Risk-benefit profile for raloxifene: 4-year data From the Multiple Outcomes of Raloxifene Evaluation (MORE) randomized trial.
Posthoc analysis of the MORE osteoporosis treatment trial assessed risk-benefit profile of raloxifene in 7705 postmenopausal women. A major disease outcomes global index resulted in annual rates of 1.39% and 1.83% in the raloxifene and placebo groups, respectively (HR, 0.75; 95% CI, 0.62-0.92), compatible with a favorable risk-benefit profile for raloxifene for treating postmenopausal osteoporosis.


BACKGROUND
The Women's Health Initiative (WHI) trial reported overall risks that exceeded benefits from use of estrogen-progestin in healthy postmenopausal women. The objective of this posthoc analysis of the Multiple Outcomes of Raloxifene Evaluation (MORE) trial was to assess the safety profile of raloxifene, a selective estrogen receptor modulator indicated for the prevention and treatment of osteoporosis, using the global index method from the WHI trial.


METHODS
A total of 7705 postmenopausal women (mean age, 67 years) were enrolled in the MORE osteoporosis treatment trial and randomly assigned to receive placebo or one of two doses of raloxifene (60 or 120 mg/day) for 4 years. A global index of clinical outcomes, defined as described for the WHI trial (the earliest occurrence of coronary heart disease, stroke, pulmonary embolism, invasive breast cancer, endometrial cancer, colorectal cancer, hip fracture, or death because of other causes) was applied to the MORE trial data. Physicians blinded to treatment assignment adjudicated events. Intention-to-treat survival analysis of time-to-first-event was performed using a proportional hazards model.


CONCLUSIONS
The annualized rate of global index events was 1.83% in the placebo group and 1.39% in the combined raloxifene dose groups (hazard ratio [HR], 0.75; 95% CI, 0.62-0.92). Analyzing individual dose groups separately yielded the same results (HR for 60 mg/day, 0.75; 95% CI, 0.60-0.96: HR for 120 mg/day, 0.75; 95% CI, 0.59-0.95). Subgroup analyses showed no significant interactions between age or hysterectomy status and the effect of raloxifene on the global index (interaction p > 0.1), whereas the global index risk reduction seemed to be greater in obese women compared with nonobese women (interaction p = 0.03). The significant 25% reduction in global index is compatible with a favorable risk-benefit safety profile when raloxifene is used for osteoporosis treatment in postmenopausal women. These results require confirmation in ongoing clinical trials.
Barrett-Connor
Elizabeth
E
Division of Epidemiology, Department of Family and Preventive Medicine, University of California at San Diego, La Jolla, California 92093-0607, USA. ebarrettconnor@ucsd.edu
Cauley
Jane A
JA
Kulkarni
Pandurang M
PM
Sashegyi
Andreas
A
Cox
David A
DA
Geiger
Mary Jane
MJ
D000368:Aged; D001943:Breast Neoplasms / Q000139:chemically induced; D003327:Coronary Disease / Q000139:chemically induced; D004311:Double-Blind Method; D005260:Female; D006620:Hip Fractures / Q000139:chemically induced; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy*; D016016:Proportional Hazards Models; D011655:Pulmonary Embolism / Q000139:chemically induced; D020849:Raloxifene Hydrochloride / Q000009:adverse effects / Q000627:therapeutic use*; D018570:Risk Assessment; D020521:Stroke / Q000139:chemically induced; D016896:Treatment Outcome
D020849:Raloxifene Hydrochloride