Pamela Youde Nethersole Eastern Hospital; Hong Kong China
| | - P-C Sham
- Centre for Genomic Sciences, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong China
- Department of Psychiatry, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong China
| | - BMY Cheung
- The State Key Laboratory of Pharmaceutical Biotechnology, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong China
- Department of Medicine, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong China
- Centre for Genomic Sciences, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong China
| | - ICK Wong
- Pharmacogenomics and Precision Therapeutics Laboratory, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong China
- The State Key Laboratory of Pharmaceutical Biotechnology, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong China
- Research Department of Practice and Policy; UCL School of Pharmacy; London United Kingdom
| | - KCB Tan
- Department of Medicine, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong China
| | - AWC Kung
- Department of Medicine, Li Ka Shing Faculty of Medicine; The University of Hong Kong; Pokfulam Hong Kong China
| |
Collapse
|