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Meta-analysis of the Impact of Patient Characteristics on Estimates of Effectiveness and Harms of Recombinant Human Bone Morphogenetic Protein-2 in Lumbar Spinal Fusion

Laurie, Amber L., MS; Chen, Yiyi, PhD; Chou, Roger, MD; Fu, Rongwei, PhD∗,†

doi: 10.1097/BRS.0000000000001580

Study Design. Meta-analysis of individual patient data from randomized controlled trials of recombinant human bone morphogenetic protein-2 (rhBMP-2) in lumbar spinal fusion.

Objective. To determine how patient characteristics impact estimates of effectiveness and harms of rhBMP-2 versus iliac crest bone graft (ICBG) in lumbar spinal fusion.

Summary of Background Data. Patient characteristics are thought to impact rates of fusion in spinal fusion surgery, but no analyses examining the effect of patient characteristics on efficacy and safety of rhBMP-2 as compared with ICBG have been conducted.

Methods. Using individual patient data obtained from the Yale Open Data Access Project, the impact of patient characteristics on the effects of rhBMP-2 on fusion, overall success, and harms were assessed using linear and generalized linear mixed effects models.

Results. Ten industry-sponsored randomized controlled trials of rhBMP-2 were included in the analysis. There is preliminary support for an association between rhBMP-2 and improved outcomes for smokers (P = 0.01), individuals under the age of 60 years (P < 0.01), and patients of normal weight (P = 0.03), but not in patients who are nonsmokers, over the age of 60 years, obese or severely obese. RhBMP-2 usage was associated with decreased harms in individuals with no previous back surgeries but this was not seen in individuals with a previous back surgery (P < 0.01).

Conclusion. Effects of rhBMP-2 may vary according to patient characteristics. Future studies of rhBMP-2 should include planned subgroup analysis in patients over 60 years, smokers, patients that are obese and severely obese, and individuals with previous back surgeries to better identify those most likely to benefit.

Level of Evidence: 1

OHSU-PSU School of Public Health, Portland, OR

Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, OR.

Address correspondence and reprint requests to Amber L. Laurie, MS, OHSU-PSU School of Public Health, 3181 SW Sam Jackson Park Road, Mail Code CSB669, Portland OR 97239; e-mail:

Received 14 October, 2015

Revised 28 January, 2016

Accepted 12 February, 2016

This manuscript includes a meta-analysis of data that were obtained from industry-sponsored trials of recombinant human bone morphogenetic protein-2 (rhBMP-2). Some data includes application of an off-label use, specifically that of the use of rhBMP-2 for posterior lumbar fusion.

This study used data obtained from the Yale University Open Data Access Project that included 17 clinical trials of rhBMP-2 funded by Medtronic, Inc. The interpretation and reporting of research using this data are solely the responsibility of the authors and does not necessarily represent the official views of the Yale University Open Data Access Project or Medtronic, Inc.

No funds were received in support of this work.

Relevant financial activities outside the submitted work: grants.

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