The effect of denosumab vs. zoledronic acid in preventing skeletal-related events, including pain-related bone metastasis: a systematic review

Purpose:
Skeletal-related events (SREs) are common complications of bone metastases that include the need for radiation or surgery to bone, pathological and radiological fractures, and hypercalcemia. Available data indicate that significant bone pain is associated with SREs, leading to an increased risk of death, higher medication costs, and reduced quality of life for patients. Bisphosphonate agents and denosumab are therapeutic options for preventing SREs in advanced cancer patients with bone metastases. This study aims to compare the effect of denosumab and zoledronic acid in SREs, with a particular focus on pain-related SREs.

Views:
Three scientific databases – PubMed, the Cochrane Library, and Google Scholar – were selected and searched for articles published in English up to March 2023. Also, a manual search of related articles was conducted. From the systematic search, four randomized clinical trial studies were identified and further assessed using the Cochrane Collaboration Risk of Bias Tool.

Conclusions:
Denosumab was found to have outcomes that are not inferior to Zoledronic acid in delaying the first incidence of SREs, which include pathologic fracture, radiotherapy to bone, surgery to bone, or spinal cord compression. This review concludes that both therapies effectively reduce pain and prevent SREs in cancer patients at risk.