Tiludronate therapy for Paget's disease of bone

McClung, Michael R.; Tou, Conrad; N, Goldstein; Picot, C

doi:10.1016/8756-3282(95)00282-1

Cited by 48 publications

(20 citation statements)

References 11 publications

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“…In a pivotal US trial, this agent was able to normalize serum alkaline phosphatase levels in 35% of patients,33 compared to 15% to 17% observed in etidronate trials. With tiludronate the likelihood of a mineralization problem was largely eliminated 33…”

Section: Treatment Options For Pdbmentioning

confidence: 88%

Current options for the treatment of Paget’s disease of the bone

Merlotti¹,

Gennari²,

Martini³

et al. 2009

OARRR

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Paget’s disease of bone (PDB) is a chronic bone remodelling disorder characterized by increased osteoclast-mediated bone resorption, with subsequent compensatory increases in new bone formation, resulting in a disorganized mosaic of woven and lamellar bone at affected skeletal sites. This disease is most often asymptomatic but can be associated with bone pain or deformity, fractures, secondary arthritis, neurological complications, deafness, contributing to substantial morbidity and reduced quality of life. Neoplastic degeneration of pagetic bone is a relatively rare event, occurring with an incidence of less than 1%, but has a grave prognosis. Specific therapy for PDB is aimed at decreasing the abnormal bone turnover and bisphosphonates are currently considered the treatment of choice. These treatments are associated with a reduction in plasma alkaline phosphatase (ALP) activity and an improvement in radiological and scintigraphic appearance and with a reduction in bone pain and bone deformity, Recently, the availability of newer, more potent nitrogen-containing bisphosphonates has improved treatment outcomes, allowing a more effective and convenient management of this debilitating disorder.

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Section: Treatment Options For Pdbmentioning

confidence: 88%

Current options for the treatment of Paget’s disease of the bone

Merlotti¹,

Gennari²,

Martini³

et al. 2009

OARRR

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“…O tiludronato é recomendado na dose de 400 mg/dia por 3 meses, normalizando a fosfatase alcalina em 35% dos pacientes (27). É mais efetivo de que o etidronato e não causa desmineralização óssea (28).…”

Section: Tratamentounclassified

Tratamento da doença de Paget óssea: importância do ácido zoledrônico

Griz

Colares

Bandeira

2006

Arq Bras Endocrinol Metab

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RESUMOA doença de Paget é uma doença esquelética, de distribuição monostótica ou poliostótica, podendo ser causada por uma infecção viral e/ou fatores genéticos. É caracterizada por um aumento da remodelação óssea, resultando em anormalidade da arquitetura óssea. A excessiva reabsorção óssea osteoclástica, seguida secundariamente de aumento da atividade osteoblástica, leva à substituição do osso normal por osso desorganizado, aumentado, e com estrutura enfraquecida, propensa a deformidades e fraturas. A doença de Paget pode ser diagnosticada através de exames radiológicos, cintilografia e exames bioquímicos. O objetivo primário do tratamento é reduzir a dor e o risco do aparecimento das complicações a longo prazo. Atualmente dispõe-se de drogas anti-reabsortivas potentes, as quais controlam a reabsorção óssea e proporcionam uma grande melhora no tratamento. O ácido zoledrônico, um bisfosfonato de última geração, tem a vantagem de maior potência e remissão mais prolongada, além de um tempo de infusão curto. Paget's disease is a localised monostotic or polyostotic bone disease of unknown origin. It may be caused by a slow viral infection and/or genetic factors. It is characterised by increased bone remodelling and an initially excessive osteoclastic bone resorption, followed by a secondary increase in osteoblastic activity, leading to replacement of the normal bone by a disorganized, enlarged, and weakened osseous structure prone to deformities and fractures. The disease may be diagnosed by radiography, scintigraphy and biochemical tests. The primary aim of treatment is to reduce pain and risk of developing long-term complications. Potent antiresorptive drugs are now available, which control the increased bone remodelling and have led to a dramatic improvement in treatment. Zoledronic acid, a new generation of bisphosphonates, has the advantage of great potency and long duration of remission and a short infusion time. A DOENÇA DE PAGET FOI DESCRITA pela primeira vez em 1877 pelo médico inglês Sir James Paget (1). É uma doença óssea localizada, monostótica ou poliostótica, caracterizada por um aumento da remodelação óssea, resultando em anormalidade da arquitetura óssea. A excessiva reabsorção óssea osteoclástica, seguida secundariamente de aumento da atividade osteoblástica, leva à substituição do osso normal por revisão Tratamento da Doença de Paget Óssea: Importância do Ácido Zoledrônico

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“…A normal SALP occurs after a course of therapy in ∼15% of patients with etidronate and was seen in 35% of those in the pivotal U.S. trial with tiludronate. (8) Greater reductions in turnover can be achieved with higher doses of etidronate, but this is contraindicated because prolonged use or doses >5 mg/kg/day can induce a transient focal osteomalacia. (10) Both alendronate and risedronate are nitrogencontaining oral bisphosphonates and are more potent than etidronate or tiludronate.…”

Section: Specific Anti-osteoclast Therapy For Paget's Disease Of Bonementioning

confidence: 99%

“…(7)(8)(9) Etidronate is given generally as 400 mg/day for 6 months, with at least a 6-month drug-free interval without retreatment. With tiludronate, 400 mg/day is given for 3 months.…”

Section: Specific Anti-osteoclast Therapy For Paget's Disease Of Bonementioning

confidence: 99%

Medical Management of Paget's Disease of Bone: Indications for Treatment and Review of Current Therapies

Siris

Lyles

Singer

et al. 2006

Journal of Bone and Mineral Research

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Treatment with a potent bisphosphonate is indicated in patients with Paget's disease who have symptoms likely to respond to reduced bone turnover at pagetic sites. In asymptomatic patients with active disease at sites susceptible to local progression and late complications, treatment is also recommended. Biochemical remission is achievable in a majority of patients with pamidronate, alendronate, risedronate, or zoledronic acid. Indications for medical treatment of active Paget's disease of bone include symptoms referable to sites of the disease such as bone pain, joint pain, and neurological complications; elective surgery at an active pagetic site to reduce intraoperative blood loss from highly vascular bone; management of rare instances of immobilization hypercalcemia with polyostotic disease; and presence of disease activity in asymptomatic patients at sites at risk for future complications to limit progression and possibly lower that risk. The treatment of choice is a potent nitrogen-containing bisphosphonate, including oral alendronate or risedronate or intravenous pamidronate or zoledronic acid. Etidronate and tiludronate are less potent and are second-line choices. Recent data with zoledronic acid indicate that a single infusion of 5 mg is associated with normalization of serum alkaline phosphatase in 89% of patients and a prolonged biochemical remission, making it the most effective therapy available to date. Side effect profiles with alendronate and risedronate include esophageal irritation in a minority of patients. Intravenous pamidronate and zoledronic acid may induce an acute phase reaction with fever and flu-like symptoms with the first dose, primarily in patients who are treatment naïve to nitrogen-containing bisphosphonates. Calcium and vitamin D repletion are mandatory with these potent anti-osteoclast therapies to avoid hypocalcemia. Acquired resistance to etidronate and pamidronate has been reported in some patients, leading to lesser reductions in bone turnover and shorter periods of remission, but substitution with a different bisphosphonate provides a more robust response. It is not known whether resistance to other bisphosphonates in Paget's disease occurs.

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Tiludronate therapy for Paget's disease of bone

Cited by 48 publications

References 11 publications

Current options for the treatment of Paget’s disease of the bone

Current options for the treatment of Paget’s disease of the bone

Tratamento da doença de Paget óssea: importância do ácido zoledrônico

Medical Management of Paget's Disease of Bone: Indications for Treatment and Review of Current Therapies

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Tiludronate therapy for Paget's disease of bone

Cited by 48 publications

References 11 publications

Current options for the treatment of Paget&rsquo;s disease of the bone

Current options for the treatment of Paget&rsquo;s disease of the bone

Tratamento da doença de Paget óssea: importância do ácido zoledrônico

Medical Management of Paget's Disease of Bone: Indications for Treatment and Review of Current Therapies

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Current options for the treatment of Paget’s disease of the bone

Current options for the treatment of Paget’s disease of the bone