Loading dose ibandronate in rapid pain management of metastatic bone disease (MBD)

Abstract

18580 Background: MBD is common complication in many malignancies. Pain is common presentation of MBD. It is major cause of morbidity, major determinant of quality of life and an important reason for emergency medical referral. Acute pain necessitates emergency pain relief measures. Besides conventional radiation and pain killers, bisphosphonates are indicated in MBD. They contribute towards pain relief. Literature suggests that ibandronate may be effective in acute pain relief. The aim of this study was to study the efficacy of ibandronate in acute pain relief. This should obviate the need for local radiation and or increase in dose of pain killers. Methods: Patients with severe pain were given inj. ibandronate 6 mg iv over 2 hrs for 3 consecutive days. Pain was assessed by direct questioning the patient . Pain was assessed on first four days and after four weeks. Patients were continued with single dose ibandronate once in a month there after. Response was assessed as excellent-more than 90% disappearance of pain, good -more than 50% but less than 90%, satisfactory -between 25– 50% and no response-if less than 25%. Results: A total 9 patients were treated using loading dose ibandronate. There were 4 patients of carcinoma prostate, 3- carcinoma lung, 2- multiple myeloma. All had intolerable bone pain and this was the main reason for this particular admission to hospital. All patients had shown satisfactory response on day 2. On day three 6/9 patients shown a good response. On day four, 4/9 patients shown an excellent response, 4/9 -good response and 1/9 satisfactory response. At the end of four weeks 6/9 patients shown an excellent response, 2/9 good response and 1/9 satisfactory response. The pain response improved over four weeks. On questioning, all patients communicated there strong willingness to continue the same treatment. Conclusion: Loading dose, consecutive three day administration of ibandronate appears to be the ideal strategy for rapid pain relief in patients with MBD. There is an excellent response to such an intervention. In compromised patients with reduced bone marrow reserves this may form the standard of care. Broader data acquisition is warranted. No significant financial relationships to disclose.

Treatment of Bone Metastases and Bone Pain with Bisphosphonates

“…Recently, 2 pilot studies found that loading-dose ibandronate 6 mg for 3 consecutive days can reduce bone pain within approximately 2-7 days of infusion, regardless of tumor type. 45,46,53 However, because pain is a symptom of the underlying pathophysiology, pain outcomes and bone health are important to consider, and these studies have not assessed whether this dosing schedule reduced SREs.…”

Optimizing Clinical Benefits of Bisphosphonates in Cancer Patients with Bone Metastases

“…The recommended dose and schedule of bisphosphonate therapy have been established in registration trials, although alternate treatment schedules for bisphosphonate therapy are under investigation. Several nonstandard, intensive treatment regimens of intravenous ibandronate have been evaluated in patients with metastatic bone disease for acute bone pain relief, followed by the approved monthly infusions [97][98][99]. Results from these pilot studies suggest that alternate ibandronate schedule provided acute pain relief, and that more flexible or individualized bisphosphonate treatment may provide clinical benefits.…”