Caution Urged in Bisphosphonate Use for Multiple Myeloma

NEW YORK aug 25, 2006 (Reuters Health) - Bisphosphonates should be used cautiously and for limited periods to prevent or treat bone disease in patients with multiple myeloma, according to a consensus statement by a multidisciplinary panel at the Mayo Clinic.

"Risks and benefits of this class of drugs should continually be re-evaluated," Dr. Martha Q. Lacy from Mayo Clinic College of Medicine, Rochester, Minnesota told Reuters Health. Dr. Lacy and colleagues prepared the consensus statement based on the collective experience of the Mayo Clinic Myeloma Group.

After reviewing the evidence supporting the use of bisphosphonates in multiple myeloma, the group concluded, "that intravenous pamidronate and intravenous zoledronic acid are equally effective and superior to placebo in reducing skeletal complications."

Based on available data regarding the risk of osteonecrosis of the jaw, the group favors pamidronate over zoledronic acid for patients with newly diagnosed multiple myeloma until more data are available.

Whichever agent is chosen, bisphosphonates should be infused monthly for 2 years, and then discontinued if the patient has achieved a response and is in a stable plateau phase, the physicians report in the August issue of the Mayo Clinic Proceedings.  For patients who continue to require treatment, the infusions should be decreased to every 3 months.

"We strongly advise patients to undergo a comprehensive dental evaluation before taking any bisphosphonate treatment," the authors write. "The goal of such an evaluation is to identify and treat teeth that may eventually require surgical intervention (dental extraction, pulpectomy, incision and drainage, or periodontal surgery) or other invasive dental procedures and to complete care before starting bisphosphonate treatment."

A dentist should be seen at least yearly by patients receiving bisphosphonates and the risk of osteonecrosis of the jaw should be evaluated carefully before any elective procedures are attempted.

For patients not receiving bisphosphonates, Dr. Lacy recommends that they be evaluated for the development of osteopenia and osteoporosis once a year.

"As more data become available," the group concludes, "the guidelines may need to be amended."
 
source:

• Mayo Clin Proc 2006;81:1047-1053.