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Pamidronate is superior to ibandronate in decreasing bone resorption, interleukin‐6 and β 2 ‐microglobulin in multiple myeloma
Author(s) -
Terpos Evangelos,
Viniou Nora,
De La Fuente Josu,
Meletis John,
Voskaridou Ersi,
Karkantaris Christos,
Vaiopoulos George,
Palermos John,
Yataganas Xenophon,
Goldman John M,
Rahemtulla Amin
Publication year - 2003
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1034/j.1600-0609.2003.02823.x
Subject(s) - medicine , n terminal telopeptide , bone resorption , bone remodeling , type i collagen , multiple myeloma , gastroenterology , urology , osteocalcin , bone disease , beta 2 microglobulin , bisphosphonate , endocrinology , resorption , alkaline phosphatase , osteoporosis , chemistry , biochemistry , enzyme
Objectives : Bisphosphonates have been found to reduce skeletal events in patients with multiple myeloma (MM). This is the first randomised trial to compare the efficacy of pamidronate and ibandronate, a third‐generation aminobisphosphonate, in bone turnover and disease activity in MM patients. Methods : Patients with MM, stage II or III, were randomly assigned to receive either pamidronate 90 mg (group I: 23 patients) or ibandronate 4 mg (group II: 21 patients) as a monthly intravenous infusion in addition to conventional chemotherapy. Skeletal events, such as pathologic fractures, hypercalcaemia, and bone radiotherapy were analysed. Bone resorption markers [ N ‐terminal cross‐linking telopeptide of type‐I collagen (NTX) and tartrate‐resistant acid phosphatase type 5b (TRACP‐5b)], bone formation markers (bone alkaline phosphatase and osteocalcin), markers of disease activity (paraprotein, CRP, β 2 ‐microglobulin), and interleukin‐6 (IL‐6) were also studied. Results : In both groups, the combination of chemotherapy with either pamidronate or ibandronate produced a reduction in bone resorption and tumour burden as measured by NTX, IL‐6, paraprotein, CRP, and β 2 ‐microglobulin from the second month of treatment, having no effect on bone formation. TRACP‐5b also had a significant reduction in the pamidronate group from the second month of treatment and in the ibandronate group from the sixth month. However, there was a greater reduction of NTX, IL‐6, and β 2 ‐microglobulin in group I than in group II, starting at the second month of treatment ( P = 0.002, 0.001, and 0.004, respectively) and of TRACP‐5b, starting at the fourth month ( P = 0.014), that being continued throughout the 10‐month follow‐up of this study. There was no difference in skeletal events during this period. A significant correlation was observed between changes of NTX and changes of TRACP‐5b, IL‐6, and β 2 ‐microglobulin from the second month for patients of both groups. Conclusions : These results suggest that a monthly dose of 90 mg of pamidronate is more effective than 4 mg of ibandronate in reducing osteoclast activity, bone resorption, IL‐6, and possibly tumour burden in MM. TRACP‐5b has also proved to be a useful new marker for monitoring bisphosphonates treatment in MM.