Safety of the cathepsin K inhibitor odanacatib in postmenopausal women with osteopenia or osteoporosis: a meta-analysis

Cathepsin K, a cysteine protease expressed in osteoclasts, degrades type 1 collagen. Odanacatib selectively and reversibly inhibited cathepsin K and rapidly decreased bone resorption in preclinical and clinical studies. By searching the PubMed, Embase, OVID and Science Direct databases, we conducted a meta-analysis to examine the safety of odanacatib in postmenopausal women with osteoporosis. Studies were pooled, and the relative risk (RR) and its corresponding 95% confidence interval (CI) were calculated. Version 12.0 STATA software was used for statistical analysis. Six relevant articles were included for this meta-analysis study. We observed that the incidence of fracture in postmenopausal women treatment with odanacatib is significantly lower than that with placebo (RR=0.34, 95% CI=0.16-0.71, P-heterogeneity<0.750, l(2)=0%), however, there was no significant difference in the incidence of AEs, SAEs, discontinuations due to AEs and skin AEs. In conclusion, compared to placebo, odanacatib treatment significantly reduced the risk of relative fracture, however, there was no difference between the safety of odanacatib and placebo. Odanacatib is a valuable new option for the treatment of postmenopausal osteoporosis in women and may be used as a first-line treatment in future.