Bisphosphonates in multiple myeloma: a network meta-analysis

Center for Evidence Based Medicine and Health Outcomes Research, University of South Florida, Tampa, Florida, USA.
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 05/2012; 5(5):CD003188. DOI: 10.1002/14651858.CD003188.pub3
Source: PubMed


Multiple myeloma (also known as myeloma or plasma cell myeloma) is a B-cell malignancy or, more precisely, plasma cell neoplasm. This cancer grows inside or outside of bones. The bone damage, or osteolytic lesions, may lead to fractures of the long bones or compression fractures in the spine. The mechanism of bone destruction appears to be related to increased bone resorption by cells called osteoclasts. Bisphosphonates are drugs that can inhibit bone resorption by reducing the number and activity of osteoclasts. This updated review of 20 trials enrolling 6692 patients shows that adding bisphosphonates to myeloma treatment reduces fractures of the vertebra and bone pain. Zoledronate is better than etidronate and placebo alone, but not superior to pamidronate or clodronate for improving overall survival and any other outcomes such as vertebral and nonvertebral fractures.

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    • "This is observed also in multiple myeloma patients, who do not receive zoledronic acid treatment, but at a lesser extent compared to patients who receive treatment.11 Without bisphosphonate treatment 31%–76% pain amelioration is expected.12 In our series of multiple myeloma patients, treated with zoledronic acid, much more prominent reduction of pain was observed – 97% if looking at VAS score, mean score decreased from 56.5 (SD 32.8) to 1.2 (SD 3.4). "
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    ABSTRACT: The aim of the study was evaluation of zoledronic acid with regard to safety, effect on analgesic consumption and impact on occurrence of skeletal related events in patients with bone lesions from solid tumors and multiple myeloma. We conducted an observational, 12-month, phase IV and multi-center study. One hundred and twenty-five symptomatic (pain) bone-metastatic patients were included between 2007 and 2009: 92 prostate cancers, 28 multiple myelomas, 5 others. They were prescribed monthly infusions of zoledronic acid in accordance to each disease's treatment guidelines. Analgesics consumption, pain and laboratory values were evaluated. Zoledronic acid was prescribed concurrent to initial therapy for myeloma and only in late stage of prostate cancer. With treatment, percentage of patients on analgesics decreased in myeloma group (from 57% to 24%) and increased in prostate cancer group (from 70% to 88%). In patients with any analgesics, the use of opiates' prescription dropped from 72.9% to 64%, percentages of non-steroidal analgesics and other mild analgesics increased slightly. Pain score (Visual Analog Scale, VAS) decreased non significantly (by 22%) in prostate cancer but significantly in myeloma (by 97%). Hypocalcaemia grade 3 or 4 was observed in 4% of patients. Deviations in creatinine remained stable throughout. A total of 31 skeletal related events were reported for 10 patients (8%). Zoledronic acid was safe medication. Different response of pain was seen between prostate cancer and myeloma patients, which might be due to different stages of disease where it was prescribed according to present guidelines. Possibility of earlier start of treatment should be explored in prostate cancer.
    Full-text · Article · Sep 2013 · Radiology and Oncology
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    • "Additionally, a network meta-analysis showed superior overall survival with zoledronate compared with etidronate and a placebo. However, there was no difference between zoledronate and other bisphosphonates [38]. Recommended regimens of bisphosphonates are shown in Table 2. Pain improved and quality-of-life and performance statuses were better in patients who received bisphosphonates [33]. "
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    ABSTRACT: Multiple myeloma is the second most common haematological malignancy. Novel therapies have led to improvement in survival. Current myeloma management is matching the progress made in improved survival through disease control while optimising quality of life with effective supportive care. Supportive treatment is an essential part of the therapeutic management of myeloma patients because it is directed towards improving the patient’s quality of life and also can improve survival. The aim of this review is to highlight the relationship among life of quality, supportive care, and improvement in survival. Conflict of interest:None declared.
    Full-text · Article · Sep 2013 · Turkish Journal of Haematology
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    • "Zoledronic acid was the most extensively studied bisphosphonate in patients with bone metastases from prostate cancer or other solid tumors, and it remains the only bisphosphonate registered worldwide for these indications.53 In patients with multiple myeloma, bisphosphonate treatment reduces the risk of pathological vertebral fractures, skeletal-related morbidity, and pain.54 The bisphosphonates most often used are ibandronate, pamidronate, and zoledronate. "
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    ABSTRACT: Neridronate is an aminobisphosphonate, licensed in Italy for the treatment of osteogenesis imperfecta (OI) and Paget's disease of bone (PDB). A characteristic property of neridronate is that it can be administered both intravenously and intramuscularly, providing a useful system for administration in homecare. In this review, we discuss the latest clinical results of neridronate administration in OI and PDB, as well as in osteoporosis and other conditions. We will focus in particular on the latest evidence of the effect of neridronate on treatment of complex regional pain syndrome type I.
    Full-text · Article · Apr 2013 · Therapeutics and Clinical Risk Management
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