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Liu Y, Ding H, Zhang T, Chen Y, Huang Z. 68 Ga-DOTA- Ibandronic Acid PET/CT in a Patient With Chemotherapy-Induced Salivary Gland Hypofunction. Clin Nucl Med 2024; 49:470-471. [PMID: 38465977 DOI: 10.1097/rlu.0000000000005133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
ABSTRACT DOTA-ibandronic acid (IBA) is a novel precursor targeting bone metastasis. It can be radiolabeled with 68 Ga for the diagnosis of bone metastases. However, extraosseous lesions can also show increased DOTA-IBA uptake. We report the 68 Ga-DOTA-IBA PET/CT findings in a case with cholangiocarcinoma with multiple bone metastases. 68 Ga-DOTA-IBA PET/CT revealed increased uptake of DOTA-IBA in bone metastases. Besides, symmetrical and diffuse increased DOTA-IBA uptake in bilateral salivary glands was observed. 99m TcO 4- salivary gland scintigraphy showed impaired salivary gland function.
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Affiliation(s)
| | | | - Ting Zhang
- General Medicine, Southwest Medical University, Luzhou, Sichuan, People's Republic of China
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Alves C, Mendes D, Penedones A, Oliveira T, Donato A, Batel-Marques F. The effectiveness of ibandronate in reducing the risk of nonvertebral fractures in women with osteoporosis: systematic review and meta-analysis of observational studies. Int J Clin Pharm 2024; 46:357-367. [PMID: 38112890 PMCID: PMC10960777 DOI: 10.1007/s11096-023-01666-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/03/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Ibandronate is effective in reducing the risk of vertebral fractures, but experimental evidence offers conflicting results regarding nonvertebral fractures. Real-world evidence has been published evaluating the anti-nonvertebral fracture effect of ibandronate. AIM This meta-analysis of observational studies assessed the effectiveness of ibandronate in reducing the risk of nonvertebral fractures in women with osteoporosis. METHOD Pubmed/Embase databases were searched for observational studies. Risks of nonvertebral fractures and hip fractures were the outcomes. Meta-analyses were performed pooling rate ratios (RRs), using random-effects models. Data were reanalysed in sensitivity analyses considering Knapp-Hartung method and Bayesian random-effects. RESULTS Six cohort studies were included. Overall, once-monthly 150 mg oral ibandronate reduced the risk of nonvertebral fractures (RR 0.84; 95% CI 0.76-0.94). Similar results were obtained when the comparison was restricted to once-monthly 150 mg risedronate, but no differences were found when the comparator was other oral bisphosphonates (weekly alendronate/risedronate). Ibandronate didn't significantly change the risk of hip fractures (RR 1.25; 95% CI 0.89-1.76). The risk of hip fracture was comparable between once monthly, 150 mg oral ibandronate and other oral bisphosphonates. Intravenous ibandronate was not effective in reducing hip fractures comparing to intravenous zoledronate. The low number of studies diminished the robustness of sensitivity analyses. CONCLUSION Results suggest that once-monthly 150 mg oral ibandronate may be as effective as other oral bisphosphonates in reducing the risk of nonvertebral fractures. However, uncertainty associated to the small number of included studies, which are characterized by heterogeneous demographics and methodologies, precluded definitive conclusions.
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Affiliation(s)
- Carlos Alves
- Laboratory of Social Pharmacy and Public Health, Faculty of Pharmacy, Polo Ciencias da Saude, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548, Coimbra, Portugal.
- Clevidence, Lda., Taguspark, Oeiras, Portugal.
| | - Diogo Mendes
- Laboratory of Social Pharmacy and Public Health, Faculty of Pharmacy, Polo Ciencias da Saude, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548, Coimbra, Portugal
- Clevidence, Lda., Taguspark, Oeiras, Portugal
| | - Ana Penedones
- Laboratory of Social Pharmacy and Public Health, Faculty of Pharmacy, Polo Ciencias da Saude, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548, Coimbra, Portugal
- Clevidence, Lda., Taguspark, Oeiras, Portugal
| | | | - António Donato
- Laboratory of Social Pharmacy and Public Health, Faculty of Pharmacy, Polo Ciencias da Saude, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548, Coimbra, Portugal
- Tecnimede, SA, Sintra, Portugal
| | - Francisco Batel-Marques
- Laboratory of Social Pharmacy and Public Health, Faculty of Pharmacy, Polo Ciencias da Saude, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548, Coimbra, Portugal
- Clevidence, Lda., Taguspark, Oeiras, Portugal
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Yang J, Deng J, Fan D, Chen G, Lu Z, Liu H, Mok GSP, Chen Y. Biodistribution and Internal Dosimetry of 68 Ga-DOTA-IBA PET Imaging for Patients With Bone Metastases. Clin Nucl Med 2023; 48:847-852. [PMID: 37418288 DOI: 10.1097/rlu.0000000000004757] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
PURPOSE We have developed a new pharmaceutical, ibandronic acid (IBA), and preliminarily demonstrated that it is an efficient bisphosphonate for the diagnosis and treatment of bone metastases. This study aims to examine the biodistribution and internal dosimetry of the diagnostic 68 Ga-DOTA-IBA in patients. PATIENTS AND METHODS 68 Ga-DOTA-IBA was intravenously injected based on 1.81-2.57 MBq/Kg into 8 patients with bone metastases. Each patient underwent 4 sequential static whole-body PET scans at 0.1, 0.45, 0.8, and 1.8 hours after injection. The acquisition time for each scan was 20 minutes with 10 bed positions. Image registrations and volume of interest delineation were first performed on Hermes, whereas percentage injected activity (%IA), absorbed dose, and effective dose were measured for source organs, using OLINDA/EXM v2.0. Dosimetrics for the bladder was based on a bladder voiding model. RESULTS No adverse effects were observed on all patients. After the injection, 68 Ga-DOTA-IBA rapidly accumulated in bone metastases and cleared from nonbone tissues, as indicated by visual analysis and %IA measured on the sequential scans. High activity uptake was presented in the expected target organs, that is, bone, red marrow, and the drug-excretion organs such as kidneys and bladder. The mean total body effective dose is 0.022 ± 0.002 mSv/MBq. CONCLUSIONS 68 Ga-DOTA-IBA has high bone affinity and is promising in the diagnosis of bone metastases. Dosimetric results show that the absorbed doses for critical organs and total body are within the safety limit and with high bone retention. It also has the potential to be used in 177 Lu-therapy as a theranostic pair.
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Affiliation(s)
| | | | | | - Gefei Chen
- Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macau SAR, China
| | - Zhonglin Lu
- Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macau SAR, China
| | | | - Greta S P Mok
- Biomedical Imaging Laboratory, Department of Electrical and Computer Engineering, Faculty of Science and Technology, University of Macau, Macau SAR, China
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Tariq S, Tariq S, Abualhamael SA, Baig M, Malik AA, Shahzad M. Osteoprotegerin genetic polymorphisms and their influence on therapeutic response to ibandronate in postmenopausal osteoporotic females. PLoS One 2023; 18:e0291959. [PMID: 37751449 PMCID: PMC10521989 DOI: 10.1371/journal.pone.0291959] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 09/10/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVES The present study investigated osteoprotegerin (OPG) genetic polymorphisms and their influence on the therapeutic response to ibandronate in postmenopausal osteoporotic females. METHODS This case-control study included 135 postmenopausal females (89 osteoporotic females and 46 non-osteoporotic females). Each osteoporotic patient received a monthly 150 mg ibandronate tablet for six months, and blood samples were taken before and after treatment. Bone mineral density (BMD) was measured using DEXA Scan. Three SNPs (A163G, T245G, and G1181C) of the OPG gene were selected for analysis. RESULTS Serum OPG levels were significantly lower in osteoporotic subjects than in the control group. The percentage changes in OPG levels in the osteoporotic group before and after treatment with ibandronate were significant (p < .001). After six months of therapy with ibandronate, the percentage changes in OPG levels with AA, TT, TC, GC, and GG genotypes were significant. Following six months of ibandronate treatment, the AA genotype of rs3134069, TT, TC genotypes of rs3102735, GG, and GC genotypes of rs2073618 SNP showed a significant increase in OPG levels. Age, BMI, and GC polymorphism (rs2073618 (G/C) G1181C) were inversely associated with low BMD. Adjusted odds ratios (OR) showed that BMI, GC, GG polymorphism (rs2073618 (G/C) G1181C) and TC polymorphism (rs3102735 (T/C) A163G) were inversely associated with low BMD. CONCLUSION The inverse association of rs2073618 and rs3102735 with low BMD indicates the protective role of these SNPs in our population. More research is needed to replicate these results in another cohort and to determine the molecular processes by which such SNPs may influence BMD.
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Affiliation(s)
- Saba Tariq
- Department of Pharmacology and Therapeutics, University Medical & Dental College, The University of Faisalabad, Faisalabad, Pakistan
- University of Birmingham, Birmingham, England, United Kingdom
| | - Sundus Tariq
- Department of Physiology, International School of Medicine, Istanbul Medipol University, Research Institute for Health Sciences and Technologies (SABITA), Istanbul, Turkey
| | | | - Mukhtiar Baig
- Department of Clinical Biochemistry, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad Azam Malik
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Muhammad Shahzad
- Department of Pharmacology, University of Health Sciences, Lahore, Pakistan
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Wang K, Gao L, Liu C, Bao X, Tian Y, Li Y. Denosumab Improves Glycaemic Parameters in Postmenopausal Osteoporosis Patients with Combined Type 2 Diabetes Mellitus. Cell Mol Biol (Noisy-le-grand) 2023; 69:185-191. [PMID: 37715387 DOI: 10.14715/cmb/2023.69.8.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Indexed: 09/17/2023]
Abstract
This study aimed to determine whether RANKL inhibitors in postmenopausal osteoporosis patients with combined type 2 diabetes mellitus (T2DM) could improve their glucose metabolism index. First of all, 84 patients affected with postmenopausal osteoporosis with combined T2DM attending the Department of Endocrinology at the Third Hospital of Hebei Medical University were selected and randomized into two groups of 42 patients each. One group was given Denosumab 60 mg once every six months (denosumab group, D.G.), and the other group was given 2 mg ibandronate once every three months (ibandronate group, I.G.). Blood glucose parameters were compared before and after treatment in both groups and serum active GLP-1 levels and DPP-4 levels were also assessed. After treatment, there was no significant difference in fasting glucose between the two groups, but there was a significant decrease in fasting glucose in the Denosumab Group (D.G.) compared to before treatment. There was a significant difference in 2-hour postprandial glucose (2hPG) between the two groups after treatment, with the D.G. being lower than the ibandronate group (I.G.). Glycosylated haemoglobin (HbA1c) was lower in the D.G. than in the I.G. after treatment, but the difference between them was insignificant. In the D.G., serum active GLP-1 levels increased after treatment, and serum DPP-4 levels decreased. Serum GLP-1 and DPP-4 levels in the I.G. did not change compared with those before treatment. In conclusion, In the clinical management of postmenopausal osteoporosis patients with combined T2DM, the choice of RANKL inhibitors as anti-osteoporosis therapy may benefit their glycaemic parameters by elevating serum active GLP-1 levels and decreasing serum DPP-4 levels.
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Affiliation(s)
- Ke Wang
- Department of Endocrinology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei,050051, China.
| | - Liu Gao
- Department of Endocrinology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei,050051, China.
| | - Chang Liu
- Department of Endocrinology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei,050051, China.
| | - Xiaoxue Bao
- Department of Endocrinology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei,050051, China.
| | - Yawei Tian
- Department of Endocrinology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei,050051, China.
| | - Yukun Li
- Department of Endocrinology, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei,050051, China.
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Mondockova V, Kovacova V, Zemanova N, Babikova M, Martiniakova M, Galbavy D, Omelka R. Vitamin D Receptor Gene Polymorphisms Affect Osteoporosis-Related Traits and Response to Antiresorptive Therapy. Genes (Basel) 2023; 14:genes14010193. [PMID: 36672934 PMCID: PMC9858724 DOI: 10.3390/genes14010193] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
The present study analyzed the effect of vitamin D receptor (VDR) gene polymorphisms (ApaI, TaqI, BsmI, FokI, and Cdx2) on bone mineral density (BMD), biochemical parameters and bone turnover markers, fracture prevalence, and response to three types of antiresorptive therapy (estrogen-progesterone, raloxifene, and ibandronate) in 356 postmenopausal women from Slovakia. Association analysis revealed a significant effect of BsmI polymorphism on lumbar spine BMD, serum osteocalcin (OC), and β-CrossLaps levels. While ApaI and Cdx2 polymorphisms were associated with OC and alkaline phosphatase, TaqI polymorphism affected all turnover markers. ApaI, TaqI, and BsmI genotypes increased the risk of spinal, radial, or total fractures with odds ratios ranging from 2.03 to 3.17. Each of therapy types evaluated had a beneficial effect on all osteoporosis-related traits; however, the VDR gene affected only ibandronate and raloxifene treatment. ApaI/aa, TaqI/TT, and BsmI/bb genotypes showed a weaker or no response to ibandronate therapy in femoral and spinal BMD. The impact of aforementioned polymorphisms on turnover markers was also genotype dependent. On the contrary, only TaqI and BsmI polymorphisms influenced raloxifene therapy, even only in lumbar spine BMD. These results point to the potential of using the VDR gene in personalized pharmacotherapy of osteoporosis.
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Affiliation(s)
- Vladimira Mondockova
- Department of Botany and Genetics, Constantine the Philosopher University in Nitra, 949 01 Nitra, Slovakia
| | - Veronika Kovacova
- Department of Zoology and Anthropology, Constantine the Philosopher University in Nitra, 949 01 Nitra, Slovakia
| | - Nina Zemanova
- Department of Botany and Genetics, Constantine the Philosopher University in Nitra, 949 01 Nitra, Slovakia
| | - Martina Babikova
- Department of Botany and Genetics, Constantine the Philosopher University in Nitra, 949 01 Nitra, Slovakia
| | - Monika Martiniakova
- Department of Zoology and Anthropology, Constantine the Philosopher University in Nitra, 949 01 Nitra, Slovakia
| | | | - Radoslav Omelka
- Department of Botany and Genetics, Constantine the Philosopher University in Nitra, 949 01 Nitra, Slovakia
- Correspondence: ; Tel.: +421-376408737
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Atar S, Yurttaser SO, Demirhan E, Er G, Kuru Ö. The ocular findings related to oral bisphosphonate use. Arch Soc Esp Oftalmol (Engl Ed) 2022; 97:497-503. [PMID: 35787381 DOI: 10.1016/j.oftale.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE We aimed to investigate ocular involvement findings in female osteoporosis patients using oral bisphosphonate (BP). METHODS A total of 51 female osteoporosis patients aged 50-75 years using oral BP for at least one year for the study group and 64 age-matched non-osteoporosis female patients for the control group were included in the study. The BP type and exposure time were noted. The ophthalmic examination findings and measurements of the flare of the patients who received oral BP due to osteoporosis and the controls were evaluated. RESULTS The mean duration of BP use was 3.96 years. In the study group, it was detected four of 51 patients were diagnosed with meibomian gland dysfunction (MGD) (7.8%), seven of 102 eyes had erythematous, irregular, thickened lid margin or telangiectasia around the glandular orifices. There were no pathological findings on fundus examination. The mean value of measurements of the flare (ph/ms) was 7.90±7.96 in the study group, and 5.02±0.81 in the control group. When the mean values were compared, there was a significant difference between the two groups (P=.001). A significant difference was found in the mean value of measurements of the flare between the patients using alendronate, and ibandronate with the control group (P=.001; P=.005, respectively). CONCLUSION Our study showed that the flare in the anterior chamber associated with chronic ocular inflammation can be seen higher rate in patients using oral alendronate, and ibandronate compared to those who do not. Morever it can be said that oral BPs may cause similar ocular side effects like as intravascular BPs.
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Affiliation(s)
- S Atar
- Department of Physical Medicine and Rehabilitation, Prof. Dr. Cemil Tascioglu City Hospital, University of Health Sciences, Istanbul, Turkey.
| | - S O Yurttaser
- Department of Opthalmology, Prof. Dr. Cemil Tascioglu City Hospital, University of Health Sciences, Istanbul, Turkey
| | - E Demirhan
- Department of Physical Medicine and Rehabilitation, Prof. Dr. Cemil Tascioglu City Hospital, University of Health Sciences, Istanbul, Turkey
| | - G Er
- Department of Physical Medicine and Rehabilitation, Prof. Dr. Cemil Tascioglu City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ö Kuru
- Department of Physical Medicine and Rehabilitation, Prof. Dr. Cemil Tascioglu City Hospital, University of Health Sciences, Istanbul, Turkey
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Castro RC, Páscoa RNMJ, Saraiva MLMFS, Santos JLM, Ribeiro DSM. Photoluminescent and visual determination of ibandronic acid using a carbon dots/AgInS 2 quantum dots ratiometric sensing platform. Spectrochim Acta A Mol Biomol Spectrosc 2022; 267:120592. [PMID: 34789406 DOI: 10.1016/j.saa.2021.120592] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
A sensing platform combining carbon dots (CDs, with blue emission) and thiomalic acid (TMA)-capped AgInS2 quantum dots (QDs, with orange emission) was developed aiming the photoluminescence (PL) ratiometric determination of ibandronic acid (IBAN), a bisphosphonate pharmaceutical. The ternary AgInS2 QDs were used for IBAN probing, undergoing a concentration-related PL quenching in its presence, whilst the PL of CDs remained practically unaffected due to its chemical inertness towards the antiresorptive drug, provided an intrinsic self-reference fluorophore. In addition, a visual sensing approach was also proposed, employing for the first time ternary QDs. This relied on RGB images acquired by means of a digital camera and seek the development of a rapid IBAN screening test. The developed sensing platforms were employed for IBAN determination in samples with pharmaceutical interest providing good results, in accordance to the reported IBAN levels, and obtaining recovery values between 98 and 103%.
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Affiliation(s)
- Rafael C Castro
- LAQV, REQUIMTE, Department of Chemical Sciences, Laboratory of Applied Chemistry, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira n° 228, 4050-313 Porto, Portugal
| | - Ricardo N M J Páscoa
- LAQV, REQUIMTE, Department of Chemical Sciences, Laboratory of Applied Chemistry, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira n° 228, 4050-313 Porto, Portugal
| | - M Lúcia M F S Saraiva
- LAQV, REQUIMTE, Department of Chemical Sciences, Laboratory of Applied Chemistry, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira n° 228, 4050-313 Porto, Portugal
| | - João L M Santos
- LAQV, REQUIMTE, Department of Chemical Sciences, Laboratory of Applied Chemistry, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira n° 228, 4050-313 Porto, Portugal.
| | - David S M Ribeiro
- LAQV, REQUIMTE, Department of Chemical Sciences, Laboratory of Applied Chemistry, Faculty of Pharmacy, University of Porto, Rua de Jorge Viterbo Ferreira n° 228, 4050-313 Porto, Portugal.
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You R, Mori T, Ke L, Wan Y, Zhang Y, Luo F, Feng D, Yu G, Liu J. Which injected antiosteoporotic medication is worth paying for? A cost-effectiveness analysis of teriparatide, zoledronate, ibandronate, and denosumab for postmenopausal osteoporotic women in China. Menopause 2021; 29:210-218. [PMID: 34930866 DOI: 10.1097/gme.0000000000001911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the cost-effectiveness of four injected antiosteoporotic medications including teriparatide, zoledronate, ibandronate, and denosumab for postmenopausal osteoporotic women in China. METHODS A Markov microsimulation model was used to compare the cost-effectiveness of the four drugs above in Chinese postmenopausal osteoporotic women with no fracture history of hip, vertebral, or wrist at various ages (65, 70, 75, and 80) of therapy initiation from the health care payer perspective. RESULTS Denosumab was dominant (ie, lower costs and greater quality-adjusted life-years [QALYs]) compared with other strategies at all ages studied. The incremental cost-effectiveness ratios (ICERs) of zoledronate or ibandronate versus no treatment were $4,482.88/ QALYs or $11,378/QALYs, respectively, at age 65 years, and the results at other ages were similar. In contrast, the incremental cost-effectiveness ratio of teriparatide strategy compared with no treatment exceeded the pre-determined threshold of a willingness-to-pay of $31,512/QALY regardless of the adoption of the patient assistance program at all ages studied, and a threshold analysis showed that teriparatide without patient assistance program became cost-effective when the annual drug cost is decreased to $1,644.87 (current cost: $8,764.65). The cost-effectiveness decision did not change in most of the one-way sensitivity analyses. A scenario analysis considering no offset effect of denosumab showed that zoledronate had the potential to become the optimal option relative to denosumab. In probabilistic sensitivity analyses, the probabilities of denosumab being cost-effective compared with other strategies were 100% at a willingness-to-pay of $31,512/QALY. CONCLUSIONS Among postmenopausal osteoporotic women in China, denosumab therapy is cost-effective at all ages examined from the health care payer perspective, compared with teriparatide, zoledronate, or ibandronate. This study will help clinicians and policymakers make better decisions about the relative economic value of osteoporosis treatments in China.
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Affiliation(s)
- Ruxu You
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Takahiro Mori
- Department of General Medical Science, Graduate School of Medicine, Chiba University, Chiba, Japan
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of General Internal Medicine, Eastern Chiba Medical Center, Togane, Chiba, Japan
| | - Lei Ke
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuansheng Wan
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yu Zhang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Fei Luo
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Da Feng
- School of Pharmacy, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guangyi Yu
- Department of Pharmacy, People's Hospital of Dongxihu District, Wuhan, Hubei 430040, China
| | - Jinyu Liu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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de Camargo Vieira MC, Gonçalves WRB, Guerra RA, Callegaro FS, Lazaretti-Castro M, Maeda SS. Hepatitis C-Associated Osteosclerosis: Improvement After Treatment with Sofosbuvir, Daclatasvir, and Ibandronate: Case Report and Literature Review. Calcif Tissue Int 2021; 109:104-109. [PMID: 33616713 DOI: 10.1007/s00223-021-00822-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/04/2021] [Indexed: 12/22/2022]
Abstract
Hepatitis C-associated osteosclerosis (HCAO) remains a rare condition despite the growing prevalence of hepatitis C virus (HCV) infection worldwide. Since the first case reported in 1992, this is the twenty-second case described. Patients with HCAO present with severe bone pain and elevated serum levels of bone markers, especially alkaline phosphatase (ALP), with increased bone density. We report here the case of a 59-year-old man with generalized bone pain and diagnosis of HCV infection. Biochemical tests showed elevated bone turnover markers, specifically, ALP, carboxy-terminal collagen crosslinks and osteocalcin. Imaging studies revealed generalized bone sclerosis. Bone mineral density was elevated in all validated sites. His clinical symptoms and bone-related findings were attributed to HCAO. He was sequentially treated with cholecalciferol, prednisone, sofosbuvir associated with daclatasvir and ibandronate, and progressed with undetectable viral load after HCV treatment, normalization of ALP levels after introduction of ibandronate, and pain improvement 1 year after discontinuation of the bisphosphonate. Bone pain complaints must be investigated in patients with HCV. HCAO is a differential diagnosis of increased bone mass.
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Affiliation(s)
- Maria Carolina de Camargo Vieira
- Department of Endocrinology, Hospital do Servidor Público Municipal (HSPM), São Paulo, SP, Brazil.
- Department of Medicine, Endocrinology Unit, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 639, Vila Clementino, São Paulo, SP, CEP 04022-001, Brazil.
| | | | - Ricardo Ayello Guerra
- Department of Endocrinology, Hospital do Servidor Público Municipal (HSPM), São Paulo, SP, Brazil
- Department of Endocrinology, Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo (IAMSPE), São Paulo, SP, Brazil
| | | | - Marise Lazaretti-Castro
- Department of Medicine, Endocrinology Unit, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 639, Vila Clementino, São Paulo, SP, CEP 04022-001, Brazil
| | - Sergio Setsuo Maeda
- Department of Medicine, Endocrinology Unit, Federal University of São Paulo (UNIFESP), Rua Estado de Israel, 639, Vila Clementino, São Paulo, SP, CEP 04022-001, Brazil
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Chiba K, Yamada S, Yoda I, Era M, Yokota K, Okazaki N, Ota S, Isobe Y, Miyazaki S, Tashiro S, Nakashima S, Morimoto S, Sato S, Tsukazaki T, Watanabe T, Enomoto H, Yabe Y, Yonekura A, Tomita M, Ito M, Osaki M. Effects of monthly intravenous ibandronate on bone mineral density and microstructure in patients with primary osteoporosis after teriparatide treatment: The MONUMENT study. Bone 2021; 144:115770. [PMID: 33249321 DOI: 10.1016/j.bone.2020.115770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/14/2020] [Accepted: 11/22/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To investigate the effects of sequential therapy with monthly intravenous ibandronate on bone mineral density (BMD) and microstructure in patients with primary osteoporosis who received teriparatide treatment. METHODS Sixty-six patients with primary osteoporosis who had undergone teriparatide treatment for more than 12 months (mean 18.6 months) received sequential therapy with 1 mg/month intravenous ibandronate for 12 months. The patients were evaluated using dual-energy X-ray absorptiometry (DXA), quantitative ultrasound, bone turnover markers, and high-resolution peripheral quantitative computed tomography (HR-pQCT) at baseline and 6 and 12 months after beginning administration. RESULTS At 12 months after beginning sequential therapy, the bone resorption marker, tartrate-resistant acid phosphatase-5b, decreased by 39.5%, with 82.3% of the patients exhibiting levels within the normal limit. DXA revealed that the BMD of the lumbar spine increased by 3.2%, with 79.0% of the patients exhibiting a response, and 40.3% experiencing an increase in BMD over 5%. HR-pQCT revealed that the cortical thickness of the distal tibia was increased by 2.6%. The cortical area increased by 2.5%, and the buckling ratio (an index of cortical instability) decreased by 2.5%. Most parameters of the trabecular bone showed no significant changes. These changes in the cortical bone were observed in both the distal radius and tibia and appeared beginning 6 months after treatment initiation. CONCLUSIONS Sequential therapy with monthly intravenous ibandronate increased the BMD and improved the cortical bone microstructure of osteoporotic patients who had undergone teriparatide treatment.
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Affiliation(s)
- Ko Chiba
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan.
| | - Shuta Yamada
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | | | - Makoto Era
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Kazuaki Yokota
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Narihiro Okazaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Shingo Ota
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Yusaku Isobe
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Satsuki Miyazaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Shigeki Tashiro
- Clinical Research Center, Nagasaki University Hospital, Japan
| | | | | | - Shuntaro Sato
- Clinical Research Center, Nagasaki University Hospital, Japan
| | | | | | | | | | - Akihiko Yonekura
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Masato Tomita
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | | | - Makoto Osaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Japan
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12
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Hildebrand S, Cunningham J. Is there a role for bisphosphonates in vascular calcification in chronic kidney disease? Bone 2021; 142:115751. [PMID: 33188959 DOI: 10.1016/j.bone.2020.115751] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 01/15/2023]
Abstract
Theoretically bisphosphonates could accelerate or retard vascular calcification. In subjects with low GFR, the position is further confounded by a combination of uncertain pharmacokinetics (GI absorption is poor and inconsistent at all levels of renal function and the effect of low GFR generally is to increase bioavailability) and a highly variable skeletal substrate with extremes of turnover that increase unpredictably further. Although bisphosphonates reduce bone formation by 70-90% in subjects with normal GFR and reduce the ability of bone to buffer exogenous calcium fluxes, in bisphosphonate treated postmenopausal women accelerated vascular calcification has not been documented. The kidneys assist with this buffering, but the capacity to modulate calcium excretion declines as GFR falls, increasing the risk of hypercalcaemia in the event of high calcium influx. In the ESRD patient, decreased buffering capacity substantially increases the risk of transient hypercalcaemia, especially in the setting of dialysis, and as such may promote vascular calcification which is highly prevalent in the CKD population. Low bone turnover may thus be less of a vascular problem in patients with preserved renal function and a bigger problem when the GFR is low. In patients with stage 4 and 5 CKD, adynamic bone disease associates with the severity and progression of arterial calcification, including coronary artery calcification, and further suppression of bone turnover by a bisphosphonate might exacerbate an already high predisposition to vascular calcification. No convincing signal of harm has emerged from clinical studies thus far. For example 51 individuals with CKD stage 3-4 treated with either alendronate 70 mg per week or placebo for 18 months showed no difference in the rate of vascular calcifications. Conversely an observational study of women with stage 3-4 CKD with pre-existing cardiovascular disease found an increased risk of mortality with a hazard ratio of 1.22 (1.04-1.42) in those given bisphosphonates. Direct suppression of vascular calcification by bisphosphonates is probably confined to etidronate - treatment of soft tissue calcification was a recognized indication for this drug and etidronate markedly reduced progression of vascular calcification in CKD patients. Bisphosphonates are analogues of pyrophosphate, a potent calcification inhibitor in bone and soft tissue. Thus the efficacy of etidronate as treatment for soft tissue calcification brought with it a problematic tendency to cause osteomalacia. In contrast, conventional doses of nitrogen-containing bisphosphonates fail to yield circulating concentrations sufficient to exert direct anti-calcifying effects, at least in patients with good renal function and studies using alendronate and ibandronate have yielded inconsistent vascular outcomes.
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Affiliation(s)
- S Hildebrand
- Centre for Nephrology, Royal Free Hospital, London, UK.
| | - J Cunningham
- Centre for Nephrology, Royal Free Hospital, London, UK
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13
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Koller G, Goetz V, Vandermeer B, Homik J, McAlister FA, Kendler D, Ye C. Persistence and adherence to parenteral osteoporosis therapies: a systematic review. Osteoporos Int 2020; 31:2093-2102. [PMID: 32613409 DOI: 10.1007/s00198-020-05507-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/15/2020] [Indexed: 12/18/2022]
Abstract
Osteoporosis is a chronic disease of low bone mass and fragility. Treatment is frequently compromised by suboptimal medication compliance causing increased morbidity. This review investigates adherence and persistence to parenteral osteoporosis therapies. Findings reveal parenteral medications requiring reduced dosing frequency have higher compliance than oral therapies. This systematic review examines real-world adherence to parenteral osteoporosis therapies. We searched PubMed, Medline, and EMBASE databases for English language observational studies that examined patient adherence and/or persistence to parenteral osteoporosis treatments (teriparatide sc, ibandronate iv, zoledronic acid iv, and denosumab sc) in adults with osteoporosis published up to September 2018. Studies with only self-reported adherence or persistence data and those with less than 20 patients were excluded. Quality assessment of included studies was completed using the Newcastle-Ottawa quality assessment scale (NOS). We identified 40 eligible studies. Teriparatide was examined in 29 studies, with persistence rates of 10-87% (median 55%) at 1 year and 10-69% (median 29.5%) at 2 years, and adherence rates of 21-89% (median 53%) at 1 year and 37-68% (median 40%) at 2 years. Ten studies of zoledronic acid reported persistence rates of 34-73% (median 42%) for second dose and 20-54% (median 35.8%) for third dose. Ten studies of ibandronate adherence reported and 2-year persistence rates of 31-58% (median 47.5%) in 1 year and 13-35% (median 25%) at 2 years, and adherence rates of 21-72% (median 47.3%) and 15-58% (median 36.5%) respectively. Denosumab was reported in 19 studies, with second (1 year) and fourth (2 year) dose persistence rates of 61-100% (median 81%) and 36-99% (median 45.5%). There is substantial heterogeneity in reports of persistence and adherence rates with parenteral osteoporosis therapies. Most of the published data are from short-term studies and evaluations of long-term adherence and persistence with parenteral therapies for osteoporosis are needed.
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Affiliation(s)
- G Koller
- Department of Medicine, Division of Rheumatology, University of Alberta, 8-130 Clinical Sciences Building, 11350 83rd Avenue NW, Edmonton, AB, T6G 2G3, Canada
| | - V Goetz
- Department of Medicine, Division of Rheumatology, University of Alberta, 8-130 Clinical Sciences Building, 11350 83rd Avenue NW, Edmonton, AB, T6G 2G3, Canada
| | - B Vandermeer
- Alberta Research Centre for Health Evidence, Biostatistician, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - J Homik
- Department of Medicine, Division of Rheumatology, University of Alberta, 8-130 Clinical Sciences Building, 11350 83rd Avenue NW, Edmonton, AB, T6G 2G3, Canada
| | - F A McAlister
- Department of Medicine, Division of General Internal Medicine, University of Alberta, Edmonton, AB, Canada
| | - D Kendler
- Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - C Ye
- Department of Medicine, Division of Rheumatology, University of Alberta, 8-130 Clinical Sciences Building, 11350 83rd Avenue NW, Edmonton, AB, T6G 2G3, Canada.
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14
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Fontalis A, Eastell R. The challenge of long-term adherence: The role of bone turnover markers in monitoring bisphosphonate treatment of osteoporosis. Bone 2020; 136:115336. [PMID: 32234415 DOI: 10.1016/j.bone.2020.115336] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 12/17/2022]
Abstract
Oral Bisphosphonates (BPs) are the mainstay of osteoporotic treatment, however long-term adherence remains a challenge, primarily owing to the chronic character of the disease and the regimen complexity. Poor compliance has been shown to have a clear link to fracture risk. The role of bone turnover markers (BTMs) as a tool to ascertain adherence and response to therapy is supported by their rapid response to treatment; a decrease in values is witnessed within days or weeks of commencing treatment. A greater reduction of serum CTX and NTX is evidenced with alendronate and ibandronate compared to risedronate. A change in bone formation BTMs appears to be related to vertebral fracture risk reduction, whereas no significant relationship is evident for hip and non-vertebral fractures. The utility of BTMs as an adjunct for monitoring withdrawal of treatment with oral BP has also been suggested. Finally, studies evaluating BTMs as an intervention, failed to demonstrate any effect on adherence. This review explores the challenge of long-term adherence with bisphosphonates and provides an analytic framework with respect to the role of BTMs in monitoring bisphosphonate treatment, adherence and the offset of treatment effect.
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Affiliation(s)
- Andreas Fontalis
- Academic Unit of Bone Metabolism, University of Sheffield, Sheffield, UK.
| | - Richard Eastell
- Academic Unit of Bone Metabolism, University of Sheffield, Sheffield, UK
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15
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Roh YH, Noh JH, Gong HS, Baek GH. Comparative adherence to weekly oral and quarterly intravenous bisphosphonates among patients with limited heath literacy who sustained distal radius fractures. J Bone Miner Metab 2018; 36:589-595. [PMID: 28983705 DOI: 10.1007/s00774-017-0867-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/27/2017] [Indexed: 10/18/2022]
Abstract
Individuals with limited health literacy (HL) are less likely to obtain preventive care. We designed a study to compare adherence to weekly oral and quarterly intravenous bisphosphonates among patients with low HL. The study enrolled a total of 432 female patients who presented with a distal radius fracture caused by low-energy trauma. Participant HL was measured using the Newest Vital Sign tool, and patients were randomized to weekly oral or quarterly intravenous bisphosphonate groups. Subjects in the intravenous bisphosphonate group received intravenous injections of 3 mg ibandronate every 3 months, and those in the oral bisphosphonate group self-administered 70 mg alendronate orally once each week for 12 months. The adherence to weekly oral or quarterly intravenous bisphosphonates was analyzed by HL level. The rate of adherence to quarterly intravenous bisphosphonates was significantly higher than that for weekly oral bisphosphonates in patients with inadequate HL (73 vs. 46%, p = 0.001), whereas no significant differences were observed between HL groups in adherence to intravenous bisphosphonate. Conversely, the rate of adherence to orally administered bisphosphonates was significantly lower in patients with inadequate HL than in those with appropriate HL (46 vs. 65%, p = 0.005). After controlling for confounding variables, inadequate HL, the presence of comorbidities, and weekly oral bisphosphonates were associated with a higher likelihood of nonadherence to osteoporosis treatment. Thus patients with limited health literacy can achieve rates of adherence to quarterly intravenous bisphosphonates, as opposed to weekly oral bisphosphonates, similar to rates among patients with appropriate literacy.
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Affiliation(s)
- Young Hak Roh
- Department of Orthopaedic Surgery, Ewha Womans University Medical Center, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jung Ho Noh
- Department of Orthopaedic Surgery, Kangwon National University Hospital, 156 Baengnyeong-ro, Chuncheon, Gangwon-do, 200-722, Korea.
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
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16
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Hagino H, Ito M, Hashimoto J, Yamamoto M, Endo K, Katsumata K, Asao Y, Matsumoto R, Nakano T, Mizunuma H, Nakamura T. Monthly oral ibandronate 100 mg is as effective as monthly intravenous ibandronate 1 mg in patients with various pathologies in the MOVEST study. J Bone Miner Metab 2018; 36:336-343. [PMID: 28389932 DOI: 10.1007/s00774-017-0839-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 03/29/2017] [Indexed: 11/27/2022]
Abstract
The non-inferiority of oral ibandronate 100 mg to intravenous (i.v.) ibandronate 1 mg in increasing lumbar spine (LS) bone mineral density (BMD) after 12 months of treatment was demonstrated in the randomized, phase III MOVEST study. We conducted subgroup analyses in the per-protocol set of the study (n = 183 oral ibandronate; n = 189 i.v. ibandronate). In patients with LS BMD T score ≥ -3.0 or < -3.0 at screening, LS BMD gains from baseline were 4.42 and 5.79%, respectively, with oral ibandronate, and 4.60 and 5.83%, respectively, with i.v. ibandronate. LS BMD gains in patients with or without prevalent vertebral fractures were 5.21 and 5.23%, respectively, with oral ibandronate, and 5.01 and 5.49%, respectively, with i.v. ibandronate. In patients aged <75 or ≥75 years, LS BMD gains were 5.46 and 4.51%, respectively, with oral ibandronate, and 5.25 and 5.77%, respectively, with i.v. ibandronate. LS BMD gains in patients with baseline 25-hydroxyvitamin D levels ≥20 or <20 ng/mL were 5.35 and 4.76%, respectively, with oral ibandronate, and 5.05 and 6.57%, respectively, with i.v. ibandronate. Similar results were obtained in patients with or without prior bisphosphonate (BP) treatment, and in those receiving osteoporosis drug treatment other than BPs. In conclusion, oral ibandronate 100 mg demonstrated comparable BMD gains with monthly i.v. ibandronate, and thus shows high utility in the lifestyle and disease conditions associated with osteoporosis in Japanese patients.
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Affiliation(s)
- Hiroshi Hagino
- Faculty of Medicine, School of Health Science and Rehabilitation Division, Tottori University, Tottori, Japan
| | - Masako Ito
- Center for Diversity and Inclusion, Nagasaki University, Nagasaki, Japan
| | | | | | - Koichi Endo
- Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
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17
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Verì A, D'Andrea MR, Bonginelli P, Gasparini G. Clinical Usefulness of Bisphosphonates in Oncology: Treatment of Bone Metastases, antitumoral Activity and Effect on Bone Resorption Markers. Int J Biol Markers 2018; 22:24-33. [PMID: 17393358 DOI: 10.1177/172460080702200104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present article overviews the role of bisphosphonates for the treatment and prevention of bone metastases and their antiangiogenic effects and antitumoral activity. The skeleton is a frequent and clinically relevant site of metastasis in cancer patients. The major events related to bone metastases include bone pain, bone loss, hypercalcemia, spinal cord compression, and fractures. On the basis of their radiographic features, bone metastases are classified as osteoblastic, osteoclastic, or mixed. The primary goals of treatment of bone metastases are reduction of the risk of pathological fractures and other skeletal-related events, and pain control. Bisphosphonates are used to prevent pathological fractures by inhibition of osteoclasts. Recent studies suggest that bisphosphonates have some direct antitumoral activity, mainly mediated through the blockade of angiogenic pathways. Further clinical studies are needed to determine the optimal treatment duration, timing and schedule of bisphosphonates, assess their role as adjuvant therapy for the prevention of bone metastases, and establish their antiangiogenic activity in association with standard cytotoxic and hormonal drugs for treatment of patients with advanced disease.
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Affiliation(s)
- A Verì
- Division of Medical Oncology, San Filippo Neri Hospital, Rome, Italy
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18
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Guo J, Zhang Q, Li J, Liu Y, Hou Z, Chen W, Jin L, Tian Y, Ju L, Liu B, Dong T, Zhang F, Zhang Y. Local application of an ibandronate/collagen sponge improves femoral fracture healing in ovariectomized rats. PLoS One 2017; 12:e0187683. [PMID: 29108027 PMCID: PMC5673204 DOI: 10.1371/journal.pone.0187683] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/24/2017] [Indexed: 01/11/2023] Open
Abstract
Non-union is a major clinical problem in the healing of fractures, especially in patients with osteoporosis. The systemic administration of drugs is time consuming and large doses are demanding and act slowly, whereas local release acts rapidly, increases the quality and quantity of the bone tissue. We hypothesize that local delivery demonstrates better therapeutic effects on an osteoporotic fracture. The aim of this paper is to investigate the effect of the local application of ibandronate loaded with a collagen sponge on regulating bone formation and remodeling in an osteoporotic rat model of fracture healing. We found that the local delivery of ibandronate exhibited excellent effects on improving the bone microarchitecture and suppressed effects on bone remodeling. At 4 weeks, more callus formation and improvement of mechanical character and microstructure were observed in a local delivery via μCT, mechanical test, histological research and serum analysis. The suppression of bone remodeling was compared with a systemic treatment at 12 weeks, and the structural mechanical properties and microarchitecture were also improved with local delivery. This research identifies an earlier, safer and integrated approach for local delivery of ibandronate with collagen and provides a better strategy for the treatment of osteoporotic fracture in rats.
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Affiliation(s)
- Jialiang Guo
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, P. R., China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, P. R., China
- Orthopaedic Research Institution of Hebei Province, Hebei, P. R., China
| | - Qi Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, P. R., China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, P. R., China
- Orthopaedic Research Institution of Hebei Province, Hebei, P. R., China
| | - Jia Li
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, P. R., China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, P. R., China
- Orthopaedic Research Institution of Hebei Province, Hebei, P. R., China
| | - Yansong Liu
- VSD Medical Science & Technology Co., Ltd, Hubei, P. R., China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, P. R., China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, P. R., China
| | - Wei Chen
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, P. R., China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, P. R., China
- Orthopaedic Research Institution of Hebei Province, Hebei, P. R., China
| | - Lin Jin
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, P. R., China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, P. R., China
- Orthopaedic Research Institution of Hebei Province, Hebei, P. R., China
| | - Ye Tian
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, P. R., China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, P. R., China
- Orthopaedic Research Institution of Hebei Province, Hebei, P. R., China
| | - Linlin Ju
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, P. R., China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, P. R., China
- Orthopaedic Research Institution of Hebei Province, Hebei, P. R., China
| | - Bo Liu
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, P. R., China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, P. R., China
- Orthopaedic Research Institution of Hebei Province, Hebei, P. R., China
| | - Tianhua Dong
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, P. R., China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, P. R., China
- Orthopaedic Research Institution of Hebei Province, Hebei, P. R., China
| | - Fei Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, P. R., China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, P. R., China
- Orthopaedic Research Institution of Hebei Province, Hebei, P. R., China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, P. R., China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, P. R., China
- Orthopaedic Research Institution of Hebei Province, Hebei, P. R., China
- * E-mail:
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19
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Takeda S, Sakai S, Tanaka K, Tomizawa H, Serizawa K, Yogo K, Urayama K, Hashimoto J, Endo K, Matsumoto Y. Intermittent Ibandronate Maintains Bone Mass, Bone Structure, and Biomechanical Strength of Trabecular and Cortical Bone After Discontinuation of Parathyroid Hormone Treatment in Ovariectomized Rats. Calcif Tissue Int 2017; 101:65-74. [PMID: 28246925 PMCID: PMC5486915 DOI: 10.1007/s00223-017-0255-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/10/2017] [Indexed: 01/17/2023]
Abstract
Although parathyroid hormone (PTH) expresses an anabolic effect on bone mass, the increased bone mass disappears once PTH treatment is withdrawn. Therefore, sequential treatment with anti-bone-resorptive agents is required to maintain bone mass after PTH treatment. We examined the effect of sequential treatment with ibandronate (IBN), a nitrogen-containing bisphosphonate, following PTH in ovariectomized (OVX) rats. Wistar-Imamichi rats (27 weeks old) were ovariectomized and treated with PTH (10 µg/kg, s.c.; 5 times/week; PTH group) for 8 weeks from 8 weeks after OVX. Thereafter, PTH was withdrawn and rats were administered IBN (10 µg/kg, s.c.; every 4 weeks; PTH-IBN group) or vehicle (PTH-Veh group) for another 8 weeks. PTH increased bone mineral density (BMD) measured by dual-energy X-ray absorptiometry and biomechanical strength in the lumbar spine and femur as compared to the disease control rats. BMD and biomechanical strength in the PTH-Veh group were lower than in the PTH group, whereas in the PTH-IBN group they were maintained at the level of the PTH group. Microstructure of the trabecular and cortical bone in the PTH-IBN group was not significantly different from that in the PTH group. In histomorphometric analysis of the lumbar vertebra, eroded surface and osteoclast surface in the PTH-Veh group were no different from those in the PTH group, whereas they were lower in the PTH-IBN group. Osteoid surface, osteoblast surface, and mineralize surface decreased in both PTH-IBN and PTH-Veh groups compared to the PTH group, and these parameters in the PTH-IBN group were lower than in the PTH-Veh group. These results indicated that intermittent IBN after PTH treatment suppressed bone turnover and maintained BMD, biomechanical strength, and microstructure in the lumbar spine and femur of OVX rats.
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Affiliation(s)
- Satoshi Takeda
- Fuji Gotemba Research Laboratories, Product Research Department, Chugai Pharmaceutical Co., Ltd, 1-135 Komakado, Gotemba, Shizuoka, 412-8513, Japan
| | - Sadaoki Sakai
- Fuji Gotemba Research Laboratories, Product Research Department, Chugai Pharmaceutical Co., Ltd, 1-135 Komakado, Gotemba, Shizuoka, 412-8513, Japan
| | - Keisuke Tanaka
- Fuji Gotemba Research Laboratories, Product Research Department, Chugai Pharmaceutical Co., Ltd, 1-135 Komakado, Gotemba, Shizuoka, 412-8513, Japan
| | - Haruna Tomizawa
- Fuji Gotemba Research Laboratories, Product Research Department, Chugai Pharmaceutical Co., Ltd, 1-135 Komakado, Gotemba, Shizuoka, 412-8513, Japan
| | - Kenichi Serizawa
- Fuji Gotemba Research Laboratories, Product Research Department, Chugai Pharmaceutical Co., Ltd, 1-135 Komakado, Gotemba, Shizuoka, 412-8513, Japan
| | - Kenji Yogo
- Fuji Gotemba Research Laboratories, Product Research Department, Chugai Pharmaceutical Co., Ltd, 1-135 Komakado, Gotemba, Shizuoka, 412-8513, Japan
| | - Koji Urayama
- Product Marketing and Management Department, Taisho Toyama Pharmaceutical Co., Ltd, 3-25-1 Takada, Toshima-ku, Tokyo, 170-8635, Japan
| | - Junko Hashimoto
- Primary Lifecycle Management Department, Chugai Pharmaceutical Co., Ltd, 2-1-1 Nihombashi Muromachi, Chuo-ku, Tokyo, 103-8324, Japan
| | - Koichi Endo
- Medical Science Department, Chugai Pharmaceutical Co., Ltd, 2-1-1 Nihombashi Muromachi, Chuo-ku, Tokyo, 103-8324, Japan
| | - Yoshihiro Matsumoto
- Fuji Gotemba Research Laboratories, Product Research Department, Chugai Pharmaceutical Co., Ltd, 1-135 Komakado, Gotemba, Shizuoka, 412-8513, Japan.
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Popp AW, Senn R, Curkovic I, Senn C, Buffat H, Popp PF, Lippuner K. Factors associated with acute-phase response of bisphosphonate-naïve or pretreated women with osteoporosis receiving an intravenous first dose of zoledronate or ibandronate. Osteoporos Int 2017; 28:1995-2002. [PMID: 28299378 DOI: 10.1007/s00198-017-3992-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 02/28/2017] [Indexed: 10/20/2022]
Abstract
UNLABELLED A first intravenous dose of bisphosphonates may be associated with an acute-phase response (APR). In bisphosphonate-naïve women with postmenopausal osteoporosis, the characteristics and frequency of APR may differ by compound. Prior bisphosphonate exposure was predictive of APR risk and severity. INTRODUCTION Intravenous (IV) administration of bisphosphonates (BP), such as zoledronate (ZOL) and ibandronate (IBN), may be associated with an APR. The characteristics of APR may differ by compound. The aim of the present study was to evaluate the characteristics of APR (rates, signs and symptoms, severity), in the absence of any preventive measure, after a first IV application of ZOL or IBN in patients naïve or previously exposed to BP in a real-world clinical setting. METHODS This is an open-label prospective exploratory study with two cohorts of consecutive postmenopausal women with osteoporosis treated with either IV ZOL or IBN at the Department of Osteoporosis of the University Hospital of Berne, Switzerland. RESULTS Intravenous BP was administered to 725 women (411 ZOL and 314 IBN). Prior oral or IV BP use was less frequent in the ZOL group (61.8 vs. 71.7%, p = 0.005). In total, 301 women (41.5%) reported the presence of one or more signs or symptoms of APR with rates for ZOL and IBN of 47.7 and 33.4%, respectively (p < 0.001). Corresponding APR rates in the subgroup of BP-naïve patients were 55.6 and 32.4%, respectively (p < 0.001). The leading APR clinical sign was the presence of post-dose myalgia or arthralgia (68.1%). Prior BP exposure was predictive of both APR risk and severity, and lower serum 25-hydroxy vitamin D (25(OH)D) levels were possibly predictive of severity. CONCLUSIONS In a real-world setting, APR rates with ZOL and IBN may be higher than reported in randomised controlled trials and may differ by compound, prior BP exposure, and serum 25(OH)D levels.
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Affiliation(s)
- A W Popp
- Department of Osteoporosis, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland
| | - R Senn
- Department of Osteoporosis, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland
| | - I Curkovic
- Department of Osteoporosis, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, Zurich, Switzerland
| | - C Senn
- Department of Osteoporosis, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland
| | - H Buffat
- Department of Osteoporosis, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland
| | - P F Popp
- Department of Osteoporosis, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland
- Institute of Microbiology, Technische Universität (TU) Dresden, 01062, Dresden, Germany
| | - K Lippuner
- Department of Osteoporosis, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, CH, Switzerland.
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Leder BZ, Tsai JN, Jiang LA, Lee H. Importance of prompt antiresorptive therapy in postmenopausal women discontinuing teriparatide or denosumab: The Denosumab and Teriparatide Follow-up study (DATA-Follow-up). Bone 2017; 98:54-58. [PMID: 28286299 DOI: 10.1016/j.bone.2017.03.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/14/2017] [Accepted: 03/08/2017] [Indexed: 11/26/2022]
Abstract
When teriparatide and denosumab are discontinued, bone mineral density (BMD) abruptly decreases. To compare rates of bone loss in postmenopausal women who discontinue denosumab or teriparatide and receive no additional prescription osteoporosis medications to women who discontinue these drugs followed by prompt antiresorptive therapy, we asked women concluding the Denosumab and Teriparatide Administration (DATA) study and its extension, DATA-Switch, to return for BMD measurements 1-2years after study completion. In these studies, women received 2-years of either teriparatide, denosumab or both medications followed by 2-years of the alternate therapy (women who received combination therapy initially received an additional 2-years of denosumab alone). Fifty of 69 women who completed DATA-Switch returned after a mean of 15.4±3.5months. Of the 28 women who received antiresorptive therapy (10 denosumab, 10 oral bisphosphonates, 8 intravenous zoledronic acid), the mean interval between ending DATA-Switch and beginning antiresorptive therapy was 3.8±3.1months. In the 22 women not receiving follow-up therapy, femoral neck, total hip, and spine BMD decreased by -4.2±4.3%, -4.5±3.6%, and -10.0±5.4%, respectively, while BMD was maintained in those who did receive follow-up antiresorptive drugs (femoral neck, total hip, and spine BMD changes of -0.6±2.7%, -0.8±3.1%, and -1.2±4.7%, respectively, P<0.001 for all between-group comparisons). Among untreated women, femoral neck BMD decreased more in those discontinuing denosumab (-5.8±4.0%) than in those discontinuing teriparatide (-0.8±2.6%, P=0.008). Total hip BMD, but not spine BMD, showed a similar pattern. Among treated women, denosumab increased femoral neck and total hip BMD more than bisphosphonates while BMD changes at the spine did not differ significantly. In summary, the large teriparatide and denosumab-induced gains in BMD achieved with 4years of intensive therapy in the DATA and DATA-Switch studies were maintained in patients who received prompt antiresorptive therapy but not in those left untreated. These results demonstrate the negative consequences of delaying consolidation therapy in women treated with these drugs and underscore the importance of timely medication transitions in such patients.
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Affiliation(s)
- Benjamin Z Leder
- Harvard Medical School, Endocrine Unit, Massachusetts General Hospital, United States.
| | - Joy N Tsai
- Harvard Medical School, Endocrine Unit, Massachusetts General Hospital, United States
| | - Linda A Jiang
- Harvard Medical School, Endocrine Unit, Massachusetts General Hospital, United States
| | - Hang Lee
- Harvard Medical School, Endocrine Unit, Massachusetts General Hospital, United States
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22
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Modi A, Sajjan S, Insinga R, Weaver J, Lewiecki EM, Harris ST. Frequency of discontinuation of injectable osteoporosis therapies in US patients over 2 years. Osteoporos Int 2017; 28:1355-1363. [PMID: 28058444 DOI: 10.1007/s00198-016-3886-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 12/14/2016] [Indexed: 01/09/2023]
Abstract
UNLABELLED Little is known about treatment patterns with injectable osteoporosis therapies. At 12 months, the probability of discontinuation was 69.1% among patients using ibandronate, followed by teriparatide (67.1%), zoledronic acid (59.2%), and denosumab (48.8%). By 24 months, discontinuation was higher for each treatment. The majority of US patients discontinue injectable osteoporosis treatment by the end of the first year following initiation. INTRODUCTION This study was designed to assess the frequency of treatment discontinuation over time among patients who initiate injectable osteoporosis therapies. METHODS This retrospective observational study utilized an administrative claims database to measure discontinuation of injectable osteoporosis therapy, reported at 6-month intervals over 2 years. Eligible patients were aged ≥55 years, had newly initiated injectable osteoporosis therapy between January 2008 and June 2012, and were continuously enrolled in the health plan for ≥1 year prior to and ≥1.5 years after the date the first injectable medication was received (the index date). Follow-up time ranged from 18 to 24 months. Injectable osteoporosis treatments included in the analysis were denosumab, ibandronate, teriparatide, and zoledronic acid. Discontinuation was assessed using Kaplan-Meier survival analysis and was defined at each time point as the percentage of patients who did not receive the dose scheduled for that time point. A 90-day grace period was allowed to accommodate flexibility in the scheduling of post-index re-administrations. Sensitivity analyses assessed discontinuation using grace periods of 60 and 30 days. RESULTS A total of 4756 patients met the inclusion criteria for the study, with 617 utilizing denosumab, 233 ibandronate, 778 teriparatide, and 3128 zoledronic acid. At 12 months, discontinuation was highest among patients using ibandronate (69.1%), followed by teriparatide (67.1%), zoledronic acid (59.2%), and denosumab (48.8%). By 24 months, discontinuation was higher for each treatment: 87.5% for ibandronate, 87.9% for teriparatide, 79.8% for zoledronic acid, and 64.3% for denosumab. CONCLUSIONS The majority of US patients discontinue injectable osteoporosis treatment by the end of the first year following initiation.
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Affiliation(s)
- A Modi
- Center for Observational and Real-World Evidence, Merck & Co., Inc, 600 Corporate Drive, Mailstop: CRB-205, Kenilworth, NJ, USA
| | - S Sajjan
- Center for Observational and Real-World Evidence, Merck & Co., Inc, 600 Corporate Drive, Mailstop: CRB-205, Kenilworth, NJ, USA
| | - R Insinga
- Center for Observational and Real-World Evidence, Merck & Co., Inc, 600 Corporate Drive, Mailstop: CRB-205, Kenilworth, NJ, USA
| | - J Weaver
- Center for Observational and Real-World Evidence, Merck & Co., Inc, 600 Corporate Drive, Mailstop: CRB-205, Kenilworth, NJ, USA.
| | - E M Lewiecki
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - S T Harris
- UCSF Medical Center, University of California, San Francisco, CA, USA
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23
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Gillespie D, Farewell D, Barrett-Lee P, Casbard A, Hawthorne AB, Hurt C, Murray N, Probert C, Stenson R, Hood K. The use of randomisation-based efficacy estimators in non-inferiority trials. Trials 2017; 18:117. [PMID: 28274254 PMCID: PMC5343391 DOI: 10.1186/s13063-017-1837-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 02/13/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In a non-inferiority (NI) trial, analysis based on the intention-to-treat (ITT) principle is anti-conservative, so current guidelines recommend analysing on a per-protocol (PP) population in addition. However, PP analysis relies on the often implausible assumption of no confounders. Randomisation-based efficacy estimators (RBEEs) allow for treatment non-adherence while maintaining a comparison of randomised groups. Fischer et al. have developed an approach for estimating RBEEs in randomised trials with two active treatments, a common feature of NI trials. The aim of this paper was to demonstrate the use of RBEEs in NI trials using this approach, and to appraise the feasibility of these estimators as the primary analysis in NI trials. METHODS Two NI trials were used. One comparing two different dosing regimens for the maintenance of remission in people with ulcerative colitis (CODA), and the other comparing an orally administered treatment to an intravenously administered treatment in preventing skeletal-related events in patients with bone metastases from breast cancer (ZICE). Variables that predicted adherence in each of the trial arms, and were also independent of outcome, were sought in each of the studies. Structural mean models (SMMs) were fitted that conditioned on these variables, and the point estimates and confidence intervals compared to that found in the corresponding ITT and PP analyses. RESULTS In the CODA study, no variables were found that differentially predicted treatment adherence while remaining independent of outcome. The SMM, using standard methodology, moved the point estimate closer to 0 (no difference between arms) compared to the ITT and PP analyses, but the confidence interval was still within the NI margin, indicating that the conclusions drawn would remain the same. In the ZICE study, cognitive functioning as measured by the corresponding domain of the QLQ-C30, and use of chemotherapy at baseline were both differentially associated with adherence while remaining independent of outcome. However, while the SMM again moved the point estimate closer to 0, the confidence interval was wide, overlapping with any NI margin that could be justified. CONCLUSION Deriving RBEEs in NI trials with two active treatments can provide a randomisation-respecting estimate of treatment efficacy that accounts for treatment adherence, is straightforward to implement, but requires thorough planning during the design stage of the study to ensure that strong baseline predictors of treatment are captured. Extension of the approach to handle nonlinear outcome variables is also required. TRIAL REGISTRATION The CODA study: ClinicalTrials.gov, identifier: NCT00708656 . Registered on 8 April 2008. The ZICE study trial: ClinicalTrials.gov, identifier: NCT00326820 . Registered on 16 May 2006.
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Affiliation(s)
- David Gillespie
- South East Wales Trials Unit, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Daniel Farewell
- Division of Population Medicine, School of Medicine, College of Biomedical and Life Sciences Cardiff University, Cardiff, UK
| | | | - Angela Casbard
- Wales Cancer Trials Unit, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | | | - Chris Hurt
- Wales Cancer Trials Unit, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Nick Murray
- North Adelaide Oncology, Kimberley House, Calvary North Adelaide Hospital, 89 Strangways Terrace, North Adelaide, SA Australia
| | - Chris Probert
- Gastroenterology Research Unit, Department of Cellular and Molecular Physiology, Institute of Translational Medicine, University of Liverpool, Ashton Street, Liverpool, UK
| | - Rachel Stenson
- Division of Infection and Immunity Research, School of Medicine, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Kerenza Hood
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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24
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Reid IR, Wattie D, Gamble GD, Kalluru R, Cundy T. Long-Term Effects of Intravenous Ibandronate in Paget's Disease of Bone. Calcif Tissue Int 2017; 100:250-254. [PMID: 27866237 DOI: 10.1007/s00223-016-0214-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 11/14/2016] [Indexed: 11/25/2022]
Abstract
We have previously demonstrated that intravenous ibandronate produces high initial response rates in Paget's disease, but the durability of this effect is unknown. It might be expected to be short lived because ibandronate has a low affinity for bone. Here we report long-term follow-up (up to 14 years) of patients from that trial. Twenty-five patients with active Paget's disease [baseline serum total alkaline phosphatase (ALP) ~3 times the upper limit of normal] received either 6 or 12 mg intravenous ibandronate at baseline. There were prompt reductions in ALP following treatment, with normalization in 88%. ALP remained in the normal range in most patients for 20-30 months, but some subjects then showed gradual increases. Three years after ibandronate, before any patients had received additional treatment, ALP was normal in 61%. Six patients maintained normal ALP beyond 6 years without further intervention. Responses to 6 and 12 mg were similar. These results indicate that long-term remissions in Paget's disease can be achieved with bolus delivery of a potent bisphosphonate, even if the drug has a low affinity for bone. Therefore, bisphosphonate retention in bone might not be the only factor determining duration of remission. Intravenous bisphosphonates are likely to produce high drug concentrations within pagetic lesions which might result in cytotoxicity to the pagetic cells, leading to long durations of remission. These findings strengthen the evidence that potent bisphosphonates delivered in a single intravenous dose are a very efficient way to manage this condition.
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Affiliation(s)
- Ian R Reid
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand.
- Department of Endocrinology, Auckland District Health Board, Auckland, New Zealand.
| | - Diana Wattie
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Gregory D Gamble
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - Ramanamma Kalluru
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
- Department of Rheumatology, Auckland District Health Board, Auckland, New Zealand
| | - Tim Cundy
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand
- Department of Endocrinology, Auckland District Health Board, Auckland, New Zealand
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25
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Ito M, Tobinai M, Yoshida S, Hashimoto J, Nakamura T. Effect of monthly intravenous ibandronate injections on vertebral or non-vertebral fracture risk in Japanese patients with high-risk osteoporosis in the MOVER study. J Bone Miner Metab 2017; 35:58-64. [PMID: 26614597 DOI: 10.1007/s00774-015-0723-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/18/2015] [Indexed: 11/30/2022]
Abstract
We examined the efficacy of intravenous (IV) ibandronate 1 mg/month in patient subgroups in the phase III MOVER study. Here we present results of analyses on the incidence of fractures in patients with prevalent vertebral fractures (1 or ≥2, and ≥3) at screening and femoral neck (FN) bone mineral density (BMD) T scores ≥-2.5 or <-2.5, and <-3.0 at baseline. The per-protocol set comprised 1134 patients (ibandronate 0.5 mg/month n = 376; ibandronate 1 mg/month n = 382; risedronate oral 2.5 mg/day n = 376). The incidence of vertebral fractures in patients with 1 or ≥2 prevalent vertebral fractures was 11.2 and 20.4 %, respectively, with ibandronate 1 mg/month, and 12.6 and 22.1 %, respectively, with risedronate. In patients with FN BMD T scores ≥-2.5 or <-2.5, the vertebral fracture incidence was 13.7 and 16.4 %, respectively, with ibandronate 1 mg/month, and 17.3 and 19.1 %, respectively, with risedronate. The incidence of non-vertebral fractures in patients with ≥2 prevalent vertebral fractures or FN BMD T score <-2.5 was 7.6 and 7.6 %, respectively, with ibandronate 1 mg/month, and 9.5 and 9.4 %, respectively, with risedronate. Fracture incidence was consistently lower, but not significant, with ibandronate 1 mg/month than with risedronate in patients with ≥2 prevalent vertebral fractures and FN BMD T score <-2.5. The efficacy of the fracture reduction of monthly IV ibandronate appears consistent and seemingly independent of the number of prevalent vertebral fractures or baseline BMD values.
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Affiliation(s)
- Masako Ito
- Center for Gender Equality, Nagasaki University, Nagasaki, Japan
| | - Masato Tobinai
- Clinical Development Division, Chugai Pharmaceutical Co. Ltd., Tokyo, Japan
| | - Seitaro Yoshida
- Clinical Development Division, Chugai Pharmaceutical Co. Ltd., Tokyo, Japan
| | - Junko Hashimoto
- Project and Lifecycle Management Unit, Chugai Pharmaceutical Co. Ltd., Tokyo, Japan.
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26
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Iwamoto J, Seki A, Nango N. Influence of Teriparatide and Ibandronate on Cortical Bone in New Zealand White Rabbits: A HR-QCT Study. Calcif Tissue Int 2016; 99:535-542. [PMID: 27465620 DOI: 10.1007/s00223-016-0180-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/19/2016] [Indexed: 10/21/2022]
Abstract
Teriparatide (TPTD) is known to increase the cortical thickness and porosity. The purpose of the present study was to determine whether switching from TPTD to ibandronate (IBN) would be useful for improving cortical bone parameters as assessed using high-resolution quantitative computed tomography (HR-QCT) analyses in mature rabbits. Forty-two female New Zealand white rabbits (18-22 weeks old) were randomized into six groups of 7 animals each as follows: 4-week vehicle administration group, 4-week TPTD administration group (20 μg/kg, subcutaneously [s.c.], daily), 12-week vehicle administration group, 4-week TPTD administration + 8-week vehicle administration group, 4-week TPTD administration + 8-week lower-dose IBN administration group (20 μg/kg, s.c., every 4 weeks), and 4-week TPTD administration + 8-week higher-dose IBN administration group (100 μg/kg, s.c., every 4 weeks). After the 4- or 12-week experimental period, the cortical bone of the distal femoral diaphysis was processed for HR-QCT analysis. The 4-week TPTD administration increased the pore ratio, number, and density as well as the cortical area, thickness, and bone mineral content (BMC), without significant influencing the volumetric bone mineral density (BMD). The 4-week TPTD administration + 8-week vehicle administration decreased the pore ratio, number, and density as well as the cortical area and thickness, compared with the 4-week TPTD administration, but the pore ratio, cortical area, and thickness were still higher compared with the 12-week vehicle administration. The 4-week TPTD administration + 8-week higher-dose IBN administration, but not the 4-week TPTD administration + 8-week lower-dose IBN administration, increased the cortical area, thickness, BMC, and volumetric BMD and decreased the pore ratio, but not the pore number or density, compared with the 4-week TPTD administration + 8-week vehicle administration. These results suggest that higher-dose IBN after TPTD therapy has a beneficial effect on the BMC, volumetric BMD, cortical area, thickness, and porosity in mature rabbits.
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Affiliation(s)
- Jun Iwamoto
- Department of Orthopaedic Surgery, Keiyu Orthopaedic Hospital, 1741 Hanetsuku-cho, Tatebayashi, Gunma, 374-0011, Japan.
| | - Azusa Seki
- Hamri Co., Ltd., 2638-2 Ozaki, Koga City, Ibaraki, 306-0101, Japan
| | - Nobuhito Nango
- Ratoc System Engineering Co., Ltd., Toho Edogawabashi Building, 1-24-8 Sekiguchi, Bunkyo-ku, Tokyo, 112-0014, Japan
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Nakano T, Yamamoto M, Hashimoto J, Tobinai M, Yoshida S, Nakamura T. Higher response with bone mineral density increase with monthly injectable ibandronate 1 mg compared with oral risedronate in the MOVER study. J Bone Miner Metab 2016; 34:678-684. [PMID: 26462480 DOI: 10.1007/s00774-015-0717-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/01/2015] [Indexed: 10/23/2022]
Abstract
We examined response to bone mineral density (BMD) gains in the MOVER study following treatment with intravenous (IV) ibandronate 1 mg/month, and investigated the characteristics of a non-responder group. At 1 year, responder rates for patients with BMD increases >0 % were similar with IV ibandronate 0.5 or 1 mg/month and oral risedronate 2.5 mg/day. However, after 3 years, responder rates with BMD increases ≥3 % were highest with ibandronate 1 mg at all bone sites (>80 % at the lumbar spine [L2-L4] and >50 % at all femur sites, which was significantly higher than with risedronate). Non-responders were defined by BMD increases ≤3 % at L2-L4 or ≤0 % at total hip, and ≤50 % reduction in creatinine-corrected urinary collagen type 1 cross-linked C-telopeptide (uCTX) from baseline to 1 year. There were a small number of non-responders in the ibandronate 1 mg group: 3.3 % (10/299) with ≤0 % total hip BMD increase and ≤50 % uCTX reduction from baseline. These non-responders had lower 25-hydroxyvitamin D (25[OH]D) levels than responders, but no differences in kidney function, L2-L4 BMD or bone turnover marker baseline values. Throughout the study, non-responders failed to show any increases in BMD. Our analysis demonstrates significantly higher responder rates with IV ibandronate 1 mg/month than with risedronate at 3 years. A small number of non-responders in the ibandronate group had lower 25(OH)D baseline levels than responders, suggesting that 25(OH)D levels could be a useful indicator of BMD response to therapy.
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Affiliation(s)
| | - Masao Yamamoto
- Project & Lifecycle Management Unit, Chugai Pharmaceutical Co. Ltd., Tokyo, Japan
| | - Junko Hashimoto
- Project & Lifecycle Management Unit, Chugai Pharmaceutical Co. Ltd., Tokyo, Japan.
| | - Masato Tobinai
- Clinical Development Division, Chugai Pharmaceutical Co. Ltd., Tokyo, Japan
| | - Seitaro Yoshida
- Clinical Development Division, Chugai Pharmaceutical Co. Ltd., Tokyo, Japan
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28
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Kutilek S, Plasilova I, Langer J. Ibandronate in the Treatment of Pediatric Osteoporosis. Indian Pediatr 2016; 53:927. [PMID: 27771681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We administered oral ibandronate (once a month) to 7 children (6 boys) with low bone mineral density and prevalent low energy fractures. We observed a significant increase (17%) in bone density after one year and additional 3% increase after second year. No further fractures occurred.
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Affiliation(s)
- Stepan Kutilek
- Departments of #*Pediatrics, Pardubice Hospital, Pardubice; *Klatovy Hospital, Klatovy; and $Department of Pediatrics, I Medical Facility, Charles University, Prague; Czech Republic. *
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29
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Mammo Z, Guo M, Maberley D, Matsubara J, Etminan M. Oral Bisphosphonates and Risk of Wet Age-Related Macular Degeneration. Am J Ophthalmol 2016; 168:62-67. [PMID: 27163238 DOI: 10.1016/j.ajo.2016.04.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 04/22/2016] [Accepted: 04/27/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To examine the risk of age-related macular degeneration (AMD) with oral bisphosphonates. DESIGN Three study designs were used: (1) disproportionality analysis; (2) case-control study; (3) self-controlled case series (SCCS). METHODS setting: (1) Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) Database; (2) 2 patient cohorts from British Columbia, Canada. STUDY POPULATION (1) All reports of AMD to the FDA with oral bisphosphoantes; (2) patients with wet AMD in British Columbia (2009-2013) and 1 million controls (2000-2007). INTERVENTION Oral bisphosphonates. MAIN OUTCOME MEASURES (1) Reports of AMD to the FDA; (2) first diagnosis of wet AMD verified by a retina specialist in British Columbia. RESULTS In the disproportionality analysis there were 133 cases of AMD reported with alendronate, 20 with ibandronate, and 14 with risedronate. The reported odds ratios (RORs) for alendronate, ibandronate, and risedronate were 3.82 (95% CI: 2.94-4.96), 2.40 (95% CI: 1.49-3.86), and 2.87 (95% CI: 1.58-5.19), respectively. In the case-control analysis there were 6367 cases and 6370 corresponding controls. The adjusted OR for wet AMD among regular users of bisphosphonates in the 1, 2, and 3 years prior to the index date were 1.24 (1.12-1.38), 1.38 (1.22-1.56), and 1.59 (1.38-1.82), respectively. In the SCCS analysis there were 198 cases of wet AMD on continuous bisphosphonate therapy. The rate ratio for wet AMD for continuous bisphosphonate use was 1.99 (95% CI: 1.41-2.79). We did not have information on intravenous bisphosphonates. CONCLUSIONS Continuous users of oral bisphosphonates are at a higher risk of developing wet AMD. Given the observational nature of this study and limitation of the data, future studies are needed to confirm these findings.
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Affiliation(s)
- Zaid Mammo
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Michael Guo
- Department of Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada
| | - David Maberley
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada; Collaboration for Epidemiology of Ocular Diseases (CEPOD), Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Joanne Matsubara
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada
| | - Mahyar Etminan
- Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada; Department of Pharmacology and Therapeutics, University of British Columbia, Vancouver, Canada; Collaboration for Epidemiology of Ocular Diseases (CEPOD), Department of Ophthalmology and Visual Sciences, University of British Columbia, Vancouver, Canada.
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Ma Z, Li Y, Zhou M, Huang K, Hu H, Liu X, Xu X. Predictors of Ibandronate Efficacy for the Management of Osteoporosis: A Meta-Regression Analysis. PLoS One 2016; 11:e0150203. [PMID: 26930292 PMCID: PMC4773099 DOI: 10.1371/journal.pone.0150203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 02/10/2016] [Indexed: 11/18/2022] Open
Abstract
Background Aim of the present study was to identify the predictors of ibandronate efficacy in subjects with osteoporosis or decreased bone mineral density (BMD). Method Several electronic databases were searched by using specific keywords for the acquisition of research articles reporting the efficacy of ibandronate in subjects with osteoporosis or decreased BMD. Metaregression analyses were carried out by using changes in the BMD of lumbar spine and total hip following ibandronate treatment as dependent (outcome) variables against several independent (explanatory) variables. Results Data were extracted from 34 studies (11,090 ibandronate treated subjects) which fulfilled eligibility criteria. A history of previous fracture/s was reported by 46% of these subjects. In overall population, longer treatment duration from 1 to 5 years, increasing age, history of previous fractures, lower baseline T score, and higher baseline levels of C-terminal telopeptide of type 1 collagen (CTX) predicted higher ibandronate efficacy in improving BMD of the lumbar spine as well as of the total hip. Lower baseline levels of vitamin D and higher baseline levels of bone specific alkaline phosphatase (BSAP) predicted higher efficacy of ibandronate for lumbar spine only. In postmenopausal women with osteoporosis or decreased BMD, in addition to above-mentioned predictors, better efficacy of ibandronate was also associated with increasing time since menopause for both lumbar spine and total hip and lower body weight for lumbar spine only. Conclusion Longer treatment duration from 1 to 5 years, increasing age, lower baseline T scores, and higher serum CTX levels are identified as the predictors of better efficacy of ibandronate in the study subjects with osteoporosis or decreased BMD.
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Affiliation(s)
- Zeren Ma
- Spinal and Joint Unit, Department of Orthopedics, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, Jiangxi 330006, China
- * E-mail:
| | - Yong Li
- Department of Orthopaedics, Shanxi Province People’s Hospital, Xi’an 710068, China
| | - Ming Zhou
- Spinal and Joint Unit, Department of Orthopedics, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, Jiangxi 330006, China
| | - Kedi Huang
- Spinal and Joint Unit, Department of Orthopedics, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, Jiangxi 330006, China
| | - Hejun Hu
- Spinal and Joint Unit, Department of Orthopedics, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, Jiangxi 330006, China
| | - Xiaoping Liu
- Spinal and Joint Unit, Department of Orthopedics, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, Jiangxi 330006, China
| | - Xiaosheng Xu
- Spinal and Joint Unit, Department of Orthopedics, Nanchang Hongdu Hospital of Traditional Chinese Medicine, Nanchang, Jiangxi 330006, China
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Naylor KE, Jacques RM, Paggiosi M, Gossiel F, Peel NFA, McCloskey EV, Walsh JS, Eastell R. Response of bone turnover markers to three oral bisphosphonate therapies in postmenopausal osteoporosis: the TRIO study. Osteoporos Int 2016; 27:21-31. [PMID: 25990354 DOI: 10.1007/s00198-015-3145-7] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/21/2015] [Indexed: 11/24/2022]
Abstract
UNLABELLED We used bone turnover markers to identify women who responded to bisphosphonate treatment for osteoporosis. Response was more likely with alendronate and ibandronate than risedronate. There was a greater decrease in bone markers if baseline bone turnover markers were higher and if the patient took more than 80 % of her medication. INTRODUCTION Biochemical response to bisphosphonate therapy can be assessed using either a decrease in bone turnover marker beyond the least significant change (LSC) or a reduction to within a reference interval (RI). We compared the performance of these target responses and determined whether response was related to the type of bisphosphonate, compliance and baseline bone turnover markers. METHODS Biochemical responses to three oral bisphosphonates were assessed in an open, controlled trial comprising 172 postmenopausal osteoporotic women (age 53-84 years), randomised to alendronate, ibandronate or risedronate, plus calcium and vitamin D supplementation for 2 years. The LSC for each marker was derived within the study population, whereas RIs were obtained from a control group of healthy premenopausal women (age 35-40 years). RESULTS Over 70 % of women achieved a target response for serum CTX and PINP, irrespective of the approach used. The percentage decrease at 12 weeks was greater for women with baseline PINP above the RI -63 % (difference 13 %, 95 % CI 0 to 27.1, P = 0.049) and good compliance -67 % (difference 15.9 %, 95 % CI 6.3 to 25.5, P = 0.001). Responders had a greater increase in spine bone density compared to nonresponders; for example 6.2 vs. 2.3 % (difference 3.9 %, 95 % CI 1.6 to 6.3, P = 0.0011) for PINP LSC. The magnitude of change in bone markers was greater with ibandronate and alendronate than risedronate. CONCLUSIONS Both approaches to response identified similar proportions of women as responders. Nonresponders had smaller increases in BMD, and we suggest that biochemical assessment of response is a useful tool for the management of women with postmenopausal osteoporosis.
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Affiliation(s)
- K E Naylor
- Academic Unit of Bone Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, Herries Road, Sheffield, South Yorkshire, S5 7AU, UK.
| | - R M Jacques
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - M Paggiosi
- Academic Unit of Bone Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, Herries Road, Sheffield, South Yorkshire, S5 7AU, UK
| | - F Gossiel
- Academic Unit of Bone Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, Herries Road, Sheffield, South Yorkshire, S5 7AU, UK
| | - N F A Peel
- Metabolic Bone Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK
| | - E V McCloskey
- Academic Unit of Bone Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, Herries Road, Sheffield, South Yorkshire, S5 7AU, UK
| | - J S Walsh
- Academic Unit of Bone Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, Herries Road, Sheffield, South Yorkshire, S5 7AU, UK
| | - R Eastell
- Academic Unit of Bone Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, Herries Road, Sheffield, South Yorkshire, S5 7AU, UK
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Veszelyné Kotan E, Mészáros Á. [Bisphosphonate use and related pharmaceutical issues II]. Acta Pharm Hung 2016; 86:23-34. [PMID: 27295874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
UNLABELLED Bisphosphonates have basic role in decreasing progression of malignant bone processes as well as in the prevention and therapy of osteoporosis. Use of bisphosphonates is common in Hungary since 20 years. In the past decade their reimbursement has been changed several times, the use of generics decreased the price of bisphosphonates. In this paper we analyze the consumption of prescribed bisphosphonates in Hungary. DATA Prescription data of the National Health Insurance Fund of Hungary. METHOD We analysed the prescribed bisphosphonates between 2006-2014. We examined the type and amount of bisphosphonates used by years. After identifying therapy areas of use, we calculated the years of therapy from the DOT data. From this data we estimated the mean bisphosphonate therapy costs and costs falling for the patients. Changes in the reimbursement system regarding these medications was analysed. RESULTS Bisphosphonate years of therapy was decreasing in osteoporosis over the 9 years examined. In oncology bisphosphonate use shows stability in drug consumption. In both therapeutic areas the proportion in therapy choice of specific bisphosphonates has changed. Bisphosphonate reimbursement costs paid by the Hungarian reimbursement system was approx. 8 billion HUF in osteoporosis and 4,7 billion HUF in oncology in 2006. Changes of the reimbursement strategy, the compulsory generic use and decreasing consumption in osteoporosis has significantly reduced the overall costs by 2014. CONCLUSION According to our results bisphpsphonate use in oncology is moderate in Hungary, a decreasing consumption can be detected in osteoporosis, that is still expected to decrease. The use of generics reduced bisphosphonate therapy costs and also overall health care costs. In osteoporosis patients cost have substantially lowered.
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Veszelyné Kotán E, Mészaros Á. [Therapeutic practice of bisphosphonate use and related pharmaceutical issues I]. Acta Pharm Hung 2016; 86:13-22. [PMID: 27295873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The therapeutic use of Bisphosphonates was common in Hungary for the past two and a half decades. The main clinical application of Bisphosphonates is the therapy of osteoporosis and bone manifestations of malignant diseases. Patients' quality of life depends on the prevalence of the typical fragility fractures and their complications. Bisphosphonates are the basis of the therapy in both therapeutic areas, since they are able to decrease progression of the disease. In patients with good compliance adequate therapy is proven to minimize the number of bone fractures. In the present paper we summarize the pharmacological knowledge of the therapeutic use of Bisphosphonates in the two main therapeutic areas: osteoporosis and osseal manifestations of malignancies. In the second part of our paper we present analysis of the prescribed bisphosphonate drug use, reimbursed by the National Health Insurance Fund. Our results provide data on the changes of druguse and reimbursement strategy of Bisphosphonates in Hungary. Our data highlights the fact that pharmacists have to pay a special attention to the growing aging population affected by osteoporosis, moreover there should be a special focus on osteoporotic patients, since there is a decreasing rate of treated patients. To help lowering this therapeutic gap in osteoporosis, pharmacists should take an active role in the therapy management.
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Sakai S, Takeda S, Sugimoto M, Shimizu M, Shimonaka Y, Yogo K, Hashimoto J, Bauss F, Endo K. Treatment with the combination of ibandronate plus eldecalcitol has a synergistic effect on inhibition of bone resorption without suppressing bone formation in ovariectomized rats. Bone 2015; 81:449-458. [PMID: 26281770 DOI: 10.1016/j.bone.2015.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 07/22/2015] [Accepted: 08/04/2015] [Indexed: 10/23/2022]
Abstract
Bisphosphonates are widely used in the treatment of osteoporosis and contribute to the reduction of bone fractures. Ibandronate (IBN) is a highly potent, nitrogen-containing bisphosphonate, which is administered orally or intravenously at extended dosing intervals. Vitamin D or active vitamin D3 derivatives are also used in the treatment of osteoporosis, and are often used in combination with other drugs. In this study, we investigated the effect of treatment with the combination of once-monthly s.c. dosing of IBN plus once-daily oral eldecalcitol (ELD), an active vitamin D3 derivative, using aged ovariectomized (OVX) rats. Treatment was started the day after OVX, and analyses were performed 4, 8, and 12 weeks thereafter by determination of bone markers, bone mineral density, biomechanical properties, and histomorphometry. The combination treatment showed a synergistic effect in increasing both lumbar and femoral BMD, and resulted in a significant increase in bone ultimate load. The combination of IBN plus ELD acted synergistically to reduce bone resorption, whereas bone formation did not decrease any more than with monotherapy with either IBN or ELD. Bone formation independent of bone resorption (a process known as 'minimodeling') was not changed in vehicle treated OVX rats despite the increase in bone turnover. ELD upregulated minimodeling, which was however not diminished in the combination treatment. In conclusion, treatment with the combination of IBN plus ELD was beneficial in the treatment of osteoporosis in aged OVX rats. It exhibited a synergistic inhibitory effect on bone resorption and keeps bone formation at the level of sham controls. This uncoupling of bone resorption/bone formation was affected, to some extent, by minimodeling-based bone formation which is independent of bone resorption. This combination regimen which showed synergistic effect on BMD and bone ultimate load without inhibition of bone formation may be beneficial in long-term osteoporosis treatment to prevent bone fractures.
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Affiliation(s)
- Sadaoki Sakai
- Product Research Department, Fuji-Gotemba Research Laboratories, Chugai Pharmaceutical Co., Ltd., 1-135 Komakado, Gotemba, Shizuoka 412-8513 Japan.
| | - Satoshi Takeda
- Product Research Department, Fuji-Gotemba Research Laboratories, Chugai Pharmaceutical Co., Ltd., 1-135 Komakado, Gotemba, Shizuoka 412-8513 Japan.
| | - Masanori Sugimoto
- Pharmacology 3, Pharmacology Laboratories, Research Headquarters, Taisho Pharmaceutical Co., Ltd., 1-403 Yoshino-cho, Kita-ku, Saitama 331-9530 Japan.
| | - Masaru Shimizu
- Discovery Pharmacology Dept. 1, Fuji-Gotemba Research Laboratories, Chugai Pharmaceutical Co., Ltd., 1-135 Komakado, Gotemba, Shizuoka 412-8513 Japan.
| | - Yasushi Shimonaka
- Product Research Department, Fuji-Gotemba Research Laboratories, Chugai Pharmaceutical Co., Ltd., 1-135 Komakado, Gotemba, Shizuoka 412-8513 Japan.
| | - Kenji Yogo
- Product Research Department, Fuji-Gotemba Research Laboratories, Chugai Pharmaceutical Co., Ltd., 1-135 Komakado, Gotemba, Shizuoka 412-8513 Japan.
| | - Junko Hashimoto
- Primary Lifecycle Management Dept., Chugai Pharmaceutical Co., Ltd., 2-1-1 Nihombashi Muromachi, Chuo-ku, Tokyo 103-8324, Japan.
| | - Frieder Bauss
- Roche Pharmaceutical Research and Early Development, Discovery Oncology, Roche Innovation Center Penzberg, Nonnenwald 2, D-82377 Penzberg, Germany.
| | - Koichi Endo
- Product Research Department, Fuji-Gotemba Research Laboratories, Chugai Pharmaceutical Co., Ltd., 1-135 Komakado, Gotemba, Shizuoka 412-8513 Japan.
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D'Amelio P, Sassi F, Buondonno I, Fornelli G, Spertino E, D'Amico L, Marchetti M, Lucchiari M, Roato I, Isaia GC. Treatment with intermittent PTH increases Wnt10b production by T cells in osteoporotic patients. Osteoporos Int 2015; 26:2785-91. [PMID: 26068297 DOI: 10.1007/s00198-015-3189-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 05/27/2015] [Indexed: 01/23/2023]
Abstract
UNLABELLED We evaluated the effect of parathyroid hormone (PTH) on Wnt10b production by immune system cells in humans. We showed that bone anabolic effect of intermittent PTH treatment may be amplified by T cells through increased production of Wnt10b. Chronic increase in PTH as in primary hyperparathyroidism does not increase Wnt10b expression. INTRODUCTION The aim of this study is to assess the effect of PTH on Wnt10b production by immune system cells in humans. We assessed both the effect of intermittent PTH administration (iPTH) and of chronic PTH hypersecretion in primary hyperparathyroidism (PHP). METHODS Eighty-two women affected by post-menopausal osteoporosis were randomly assigned to treatment with calcium and vitamin D alone (22) or plus 1-84 PTH (42), or intravenous ibandronate (18). Wnt10b production by unfractioned blood nucleated cells and by T, B cells and monocytes was assessed by real-time RT-PCR and ELISA at baseline, 3, 6, 12 and 18 months of treatment. The effect of chronic elevation of PTH was evaluated in 20 patients affected by PHP at diagnosis and after surgical removal of parathyroid adenoma. WNT10b from both osteoporotic and PHP patients was compared to healthy subjects matched for age and sex. RESULTS iPTH increases Wnt10b production by T cells, whereas PHP does not. After surgical restoration of normal parathyroid function, WNT10b decreases, although it is still comparable with healthy subjects' level. Thus, chronic elevation of PTH does not significantly increase WNT10b production as respect to control. CONCLUSIONS This is the first work showing the effect of both intermittent and chronic PTH increase on Wnt10b production by immune system cells. We suggest that, in humans, T cells amplified the anabolic effect of PTH on bone, by increasing Wnt10b production, which stimulates osteoblast activity.
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Affiliation(s)
- P D'Amelio
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy.
| | - F Sassi
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - I Buondonno
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - G Fornelli
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - E Spertino
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - L D'Amico
- CeRMS, Città della Salute e della Scienza University Hospital of Torino-Italy, Torino, Italy
| | - M Marchetti
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
| | - M Lucchiari
- Clinical Biochemistry Laboratory, Città della Salute e della Scienza University Hospital of Torino-Italy, Torino, Italy
| | - I Roato
- CeRMS, Città della Salute e della Scienza University Hospital of Torino-Italy, Torino, Italy
| | - G C Isaia
- Gerontology Section, Department of Medical Science, University of Torino, Corso Bramante 88/90, 10126, Torino, Italy
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Chung YS, Kang HC, Lee T. Comparative Effects of Ibandronate and Paclitaxel on Immunocompetent Bone Metastasis Model. Yonsei Med J 2015; 56:1643-50. [PMID: 26446649 PMCID: PMC4630055 DOI: 10.3349/ymj.2015.56.6.1643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 12/26/2014] [Accepted: 01/02/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Bone metastasis invariably increases morbidity and mortality. This study compares the effects of ibandronate and paclitaxel on bone structure and its mechanical properties and biochemical turnover in resorption markers using an immunocompetent Walker 256-Sprague-Dawley model, which was subjected to tumor-induced osteolysis. MATERIALS AND METHODS Seventy rats were divided equally into 4 groups: 1) sham group (SHAM), 2) tumor group (CANC), 3) ibandronate treated group (IBAN), and 4) paclitaxel treated group (PAC). Morphological indices [bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp)] and mechanical properties (failure load, stiffness) were evaluated after thirty days of treatment period. Bone resorption rate was analysed using serum deoxypyridinoline (Dpd) concentrations. RESULTS Morphological indices showed that ibandronate (anti-resorptive drug) had a better effect in treating tumor-induced architectural changes in bone than paclitaxel (chemotherapeutic drug). The deterioration in bone architecture was reflected in the biomechanical properties of bone as studied with decreased failure load (F(x)) and stiffness (S) of the bone on the 30th day postsurgery. Dpd concentrations were significantly lower in the IBAN group, indicating successful inhibition of bone resorption and destruction. CONCLUSION Ibandronate was found to be as effective as higher doses of paclitaxel in maintaining stiffness of bone. Paclitaxel treatment did not appear to inhibit osteoclast resorption, which is contrary to earlier in-vitro literature. Emphasis should be placed on the use of immunocompetent models for examining drug efficacy since it adequately reflects bone metastasis in clinical scenarios.
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Affiliation(s)
- Yoon-Sok Chung
- Department of Endocrinology & Metabolism, Ajou University School of Medicine, Suwon, Korea
| | - Ho Chul Kang
- Department of Medical Biotechnology, Dongguk University, Seoul, Korea
| | - Taeyong Lee
- Department of Medical Biotechnology, Dongguk University, Seoul, Korea.
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Nakamura T, Ito M, Hashimoto J, Shinomiya K, Asao Y, Katsumata K, Hagino H, Inoue T, Nakano T, Mizunuma H. Clinical efficacy and safety of monthly oral ibandronate 100 mg versus monthly intravenous ibandronate 1 mg in Japanese patients with primary osteoporosis. Osteoporos Int 2015; 26:2685-93. [PMID: 26001561 PMCID: PMC4605968 DOI: 10.1007/s00198-015-3175-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 05/13/2015] [Indexed: 11/13/2022]
Abstract
UNLABELLED The MOVEST study evaluated the efficacy and safety of monthly oral ibandronate versus licensed monthly IV ibandronate in Japanese osteoporotic patients. Relative BMD gains after 12 months were 5.22 % oral and 5.34 % IV, showing non-inferiority of oral to IV ibandronate (primary endpoint). No new safety concerns were identified. INTRODUCTION The randomized, phase 3, double-blind MOVEST (Monthly Oral VErsus intravenouS ibandronaTe) study evaluated the efficacy and safety of monthly oral ibandronate versus the licensed monthly intravenous (IV) ibandronate regimen in Japanese patients with osteoporosis. METHODS Ambulatory patients aged ≥ 55 years with primary osteoporosis were randomized to receive oral ibandronate 100 mg/month plus monthly IV placebo, or IV ibandronate 1 mg/month plus monthly oral placebo. The primary endpoint was non-inferiority of oral versus IV ibandronate with respect to bone mineral density (BMD) gains at the lumbar spine after 12 months of treatment. RESULTS Four hundred twenty-two patients were enrolled with 372 patients in the per-protocol set (183 and 189 in the oral and IV ibandronate groups, respectively). The relative change from baseline in lumbar spine BMD values for the oral and IV ibandronate groups, respectively, was 5.22 % (95 % confidence interval [CI] 4.65, 5.80) and 5.34 % (95 % CI 4.78, 5.90). The least squares mean difference between the two groups was -0.23 % (95 % CI -0.97, 0.51), showing non-inferiority of oral ibandronate to IV ibandronate (non-inferiority limit = -1.60). Changes in BMD values at other sites, and bone turnover marker levels in the oral ibandronate group, were comparable with those of the IV group. The safety profile was similar to that previously demonstrated; no new safety concerns were identified. CONCLUSIONS This study demonstrated the non-inferiority of oral ibandronate 100 mg/month to IV ibandronate 1 mg/month (licensed dose in Japan) in increasing lumbar spine BMD in Japanese patients with primary osteoporosis.
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Affiliation(s)
- T Nakamura
- National Center for Global Health and Medicine, Tokyo, Japan
| | - M Ito
- Center for Gender Equality, Nagasaki University, Nagasaki, Japan
| | - J Hashimoto
- Chugai Pharmaceutical Co. Ltd., Tokyo, Japan.
| | - K Shinomiya
- Chugai Pharmaceutical Co. Ltd., Tokyo, Japan
| | - Y Asao
- Chugai Pharmaceutical Co. Ltd., Tokyo, Japan
| | - K Katsumata
- Chugai Pharmaceutical Co. Ltd., Tokyo, Japan
| | - H Hagino
- School of Health Science & Rehabilitation Division, Tottori University Faculty of Medicine, Tottori, Japan
| | - T Inoue
- Taisho Pharmaceutical Co. Ltd., Tokyo, Japan
| | - T Nakano
- Tamana Central Hospital, Kumamoto, Japan
| | - H Mizunuma
- Department of Obstetrics & Gynecology, Hirosaki University School of Medicine, Hirosaki, Japan
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Hoskin P, Sundar S, Reczko K, Forsyth S, Mithal N, Sizer B, Bloomfield D, Upadhyay S, Wilson P, Kirkwood A, Stratford M, Jitlal M, Hackshaw A. A Multicenter Randomized Trial of Ibandronate Compared With Single-Dose Radiotherapy for Localized Metastatic Bone Pain in Prostate Cancer. J Natl Cancer Inst 2015; 107:djv197. [PMID: 26242893 DOI: 10.1093/jnci/djv197] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 06/23/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The radiotherapy or ibandronate (RIB) trial was a randomized multicenter nonblind two-arm trial to compare intravenous ibandronate given as a single infusion with single-dose radiotherapy for metastatic bone pain. METHODS Four hundred seventy prostate cancer patients with metastatic bone pain who were suitable for local radiotherapy were randomly assigned to radiotherapy (single dose, 8 Gy) or intravenous infusion of ibandronate (6mg) in a noninferiority trial. Pain was measured using the Brief Pain Inventory at baseline and four, eight, 12, 26, and 52 weeks. Pain response was assessed using World Health Organization (WHO) criteria and the Effective Analgesic Score (EAS); the maximum allowable difference was ±15%. Patients failing to respond at four weeks were offered retreatment with the alternative treatment. Quality of life (QoL) was assessed at baseline and four and 12 weeks. Because the trial was designed with a 5% one-sided test, we provide 90% confidence intervals (two-sided) for differences in pain response. RESULTS Overall, pain response was not statistically different at four or 12 weeks (WHO: -3.7%, 90% confidence interval [CI] = -12.4% to 5.0%; and 6.7%, 90% CI = -2.6 to 16.0%, respectively). Corresponding differences using the EAS were -7.5% and -3.5%. However, a more rapid initial response with radiotherapy was observed. There was no overall difference in toxicity, although each treatment had different side effects. QoL was similar at four and 12 weeks. Overall survival was similar between the two groups but was better among patients having retreatment than those who did not. CONCLUSIONS A single infusion of ibandronate had outcomes similar to a single dose of radiotherapy for metastatic prostate bone pain. Ibandronate could be considered when radiotherapy is not available.
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Affiliation(s)
- Peter Hoskin
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS).
| | - Santhanam Sundar
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Krystyna Reczko
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Sharon Forsyth
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Natasha Mithal
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Bruce Sizer
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - David Bloomfield
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Sunil Upadhyay
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Paula Wilson
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Amy Kirkwood
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Michael Stratford
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Mark Jitlal
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
| | - Allan Hackshaw
- Mount Vernon Cancer Center, Northwood, UK (PH); Nottingham University Hospitals NHS Trust, Nottingham, UK (SS); Cancer Research UK & UCL Cancer Trials Center, London, UK (KR, SF, AK MJ, AH); Kent & Canterbury Hospital, Canterbury, UK (NM); Essex County Hospital, Colchester, UK (BS); Royal Sussex County Hospital, Brighton, UK (DB); Scunthorpe General Hospital, Scunthorpe, UK (SU); Bristol Haematology & Oncology Center, Bristol, UK (PW); CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK (MS)
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Abstract
The purpose of this study was to perform a meta-analysis on the efficacy of ibandronate by evaluating the effect sizes of different dosing regimens.Major electronic databases were searched from 1985 to February 2015. A random effects meta-analysis was performed in STATA.Data from 34 studies (13,639 patients) were included in this meta-analysis. Ibandronate treatment significantly improved lumbar spine bone mineral density (BMD) as shown by the percent change from baseline (4.80%, P < 0.0001, 95% confidence interval [CI] [4.14, 5.45]). The respective effect sizes for oral intake and intravenous (IV) infusion were 4.57% and 5.22% (P < 0.0001, CIs [3.71, 5.42] and [4.37, 6.07]), respectively. All doses led to a significant increase in BMD except 2 oral dose regimens (1 mg/d: 4.65%, P = 0.285, 95% CI [-3.87, 13.18] and 0.5 mg/d: 3.60%, P = 0.38, 95% CI [-4.43, 11.64]. Ibandronate treatment (overall as well as dose wise) also significantly improved the total hip BMD-2.30% overall, 2.13% oral, and 2.63% IV (P < 0.0001, 95% CIs [1.96, 2.64], [1.70, 2.55], and [2.07, 3.20]), respectively. Ibandronate administration significantly decreased serum markers of bone resorption to -46.53% for C-terminal telopeptide of type 1 collagen, -24.03% for bone-specific alkaline phosphatase, and -50.17% for procollagen type I N-terminal propeptide (P < 0.0001, 95% CIs [-53.16, -39.91], [-31.28, -16.77], and [-64.13, -36.20]), respectively. Parathyroid hormone levels remained unaffected by ibandronate treatment (3.03%, P = 0.439, 95% CI [-5.06, 11.66]).There was no significant difference in the efficacy of ibandronate between oral or IV administration. Predominant dose regimens for IV administration were 1 to 3 mg/3 mo and 150 mg/mo oral and 2.5 mg/d for oral ibandronate treatment.
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Affiliation(s)
- Yanjie Hou
- From the Department of Orthopaedics (YH, CX, HD, YT), The Second Affiliated Hospital of Xinjiang Medical University, Urumchi; Department of Pain and Minimally Invasive (KG), The 316th Hospital of People's Liberation Army, Beijing; and Pain Center (CL), The First Affiliated Hospital of Beijing University of Chinese Medicine, Beijing, China
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Geng CJ, Liang Q, Zhong JH, Zhu M, Meng FY, Wu N, Liang R, Yuan BY. Ibandronate to treat skeletal-related events and bone pain in metastatic bone disease or multiple myeloma: a meta-analysis of randomised clinical trials. BMJ Open 2015; 5:e007258. [PMID: 26038356 PMCID: PMC4458633 DOI: 10.1136/bmjopen-2014-007258] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Randomised controlled trials (RCTs) have given contradictory results about the efficacy and safety of ibandronate in treating metastatic bone disease (MBD) or multiple myeloma. This review meta-analysed the literature to gain a more comprehensive picture. DESIGN Systematic review and meta-analysis of ibandronate compared with placebo or zoledronate. DATA SOURCES PubMed, EMBASE and the Cochrane Library databases were systematically searched to identify RCTs published up to March 2015 evaluating ibandronate to treat MBD or multiple myeloma. REVIEW METHOD 10 RCTs involving 3474 patients were included. Six RCTs were placebo-controlled and four compared ibandronate with zoledronate. The studies included in this review were mainly from European countries. RESULTS Intravenous ibandronate (6 mg) or oral drug (50 mg) decreased the risk of skeletal-related events compared to placebo (risk ratio (RR) 0.80, 95% CI 0.71 to 0.90, p=0.002). It also reduced the bone pain score below baseline significantly more than did placebo at 96 weeks (weighted mean difference -0.41, 95% CI -0.56 to -0.27, p<0.001). The incidence of diarrhoea, nausea and adverse renal events was similar between the ibandronate and placebo groups, but ibandronate was associated with greater risk of abdominal pain. Ibandronate was associated with similar risk of skeletal-related events as another bisphosphonate drug, zoledronate (RR 1.02, 95% CI 0.82 to 1.26, p=0.87). The incidence of nausea, jaw osteonecrosis and fatigue was similar for the two drugs, but the incidence of adverse renal events was significantly lower in the ibandronate group. CONCLUSIONS Ibandronate significantly reduces the incidence of skeletal-related events and bone pain in patients with MBD or multiple myeloma relative to placebo. It is associated with a similar incidence of skeletal-related events as zoledronate.
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Affiliation(s)
- Chun-Jing Geng
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Qian Liang
- Postgraduate School of Guangxi Medical University, Nanning, People's Republic of China
| | - Jian-Hong Zhong
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Min Zhu
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Fan-Ying Meng
- Department of Anesthesiology, Affiliated Hospital of Chifeng University, Inner Mongolia Autonomous Region,Nanning, People's Republic of China
| | - Ning Wu
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Rui Liang
- Department of Anesthesiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Bin-Yi Yuan
- Out-patient Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
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Muschitz C, Kocijan R, Pahr D, Patsch JM, Amrein K, Misof BM, Kaider A, Resch H, Pietschmann P. Ibandronate increases sclerostin levels and bone strength in male patients with idiopathic osteoporosis. Calcif Tissue Int 2015; 96:477-89. [PMID: 25911186 DOI: 10.1007/s00223-015-0003-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/11/2015] [Indexed: 01/24/2023]
Abstract
The pathomechanism of male idiopathic osteoporosis (MIO) differs from postmenopausal osteoporosis with regard to alterations in osteoblast activity. We evaluated intravenous ibandronate (IBN) in 25 MIO patients with fragility fractures in a prospective, monocentric, single-arm, and open-label study for 24 months. The impact and changes of sclerostin (Scl), Dickkopf-1 (DKK-1), CTX, and PINP were examined. Additionally, volumetric cortical, trabecular and areal bone mineral density (BMD), trabecular bone score (TBS), and finite element analyses (FEA) were evaluated. Compared to baseline, median Scl levels were increased after 1 month (Δ 121%, p < 0.0001) and remained elevated for 12 months. DKK-1 decreased (p < 0.001) to a lesser extent until month 9 with values comparable to baseline at study endpoint. Early changes (baseline-month 1) of Scl negatively correlated with early changes of DKK-1 (-0.72), CTX (-0.82), and PINP (-0.55; p < 0.005 for all). The overall changes over the 24 months study period of Scl negatively correlated with decreased CTX (-0.32) and DKK-1 levels (-0.57, p < 0.0001 for both); CTX and PINP changes positively correlated at each time point (p < 0.001). Volumetric hip BMD increased by 12 and 18%, respectively (p < 0.0001 for both). Cross-sectional moment of inertia and section modulus for total hip significantly improved (p < 0.05 for all). Areal BMD at total hip, spine, and TBS increased. FEA displayed an increase in bone strength both in the hip (17%) and vertebrae (13%, all p < 0.0001) at anatomical sites susceptible for fragility fracture. IBN increases Scl and improves cortical and trabecular bone strength with early and ongoing vigorous suppression of bone resorption.
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Affiliation(s)
- Christian Muschitz
- Medical Department II, St. Vincent Hospital, Academic Teaching Hospital of the Medical University of Vienna, Stumpergasse 13, 1060, Vienna, Austria,
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Srividhya NB, Singh N, Goel N, Gambhir JK, Rathi V, Rajaram S. Comparison of antiresorptive effect of hormone therapy and ibandronate in postmenopausal osteoporotic women by assessing type I collagen C-telopeptide levels. Post Reprod Health 2015; 21:48-55. [PMID: 25792627 DOI: 10.1177/2053369115574613] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The aim of this study is to compare the antiresorptive effect of hormone therapy and oral ibandronate in postmenopausal osteoporotic women by measuring bone mineral density (BMD) and degradation products of C-terminal telopeptide of type I collagen (CTX) using serum crosslaps ELISA. STUDY DESIGN The study is a randomized comparative trial. METHODS About 60 women with age > 40 years, having either surgical or medical menopause with T- or Z-score below -2.5 SD were included in the study. They were randomized into two groups of 30 each; one group received conventional hormone therapy (group I) and the other group received ibandronate monthly (group II). The treatment was given for 6 months. RESULTS The BMD increased from 0.894 g/cm(2) to 0.933 g/cm(2) (p < 0.01) in group I and from 0.865 g/cm(2) to 0.934 g/cm(2) (p < 0.01) in group II. The increase in BMD in group I (4.3%) was less than group II (7.9%) which was significant (p < 0.01). The serum CTX levels also showed significant reduction in both groups after 6 months of therapy; more reduction was seen in group II as compared to group I (41.5% vs. 4.6%, p < 0.01). CONCLUSION Ibandronate can be used as a substitute to hormone therapy in women presenting with osteoporosis. Long-term studies are needed to authenticate the observation.
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Affiliation(s)
- N B Srividhya
- Department of Obstetrics and Gynaecology, University College of Medical Sciences & Guru Tegh Bahadur Hospital, New Delhi, India
| | - Nilanchali Singh
- Department of Obstetrics and Gynaecology, University College of Medical Sciences & Guru Tegh Bahadur Hospital, New Delhi, India
| | - Neerja Goel
- Department of Obstetrics and Gynaecology, University College of Medical Sciences & Guru Tegh Bahadur Hospital, New Delhi, India
| | - J K Gambhir
- Department of Biochemistry, University College of Medical Sciences, New Delhi, India
| | - Vinita Rathi
- Department of Radiology, University College of Medical Sciences, New Delhi, India
| | - Shalini Rajaram
- Department of Obstetrics and Gynaecology, University College of Medical Sciences & Guru Tegh Bahadur Hospital, New Delhi, India
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Chen LX, Zhou ZR, Li YL, Ning GZ, Zhang TS, Zhang D, Feng SQ. Comparison of Bone Mineral Density in Lumbar Spine and Fracture Rate among Eight Drugs in Treatments of Osteoporosis in Men: A Network Meta-Analysis. PLoS One 2015; 10:e0128032. [PMID: 26010450 PMCID: PMC4444106 DOI: 10.1371/journal.pone.0128032] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 04/21/2015] [Indexed: 01/09/2023] Open
Abstract
Context The preferred treatment for osteoporosis in men is debated, and pairwise meta-analysis cannot obtain hierarchies of these treatments. Objective The objective of this study was to integrate the evidence and provide hierarchies of eight drugs based on their effect on the bone mineral density in the lumbar spine (BMD in LS) and the fracture rate. Data Sources Eligible studies were identified by searching Amed, British Nursing Index, EMBASE, PubMed, the Cochrane Central Register of Controlled Trials (CENTRAL), Google Scholar, SIGLE, the National Technical Information Service, the National Research Register (UK), and the Current Controlled Trials databases. Study Selection RCTs or quasi-RCTs reporting at least two drugs (two active drugs or one active drug and a placebo) used to treat osteoporosis in men were selected by two authors. Data Extraction Two authors independently extracted the data. Data Synthesis Thirteen studies involving 3647 patients were included. Compared with placebo therapy, zoledronate (SMDs 13.48, 95% credible intervals 11.88-15.08) yielded the most significant effect on increasing the BMD in LS, followed by alendronate (11.04, 9.68-12.41), teriparatide (20mcg) + risedronate (10.98, 8.55-13.48), risedronate (10.33, 8.68-12.01), teriparatide (20mcg) (9.33, 6.87-11.76), strontium ranelate (8.88, 7.51-10.24), ibandronate (5.49, 3.82-7.16), parathyroid hormone (1-84) (4.89, 3.12-6.62) and alfacalcidol (3.42, 1.7-5.2). Placebo therapy had a significantly higher fracture rate in contrast to risedronate (OR 2.51, 95% CrI 1.23-4.24) or zoledronate (2.92, 1.29-5.62) or teriparatide (20mcg) (4.04, 1.36-8.49) or teriparatide (40mcg) (3.5, 1.14-8.34). Zoledronate ranked first for increasing the BMD in LS, and teriparatide (20mg) was ranked first for decreasing the fracture rate. Conclusions Zoledronate might be the best choice to increase the BMD in LS and teriparatide (20mg) might lead to the lowest fracture rate.
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Affiliation(s)
- Ling-Xiao Chen
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, People’s Republic of China
| | - Zhi-Rui Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yu-Lin Li
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, People’s Republic of China
| | - Guang-Zhi Ning
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, People’s Republic of China
| | - Tian-Song Zhang
- Internal medicine of traditional Chinese medicine department, Jing 'an district central hospital of Shanghai, NO. 259, Xikang road, 200040, Shanghai, P.R. China
| | - Di Zhang
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, People’s Republic of China
| | - Shi-Qing Feng
- Department of Orthopaedics, Tianjin Medical University General Hospital, 154 Anshan Road, Heping District, Tianjin, People’s Republic of China
- * E-mail:
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Yang Z, Chen W, Xia Z, Liu Y, Peggrem S, Geng T, Yang Z, Li H, Xu B, Zhang C, Triffitt JT, Zhang Y. Local application of ibandronate/gelatin sponge improves osteotomy healing in rabbits. PLoS One 2015; 10:e0125807. [PMID: 25951178 PMCID: PMC4423918 DOI: 10.1371/journal.pone.0125807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 03/24/2015] [Indexed: 11/18/2022] Open
Abstract
Delayed healing or non-union of skeletal fractures are common clinical complications. Ibandronate is a highly potent anti-catabolic reagent used for treatment of osteopenia and fracture prevention. We hypothesized that local application of ibandronate after fracture fixation may improve and sustain callus formation and therefore prevent delayed healing or non-union. This study tested the effect of local application of an ibandronate/gelatin sponge composite on osteotomy healing. A right-side distal-femoral osteotomy was created surgically, with fixation using a k-wire, in forty adult male rabbits. The animals were divided into four groups of ten animals and treated by: (i) intravenous injection of normal saline (Control); (ii) local implantation of absorbable gelatin sponge (GS); (iii) local implantation of absorbable GS containing ibandronate (IB+GS), and (iv) intravenous injection of ibandronate (IB i.v.). At two and four weeks the affected femora were harvested for X-ray photography, computed tomography (CT), biomechanical testing and histopathology. At both time-points the results showed that the calluses in both the ibandronate-treated groups, but especially in the IB+GS group, were significantly larger than in the control and GS groups. At four weeks the cross sectional area (CSA) and mechanical test results of ultimate load and energy in the IB+GS group were significantly higher than in other groups. Histological procedures showed a significant reduction in osteoclast numbers in the IB+GS and IB i.v. groups at day 14. The results indicate that local application of an ibandronate/gelatin sponge biomaterial improved early osteotomy healing after surgical fixation and suggest that such treatment may be a valuable local therapy to enhance fracture repair and potentially prevent delayed or non-union.
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Affiliation(s)
- Zongyou Yang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051 P R China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, 050051, P R China
- Orthopaedic Research Institution of Hebei Province, Hebei, P R China
| | - Wei Chen
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051 P R China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, 050051, P R China
- Orthopaedic Research Institution of Hebei Province, Hebei, P R China
| | - Zhidao Xia
- Centre for Nanohealth, College of Medicine, Swansea University, Singleton Park, Swansea, SA2 8PP, United Kingdom
| | - Yueju Liu
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051 P R China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, 050051, P R China
- Orthopaedic Research Institution of Hebei Province, Hebei, P R China
| | - Shaun Peggrem
- Centre for Nanohealth, College of Medicine, Swansea University, Singleton Park, Swansea, SA2 8PP, United Kingdom
| | - Tao Geng
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051 P R China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, 050051, P R China
- Orthopaedic Research Institution of Hebei Province, Hebei, P R China
| | - Zhaoxu Yang
- Department of Orthopaedic Surgery, Hebei General Hospital, Shijiazhuang, 050051, P.R. China
| | - Han Li
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051 P R China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, 050051, P R China
- Orthopaedic Research Institution of Hebei Province, Hebei, P R China
| | - Bin Xu
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051 P R China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, 050051, P R China
- Orthopaedic Research Institution of Hebei Province, Hebei, P R China
| | - Chi Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051 P R China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, 050051, P R China
- Orthopaedic Research Institution of Hebei Province, Hebei, P R China
| | - James T. Triffitt
- Botnar Research Centre, Nuffield Orthopaedic Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom OX37LD
| | - Yingze Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051 P R China
- Key Laboratory of Orthopaedic Biomechanics of Hebei Province, Shijiazhuang, 050051, P R China
- Orthopaedic Research Institution of Hebei Province, Hebei, P R China
- * E-mail:
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Macpherson IR, Bray C, Hopkins C, Hannon RA, Lewsley LA, Ritchie DM, Canney P. Loading dose ibandronate versus standard oral ibandronate in patients with bone metastases from breast cancer. Clin Breast Cancer 2015; 15:117-27. [PMID: 25454689 DOI: 10.1016/j.clbc.2014.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 09/25/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION In this phase II trial, the efficacy and safety of loading-dose I.V. ibandronate in patients with breast cancer with bone metastases were evaluated. PATIENTS AND METHODS Thirty-four patients were randomized to receive a loading dose of 12 mg I.V. ibandronate on day 1 then oral ibandronate 50 mg daily (arm A), or standard oral therapy of 50 mg ibandronate daily from day 1 (arm B). The primary end point was percentage change in serum C-terminal crosslinking telopeptide of type I collagen (S-CTX) from baseline by day 5 of study. Secondary/exploratory end points included percentage change in other bone turnover markers (N-terminal cross-linking telopeptides of type I collagen [NTX], procollagen type I N propeptide, bone alkaline phosphatase) and change in average bone pain score. RESULTS There was a significantly greater reduction in S-CTX at day 5 in arm A compared with arm B (median difference, 15.82%; P = .005). There was also a significantly greater reduction in urine NTX/creatinine at day 5 (P = .009) and at the end of weeks 1 to 8 (averaged; P = .006). Average bone pain score was lower in arm A at the end of 8 weeks (P = .012). There were no additional adverse events after administration of 12 mg I.V. loading dose of ibandronate. CONCLUSION A 12-mg dose of I.V. ibandronate rapidly reduced markers of bone turnover and can be administered without additional toxicity.
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Affiliation(s)
- Iain R Macpherson
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Wolfson Wohl Cancer Research Centre, University of Glasgow, United Kingdom
| | - Caroline Bray
- Cancer Research UK, Clinical Trials Unit, University of Glasgow, Glasgow, United Kingdom.
| | - Carol Hopkins
- Cancer Research UK, Clinical Trials Unit, University of Glasgow, Glasgow, United Kingdom
| | - Rosemary A Hannon
- Academic Unit of Bone Metabolism, University of Sheffield Clinical Sciences Centre, Sheffield, United Kingdom
| | - Liz-Anne Lewsley
- Cancer Research UK, Clinical Trials Unit, University of Glasgow, Glasgow, United Kingdom
| | - Diana M Ritchie
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Peter Canney
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom.
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Wang Z, Qiao D, Lu Y, Curtis D, Wen X, Yao Y, Zhao H. Systematic literature review and network meta-analysis comparing bone-targeted agents for the prevention of skeletal-related events in cancer patients with bone metastasis. Oncologist 2015; 20:440-9. [PMID: 25732263 PMCID: PMC4391764 DOI: 10.1634/theoncologist.2014-0328] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 01/02/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Complications from skeletal-related events (SREs) constitute a challenge in the care of cancer patients with bone metastasis (BM). OBJECTIVES This study evaluated the comparative effectiveness of pamidronate, ibandronate, zoledronate, and denosumab in reducing the morbidity of SREs in cancer patients with BM. METHODS Medline (1948 to January 2014), Embase (1980 to January 2014), the Cochrane Library (2014 issue 1), and Web of Science with Conference Proceedings (1970 to January 2014) were searched. Only randomized controlled trials assessing denosumab, bisphosphonates, or placebo in cancer patients with BM were included. The primary outcomes were SREs and SREs by type. The network meta-analysis (NMA) was performed with a random-effects Bayesian model. RESULTS The NMA included 14 trials with 10,192 patients. Denosumab was superior to placebo in reducing the risk of SREs (odds ratio [OR]: 0.49; 95% confidence interval [CI]: 0.31-0.75), followed by zoledronate (OR: 0.57; 95% CI: 0.41-0.77) and pamidronate (OR: 0.55; 95% CI: 0.41-0.72). Ibandronate compared with placebo could not reduce the risk of SREs. Denosumab was superior to placebo in reducing the risk of pathologic fractures (OR: 0.50; 95% CI: 0.32-0.79), followed by zoledronate (OR: 0.61; 95% CI: 0.43-0.86). Denosumab was superior to placebo in reducing the risk of radiation (OR: 0.51; 95% CI: 0.35-0.75), followed by pamidronate (OR: 0.67; 95% CI: 0.52-0.86) and zoledronate (OR: 0.70; 95% CI: 0.52-0.96). CONCLUSION This NMA showed that denosumab, zoledronate, and pamidronate were generally effective in preventing SREs in cancer patients with BM. Denosumab and zoledronate were also associated with reductions in the risk of pathologic fractures and radiation compared with placebo. Denosumab was shown to be the most effective of the bone-targeted agents.
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Affiliation(s)
- Zhiyu Wang
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China; Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Dan Qiao
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China; Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yaohong Lu
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China; Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Dana Curtis
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China; Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Xiaoting Wen
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China; Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yang Yao
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China; Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Hui Zhao
- Department of Internal Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China; Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Palacios S, Agodoa I, Bonnick S, Van den Bergh JP, Ferreira I, Ho PR, Brown JP. Treatment satisfaction in postmenopausal women suboptimally adherent to bisphosphonates who transitioned to denosumab compared with risedronate or ibandronate. J Clin Endocrinol Metab 2015; 100:E487-92. [PMID: 25514106 DOI: 10.1210/jc.2014-3594] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT For many patients, adhering to postmenopausal osteoporosis treatment is a challenge. Higher treatment satisfaction is associated with greater persistence with these therapies, which is associated with better outcomes. OBJECTIVE This study aimed to evaluate the change in treatment satisfaction in postmenopausal women who were suboptimally adherent to daily or weekly oral bisphosphonates and who transitioned to denosumab vs a monthly oral bisphosphonate. DESIGN AND SETTING Pooled data of outpatients from two international, multicenter, randomized, open-label studies were analyzed. PATIENTS Postmenopausal women (n = 1703) age 55 years or greater with low bone mineral density who were suboptimally adherent with prior oral bisphosphonate therapy, as assessed by the Osteoporosis-Specific Morisky Medication Adherence Scale, were included in the study. INTERVENTIONS Patients received denosumab, a fully human monoclonal antibody to receptor activator of nuclear factor-kappa B ligand, 60 mg s.c. every 6 months vs the oral bisphosphonates ibandronate or risedronate, 150 mg once monthly for 12 months. MAIN OUTCOME MEASURES Change in treatment satisfaction scores from baseline to months 6 and 12 were measured using the Treatment Satisfaction Questionnaire for Medication (TSQM). The TSQM is a validated tool that measures perception of four domains of treatment satisfaction: effectiveness, side effects, convenience, and global satisfaction. RESULTS Patients in both treatment groups showed improvement from baseline for all four TSQM domains at 6 and 12 months. However, the denosumab group had significantly (all P < .001) greater improvements among all four TSQM domains at 6 and 12 months compared with the oral bisphosphonate group. CONCLUSIONS Women with low adherence to oral bisphosphonates reported greater treatment satisfaction when transitioned to denosumab vs switching to a monthly oral bisphosphonate.
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Affiliation(s)
- Santiago Palacios
- Instituto Palacios (S.P.), 9-28009 Madrid, Spain; Amgen (I.A., P.-R.H.), Thousand Oaks, California 91320; Clinical Research Center of North Texas (S.B.), Denton, Texas 76210; VieCuri Medical Center and Maastricht University (J.P.V.), 6200 MD Maastricht, Netherlands; Amgen (I.F.), Cambridge CB4 0WD, United Kingdom; and Laval University and CHU de Québec Research Centre (J.P.B.), Québec City, Canada G1V 4G2
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Schmidberger JW, Schnell R, Schneider G. Structural characterization of substrate and inhibitor binding to farnesyl pyrophosphate synthase from Pseudomonas aeruginosa. Acta Crystallogr D Biol Crystallogr 2015; 71:721-31. [PMID: 25760619 PMCID: PMC4356374 DOI: 10.1107/s1399004715001121] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/19/2015] [Indexed: 12/23/2022]
Abstract
Locus PA4043 in the genome of Pseudomonas aeruginosa PAO1 has been annotated as coding for a farnesyl pyrophosphate synthase (FPPS). This open reading frame was cloned and expressed recombinantly in Escherichia coli. The dimeric enzyme shows farnesyl pyrophosphate synthase activity and is strongly inhibited by ibandronate and zoledronate, drugs that are presently in clinical use. The structures of the unliganded enzyme and complexes with the substrate geranyl diphosphate (GPP), the inhibitor ibandronate and two compounds obtained from a differential scanning fluorimetry-based screen of a fragment library were determined by X-ray crystallography to resolutions of better than 2.0 Å. The enzyme shows the typical α-helical fold of farnesyl pyrophosphate synthases. The substrate GPP binds in the S1 substrate site in an open conformation of the enzyme. In the enzyme-ibandronate complex three inhibitor molecules are bound in the active site of the enzyme. One inhibitor molecule occupies the allylic substrate site (S1) of each subunit, as observed in complexes of nitrogen-containing bisphosphonate inhibitors of farnesyl synthases from other species. Two (in subunit A) and one (in subunit B) additional ibandronate molecules are bound in the active site. The structures of the fragment complexes show two molecules bound in a hydrophobic pocket adjacent to the active site. This allosteric pocket, which has previously only been described for FPPS from eukaryotic organisms, is thus also present in enzymes from pathogenic prokaryotes and might be utilized for the design of inhibitors of bacterial FPPS with a different chemical scaffold to the highly charged bisphosphonates, which are less likely to pass bacterial membranes.
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Affiliation(s)
- Jason W. Schmidberger
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Robert Schnell
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Gunter Schneider
- Department of Medical Biochemistry and Biophysics, Karolinska Institutet, SE-171 77 Stockholm, Sweden
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Tariq S, Tariq S, Alam SS, Baig M. Effect of ibandronate therapy on serum homocysteine and leptin in postmenopausal osteoporotic females. Osteoporos Int 2015; 26:1187-92. [PMID: 25274281 DOI: 10.1007/s00198-014-2909-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 09/18/2014] [Indexed: 01/22/2023]
Abstract
UNLABELLED A significant change in serum leptin level and no change in homocysteine were observed with ibandronate treatment. No correlation of homocysteine and leptin was found with bone mass density (BMD). Results indicate that ibandronate reduces serum leptin levels but how does it help in reducing the osteoporosis. It needs to be explored. INTRODUCTION The current study was planned to determine the effects of ibandronate on serum homocysteine and leptin levels in postmenopausal osteoporotic females and to correlate these with BMD. METHODS Forty-two newly diagnosed and untreated postmenopausal osteoporotic females were selected on the basis of their BMD (BMD < -2.5) from Orthopaedic Out Patient Department of Shaikh Zayed Hospital, Lahore, Pakistan, and 36, age and BMI matched non-osteoporotic postmenopausal females, were also selected as a control group. Baseline physical and biochemical parameters were compared. In osteoporotic patients, changes in circulating leptin and homocysteine levels were studied after 6 months of therapy with ibandronate (150 mg). The collected data were analyzed on SPSS 16. RESULTS There was no significant difference observed in the mean value of all baseline parameters except BMD in both groups. After 6 months of treatment with ibandronate (150 mg), a significant change was observed in serum leptin levels (19.48 ± 1.60 ng/ml vs. 14.09 ± 0.85 ng/ml, p < 0.002), while no considerable change observed in serum homocysteine levels (16.22 ± 0.95 μmol/l vs. 16.80 ± 1.03 μmol/l, p < 0.63). Serum leptin was found significantly correlated with anthropometric parameters. No correlation of serum leptin and homocysteine was found with BMD (r = 0.09, p value = 0.54; r = -0.17, p value = 0.27). CONCLUSION Our results show that ibandronate reduces serum leptin levels while it has no effect on serum homocysteine levels. Further studies are needed to explain how the decrease in serum leptin level may help in reducing the progression of osteoporosis.
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Affiliation(s)
- S Tariq
- Department of Pharmacology, University Medical & Dental College, Faisalabad, 38000, Pakistan,
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Luedders DW, Steinhoff J, Thill M, Rody A, Bohlmann MK. Lack of difference in acute nephrotoxicity of intravenous bisphosphonates zoledronic acid and ibandronate in women with breast cancer and bone metastases. Anticancer Res 2015; 35:1797-1802. [PMID: 25750345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND More than 50% of patients with advanced breast cancer develop bone metastases that may lead to multiple complications such as pathological fractures, bone pain or hypercalcaemia. The standard treatment, besides endocrine, targeted-therapy or chemotherapy, is the use of bisphosphonates. However, one of their main adverse side-effects is bisphosphonate-induced nephrotoxicity. The mechanism by which the latter occurs is not well-understood, although emerging evidence suggests that the effect of bisphosphonates on the kidney may differ between agents. PATIENTS AND METHODS The aim of this evaluation was to compare the renal toxicity of 6 mg ibandronate i.v. versus 4 mg zoledronic acid i.v. over a period of six months in women with breast cancer and bone metastases. A prospective randomized trial was carried out to examine specific kidney and other parameters (α1- and β2-microglobulin, albumin, α2-macroglobulin, IgG and C-reactive protein (CRP) generated from spontaneous urine samples from 17 patients of each group. RESULTS We were unable to find any significant difference between the two treatment groups with regard to renal toxicity. All patients, independently of the applied bisphosphonate, experienced only temporary renal dysfunction without any evidence of irreversible damage in terms of acute nephrotoxicity during the study period. α1-Microglobulin, a marker for proximal tubular damage, in particular, was not differently elevated in either group. CONCLUSION Both applied bisphosphonates were found to be well-tolerated and safe with regard to renal toxicity during a six-month treatment period in patients with otherwise healthy kidneys having advanced breast cancer and bone metastases.
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Affiliation(s)
- Dörte W Luedders
- Department of Obstetrics and Gynaecology, University Hospital Oldenburg, Oldenburg, Germany Department of Obstetrics and Gynaecology, University Hospital of Schleswig-Holstein, Luebeck, Germany
| | - Jürgen Steinhoff
- Department of Internal Medicine, University Hospital of Schleswig-Holstein, Luebeck, Germany
| | - Marc Thill
- Department of Gynaecology and Obstetrics, Agaplesion Markus Hospital, Frankfurt (Main), Germany
| | - Achim Rody
- Department of Obstetrics and Gynaecology, University Hospital of Schleswig-Holstein, Luebeck, Germany
| | - Michael K Bohlmann
- Department of Obstetrics and Gynaecology, University Hospital of Schleswig-Holstein, Luebeck, Germany
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