Optimal frequency of administration of pamidronate in patients with hypercalcaemia of malignancy

Wimalawansa, Sunil J.

doi:10.1111/j.1365-2265.1994.tb01823.x

Cited by 31 publications

(8 citation statements)

References 23 publications

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“…Furthermore, the effect on bone pain and performance status of clodronate only differs significantly from placebo at one timepoint, similar to that observed in the pamidronate study. In contrast to clodronate, there was no effect of pamidronate to reduce the incidence of hypercalcaemia, perhaps reflecting the interval between doses (4 weeks) which may be too long in some patients ( Wimalawansa, 1994). An open controlled prospective study of parenterally administered clodronate has also demonstrated significant reductions in skeletal morbidity ( Riccardi et al , 1994 ).…”

Section: Discussionmentioning

confidence: 95%

A randomized trial of the effect of clodronate on skeletal morbidity in multiple myeloma

McCloskey¹,

MacLennan²,

Drayson³

et al. 1998

Br J Haematol

298

167

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In patients with multiple myeloma, despite a major reduction of bone pain achieved with chemotherapy, skeletal disease continues to progress. The effects of clodronate, an inhibitor of osteoclastic bone resorption, are evaluated on the natural history of skeletal disease in patients with newly diagnosed multiple myeloma. Within the framework of the VIth MRC Multiple Myeloma Trial, 536 patients (218 women, 318 men) with recently diagnosed multiple myeloma were randomized to receive either clodronate 1600 mg daily (n=264) or an outwardly identical placebo (n=272) in addition to chemotherapy. Treatment with clodronate was associated with a 50% decrease in the proportion of patients with severe hypercalcaemia (5.1% v 10.1%, P=0.06) and a similar reduction in reported non-vertebral fractures (6.8% v 13.2%, P=0.04). Fewer patients receiving clodronate sustained vertebral fractures after entry to the trial (38% v 55%, P=0.01) and patients also lost less height over 3 years compared to those receiving placebo (2.0 v 3.4 cm, P=0.01). Biochemical indices of bone turnover were significantly lower in patients receiving concomitant clodronate, both at plateau and at disease relapse. The frequencies of back pain and poor performance status were significantly lower at 24 months in clodronate than in placebo-treated patients (10.9% v 19.9%, P=0.05, and 18.3% v 30.5% P=0.03 respectively.) There was no statistically significant difference in survival between the clodronate and placebo treated patients. The study indicates that long-term oral clodronate slows the progression of skeletal disease in multiple myeloma and decreases the associated morbidity. Patients without overt skeletal disease at diagnosis were also found to benefit from clodronate, indicating that this treatment should be initiated as early in the course of the disease as possible.

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Section: Discussionmentioning

confidence: 95%

A randomized trial of the effect of clodronate on skeletal morbidity in multiple myeloma

McCloskey¹,

MacLennan²,

Drayson³

et al. 1998

Br J Haematol

298

167

View full text Add to dashboard Cite

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“…We have previously shown that by using this regime the normocalcemia can be maintained for several weeks, which will minimize hypercalcemic symptoms and avoid hospitalization [10]. A similar effect can also be achieved with infusions of disodium etidronate, but with a higher dose and more frequent infusions.…”

Section: Discussionmentioning

confidence: 81%

“…3) [2,8,21]. Pamidronate infusions can be repeated every 2 weeks on an outpatient or day-patient basis [2,10,29], depending on the relapses of hypercalcemia, to maintain normal serum calcium levels.…”

Section: Discussionmentioning

confidence: 99%

“…Parenterally administered bisphosphonates are extremely potent in lowering serum calcium levels, but require 2-3 days to be effective. However, the calcium-lowering effect lasts 1-3 weeks and is more potent and effective than that of calcitonin [2,[6][7][8][9][10]. During the past few years, both calcitonin and bisphosphonate~ have been used successfully to treat diseases characterized by increased bone turnover and for the treatment of HM [1][2][3][4][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

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Combined therapies with calcitonin and corticosteroids, or bisphosphonate, for treatment of hypercalcemia of malignancy

Wimalawansa

1997

J Bone Miner Metab

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Abstract:Thirty-four patients with hypercalcemia of malignancy were studied in three randomized prospective clinical studies. In study 1, 10 patients with solid tumors and in study 2, 10 patients with multiple myeloma, received calcitonin alone or combined calcitonin and corticosteroids. In study 3, 14 hypercalcemic patients with solid tumors received either pamidronate alone or pamidronate and calcitonin. Patients with solid tumors had at least one bony metastasis at the time of the study. Serum immunoreactive parathyroid hormone (PTH) levels in all patients were either undetectable or below the lower limit of the normal range, suggesting that the hypercalcemia is secondary to malignancy and not caused by an underlying primary hyperparathyroidism. The calciumlowering effect of calcitonin was rapid, but disappeared in 3-4 days. Corticosteroids significantly prolonged the duration of normocalcemia in patients with hematological malignancies but not in patients with solid tumors. After a single dose of 60mg of pamidronate, serum calcium was lowered within 2-3 days, and normocalcemia was maintained for an average of 14 days. The addition of calcitonin lowered serum calcium within 24 h and led to a rapid improvement in hypercalcemic symptoms. Except in patients with hypercalcemia caused by hematological malignancies, the calcium-lowering effect was not enhanced by adding steroids to calcitonin therapy. In patients with moderate to severe symptomatic hypercalcemia, infusions of pamidronate every 2 weeks and calcitonin therapy for the first 2-3 days rapidly reduced serum calcium levels and sustained normocalcemia.

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“…Die Wirkung tritt innerhalb von 48 h ein und hält meist 3-4 Wochen an (12,17). Auch durch Calcitonin werden die Osteoklasten gehemmt (100-500 IE über 24h i.v.).…”

Section: Diskussionunclassified

Lebensbedrohliche Hyperkalzämie bei einem jungen Mann mit ALL

Schneider¹,

Seydlitz²,

Zimmermann³

et al. 2001

Dtsch med Wochenschr

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The acute treatment of hypercalcemia is independent of the underlying cause (rehydration with physiologic saline, renal excretion with furosemide, inhibition of osteoclastic activity). The main causes are hyperparathyreoidism or malignancys (90%). We describe TNF-alpha as a possible marker of tumoral load of a common ALL but we are not able to reveal a correlation between TNF-alpha and the calcium level.

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Optimal frequency of administration of pamidronate in patients with hypercalcaemia of malignancy

Abstract: Intravenous pamidronate 60 mg/dose, administered every two weeks, can maintain normocalcaemia in the vast majority of patients with hypercalcaemia of malignancy.

Cited by 31 publications

References 23 publications

A randomized trial of the effect of clodronate on skeletal morbidity in multiple myeloma

A randomized trial of the effect of clodronate on skeletal morbidity in multiple myeloma

Combined therapies with calcitonin and corticosteroids, or bisphosphonate, for treatment of hypercalcemia of malignancy

Lebensbedrohliche Hyperkalzämie bei einem jungen Mann mit ALL

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